The burden of cognitive impairment

Abstract

INTRODUCTION: Over 10% of older American adults (age ≥ 65) experience cognitive impairment (CI) from Alzheimer's disease and related dementias (ADRD). An additional 15%-22% experience mild cognitive impairment (MCI), often preceding ADRD and in earlier life. However, CI burden estimates including MCI and early-onset CI (age < 65), remain limited. METHODS: Using microsimulation, we estimated CI burden (ADRD and/or MCI) over remaining life-years for Americans (aged 51/52) who developed CI overall, by disease progression, onset age, and sociodemographic subgroups. Burden equaled the difference in quality-adjusted life-years (QALY valued at $150K/year) and economic outcomes between a hypothetical intervention preventing CI and status quo. RESULTS: Per capita lifetime CI burden was $124K, driven by lost QALYs. Aggregate CI burden was $627B, 59% from ADRD, 41% from MCI. Early-onset CI carried the largest per capita burden ($376K), ∼50% from MCI. Individuals with less education, progression to ADRD, or from minoritized racial/ethnic subgroups also carried disproportionate burden. DISCUSSION: MCI constitutes 41% of CI burden, disproportionately impacting individuals with early-onset. HIGHLIGHTS: The lifetime burden of cognitive impairment (CI) was estimated at $124,000 per capita, totaling $627 billion in aggregate-with 59% attributed to Alzheimer's disease and related dementias (ADRD) and 41% to mild cognitive impairment (MCI). Early-onset CI (before age 65) carried the highest per capita burden at $376,000, with these individuals living with MCI for about 13 years-over 7 years longer than those with late-onset CI. Significant disparities exist in CI burden, with racial/ethnic minorities and those without a high school degree experiencing disproportionately higher burden. Despite representing just 36% of the CI population, non-White individuals accounted for 47% of the aggregate CI burden.

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