Costs of Early Stage Alzheimer's Disease in the United States: Cross-Sectional Analysis of a Prospective Cohort Study (GERAS-US)

Rebecca L. Robinson, Dorene M. Rentz, Jeffrey Scott Andrews, Anthony Zagar, Yongin Kim, Valerie Bruemmer, Ronald L. Schwartz, Wenyu Ye, Howard M. Fillit

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


Background: Costs associated with early stages of Alzheimer's disease (AD; mild cognitive impairment [MCI] and mild dementia [MILD]) are understudied. Objective: To compare costs associated with MCI and MILD due to AD in the United States. Methods: Data included baseline patient/study partner medical history, healthcare resource utilization, and outcome assessments as part of a prospective cohort study. Direct, indirect, and total societal costs were derived by applying standardized unit costs to resources for the 1-month pre-baseline period (USD2017). Costs/month for MCI and MILD cohorts were compared using analysis of variance models. To strengthen the confidence of diagnosis, amyloid-β (Aβ) tests were included and analyses were replicated stratifying within each cohort by amyloid status [+/-]. Results: Patients (N=1327) with MILD versus MCI had higher total societal costs/month (4243 versus 2816; p<0.001). These costs were not significantly different within each severity cohort by amyloid status. The largest fraction of overall costs were informal caregiver costs (45.1%) for the MILD cohort, whereas direct medical patient costs were the largest for the MCI cohort (39.0%). Correspondingly, caregiver time spent on basic activities of daily living (ADLs), instrumental ADLs, and supervision time was twice as high for MILD versus MCI (all p<0.001). Conclusion: Early AD poses a financial burden, and despite higher functioning among those with MCI, caregivers were significantly impacted. The major cost driver was the patient's clinical cognitive-functional status and not amyloid status. Differences were primarily due to rising need for caregiver support.

Original languageEnglish
Pages (from-to)437-450
Number of pages14
JournalJournal of Alzheimer's Disease
Issue number2
StatePublished - 2020


  • Amyloid
  • burden of illness
  • dementia
  • economic burden
  • florbetapir F18
  • mild cognitive impairment
  • societal burden


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