Concerning Jump in Dementia Diagnoses in Younger Americans

Megan Brooks

March 05, 2020

The number of commercially insured Americans aged 30 to 64 years who were diagnosed with early-onset dementia or Alzheimer disease (AD) jumped 200% from 2013 to 2017, from 4.2 to 12.6 per 10,000, according to a new report from the Blue Cross Blue Shield Association (BCBSA).

Dementia diagnosis rates increased 373% among adults aged 30 to 44 (from 0.9 to 4.4 per 10,000) and 311% among those aged 45 to 54 years (from 2.7 to 10.9 per 10,000).

The average age of a person in the commercially insured population who is living with early-onset dementia or AD is 49 years. Women make up 58% of those diagnosed with dementia or AD, the report states.

"The increase in early-onset dementia and Alzheimer's diagnoses among a generation who typically would not expect to encounter these conditions for several decades is concerning, particularly since there is no cure for Alzheimer's disease," Vincent Nelson, MD, president of medical affairs and interim chief medical officer of the BCBSA, told Medscape Medical News.

"Additionally, as early-onset dementia and Alzheimer's disease continue to affect younger people, it is important to understand the impact of both forms of dementia on the health of Americans and their caregivers," said Nelson.

The BCBSA report, Early-Onset Dementia and Alzheimer's Rates Grow for Younger American Adults, is the latest in the company's Health of America Report series.

Regarding only early-onset AD, the diagnosis rate increased 131% among adults aged 30 to 64 years, from 1.3 per 10,000 in 2013 to 3.0 per 10,000 in 2017. Especially large increases occurred among people aged 30 to 44 (407% increase, from 0.1 to 0.6 per 10,000) and 45 to 54 (242% increase, from 0.6 to 2.0 per 10,000).

Nelson cautioned that the increase in the rate of diagnosis in the 30- to 44-year group is "on a small base size, which means small numerical increases in rate drive substantial percentage changes."

Potential Drivers

He said several factors could be driving an increase in prevalence.

"It could be heightened awareness of symptoms amongst providers, better usage of diagnosis codes, or accumulation of people who are diagnosed with the condition and remain within the commercially insurer population during the study period rather than to an actual increase in the rate of diagnosis year over year," he told Medscape Medical News.

The report also notes that for people living with early-onset dementia or AD, the average BCBS Health Index is 62.5, which means these patients have only 63% of optimal health. This amounts to about 11 years of healthy life lost.

The report is based on data from BCBS Axis, a database of medical claims from more than 48 million commercially insured members of BCBS companies, from 2013 to 2017.

Nelson said it's important to keep in mind that the data in this report represent a "point-in-time measurement" of the diagnosis of early-onset dementia and AD among commercially insured American adults aged 30 to 64 years. In addition, the report used medical claims data, from which causes of diagnosed conditions cannot be determined.

Keith Fargo, PhD, director of scientific programs and outreach at the Alzheimer's Association, urged caution in interpreting the data.

"The numbers in this report only reflect diagnosed cases coded under Blue Cross Blue Shield's insurance network. As we know, Alzheimer's is underdiagnosed, so these numbers are likely not truly representative of the prevalence of younger-onset dementia," Fargo told Medscape Medical News.

"More epidemiological research is needed to better understand the full scope of individuals affected by younger-onset dementia," said Fargo.

The full report is available online.

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