@article {9930, title = {The Effect of Adherence to Screening Guidelines on the Risk of Alzheimer{\textquoteright}s Disease in Elderly Individuals Newly Diagnosed With Type 2 Diabetes Mellitus.}, journal = {Gerontology \& Geriatric Medicine}, volume = {4}, year = {2018}, month = {2018 Jan-Dec}, pages = {2333721418811201}, abstract = {The aim of this study was to examine the possibility that type 2 diabetes and Alzheimer{\textquoteright}s disease may share common behavioral protective factors such as adherence to type 2 diabetes treatment guidelines given that these two diseases have both epidemiological and metabolic similarities. : The method used in this study is a retrospective cohort study of 3,797 U.S. Medicare fee-for-service beneficiaries aged 66+ newly diagnosed with type 2 diabetes and without a prior record of Alzheimer{\textquoteright}s disease based on the Health and Retirement Study. : Results of a left-truncated Cox model showed that adherence reduces the risk of Alzheimer{\textquoteright}s disease by 20\% to 24\%. Other significant effects were college education (hazard ratio [HR]: 0.65; value: .023), stroke (HR: 1.40; value: .013), and 4+ limitations in physical functioning (HR: 1.33; value: .008). : Risk of Alzheimer{\textquoteright}s disease can be reduced by behavioral factors. Possible mechanisms may include earlier start of interventions to reduce blood glucose levels and improve insulin sensitivity.}, keywords = {Alzheimer{\textquoteright}s disease, Cognitive Ability, Diabetes, Medicare linkage, Screenings}, issn = {2333-7214}, doi = {10.1177/2333721418811201}, author = {Arseniy P Yashkin and Akushevich, Igor and Svetlana Ukraintseva and Anatoliy Yashin} } @article {9730, title = {Time Trends in the Prevalence of Neurocognitive Disorders and Cognitive Impairment in the United States: The Effects of Disease Severity and Improved Ascertainment}, journal = {Journal of Alzheimer{\textquoteright}s Disease}, volume = {64}, year = {2018}, pages = {137-148}, abstract = {Background: Trends in the prevalence of cognitive impairment (CI) based on cognitive assessment instruments are often inconsistent with those of neurocognitive disorders (ND) based on Medicare claims records. Objective: We hypothesized that improved ascertainment and resulting decrease in disease severity at the time of diagnosis are responsible for this phenomenon. Methods: Using Medicare data linked to the Health and Retirement Study (1992{\textendash}2012), we performed a joint analysis of trends in CI and ND to test our hypothesis. Results: We identified two major contributors to the divergent directions in CI and ND trends: reductions in disease severity explained more than 60\% of the differences between CI and ND prevalence over the study period; the remaining 40\% was explained by a decrease in the fraction of undiagnosed individuals. Discussion: Improvements in the diagnoses of ND diseases were a major contributor to reported trends in ND and CI. Recent forecasts of CI and ND trends in the U.S. may be overly pessimistic.}, keywords = {CIND, Cognitive Ability, Dementia, Medicare linkage, Medicare/Medicaid/Health Insurance}, issn = {13872877}, doi = {10.3233/JAD-180060}, url = {http://www.medra.org/servlet/aliasResolver?alias=iospress\&doi=10.3233/JAD-180060}, author = {Akushevich, Igor and Arseniy P Yashkin and Kravchenko, Julia and Svetlana Ukraintseva and Stallard, Eric and Anatoliy Yashin} } @article {9063, title = {Comparison of self-reported and Medicare claims-identified acute myocardial infarction.}, journal = {Circulation}, volume = {131}, year = {2015}, month = {2015 Apr 28}, pages = {1477-85; discussion 1485}, abstract = {

BACKGROUND: Cardiovascular disease is often studied through patient self-report and administrative data. However, these 2 sources provide different information, and few studies have compared them.

METHODS AND RESULTS: We compared data from a longitudinal, nationally representative survey of older Americans with matched Medicare claims. Self-reported heart attack in the previous 2 years was compared with claims-identified acute myocardial infarction (AMI) and acute coronary syndrome. Among the 3.1\% of respondents with self-reported heart attack, 32.8\% had claims-identified AMI, 16.5\% had non-AMI acute coronary syndrome, and 25.8\% had other cardiac claims; 17.3\% had no inpatient visits in the previous 2.5 years. Claims-identified AMIs were found in 1.4\% of respondents; of these, 67.8\% reported a heart attack. Self-reports were less likely among respondents >75 years of age (62.7\% versus 74.6\%; P=0.006), with less than high school education (61.6\% versus 71.4\%; P=0.015), with at least 1 limitation in activities of daily living (59.6\% versus 74.7\%; P=0.001), or below the 25th percentile of a word recall memory test (60.7\% versus 71.3\%; P=0.019). Both self-reported and claims-identified cardiac events were associated with increased mortality; the highest mortality was observed among those with claims-identified AMI who did not self-report (odds ratio, 2.8; 95\% confidence interval, 1.5-5.1) and among those with self-reported heart attack and claims-identified AMI (odds ratio, 2.5; 95\% confidence interval, 1.7-3.6) or non-AMI acute coronary syndrome (odds ratio, 2.7; 95\% confidence interval, 1.8-4.1).

CONCLUSIONS: There is considerable disagreement between self-reported and claims-identified events. Although self-reported heart attack may be inaccurate, it indicates increased risk of death, regardless of whether the self-report is confirmed by Medicare claims.

}, keywords = {Heart disease, Medicare linkage, Medicare/Medicaid/Health Insurance, Self-reported health}, issn = {1524-4539}, doi = {10.1161/CIRCULATIONAHA.114.013829}, author = {Laura Yasaitis and Lisa F Berkman and Chandra, Amitabh} }