Public Health.

Area of Science:

• Neuropathology
• Dementia Diagnosis
• Clinical Outcomes

Background:

• Dementia diagnosis is frequently delayed, potentially hindering timely treatment and support.
• The association between specific brain pathologies and the timeliness of dementia diagnosis remains unclear.
• Understanding these associations is crucial for improving dementia care pathways.

Purpose of the Study:

• To investigate the relationship between specific neuropathologies and the timeliness of dementia diagnosis.
• To determine if Alzheimer's disease (AD), LATE-NC, vascular, or Lewy body pathologies influence diagnostic delays.
• To identify factors affecting dementia diagnosis timeliness in healthcare settings.

Main Methods:

• Utilized five cohorts from Rush Alzheimer's Disease Center with linked Medicare data and postmortem autopsy.
• Identified neuropathologies including AD, LATE-NC, vascular, and Lewy bodies (LB).
• Defined timely diagnosis based on Medicare claims relative to cohort dementia onset; logistic regression assessed pathology associations.

Main Results:

• Only 54% of 548 participants received a timely dementia diagnosis.
• Alzheimer's disease (AD) and LATE-NC pathologies were independently associated with a higher likelihood of timely diagnosis (OR=1.91 and OR=1.83, respectively).
• Vascular and Lewy body (LB) pathologies showed no significant association with timely diagnosis.

Conclusions:

• Individuals with AD and LATE-NC pathologies were twice as likely to be diagnosed promptly.
• The reasons for timely diagnosis in AD/LATE-NC cases may stem from distinct clinical presentations.
• The lack of association for vascular pathology highlights a potential gap in recognizing cognitive impairment related to vascular health.