Analysis of cognitive, functional, health service use, and cost trajectories prior to and following memory loss.

OBJECTIVES This brief report examines whether significant changes in cognition, functional dependence, health service use, and out-of-pocket medical expenditures (OOPMD) occur in the years prior to a physician-identified memory problem in a nationally representative sample of older adults. METHOD Longitudinal data from the RAND-Health and Retirement Survey were utilized. Those who reported a physician-identified memory problem (n = 387) were compared with a randomly selected control group of similar age, race, and gender who did not indicate a memory problem (n = 387). Multilevel linear models were used to construct trajectories for various measures of cognition, function, health service use, and OOPMD in the years prior to and following memory problem identification. RESULTS Several trajectories demonstrated significant rates of change in the years leading up to a physician-identified memory problem, including symptoms (mental status, fine motor skills, and instrumental activities of daily living) and utilization (OOPMD and overnight stays in hospital). DISCUSSION Preclinical declines in mental status and function and increases in hospital use and OOPMD are apparent prior to the formal identification of memory problems. Earlier identification of these changes might provide a basis for interventions that could alter the clinical course of dementia.