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@ARTICLE{Platen:280975,
      author       = {Platen, Moritz and Buchholz, Maresa and Rädke, Anika and
                      Glaeser, Eva and Iskandar, Audrey and van den Berg, Neeltje
                      and Hoffmann, Wolfgang and Michalowsky, Bernhard},
      title        = {{D}ifferentiation {B}etween {E}arly and {S}evere {S}tages
                      of {D}ementia in {C}laims {D}ata {B}ased on {D}iagnosis,
                      {P}rescription, and {U}tilization {P}atterns.},
      journal      = {Neurology and Therapy},
      volume       = {14},
      number       = {4},
      issn         = {2193-6536},
      address      = {Heidelberg [u.a.]},
      publisher    = {Springer},
      reportid     = {DZNE-2025-01057},
      pages        = {1589 - 1608},
      year         = {2025},
      abstract     = {Claims data typically lack clinical parameters such as
                      dementia severity, limiting insights into disease
                      progression and related healthcare utilization and costs.
                      Although diagnoses, prescriptions, and utilization patterns
                      may serve as proxies, their validity is unclear. This study
                      aimed to identify and validate these parameters to
                      distinguish early from severe dementia stages.Baseline data
                      from 737 patients with dementia were analyzed. Dementia
                      severity was assessed using the Mini-Mental State
                      Examination and classified as early (≥ 27), mild (20-26),
                      and moderate to severe (0-19). Healthcare utilization was
                      recorded via structured interviews. Diagnoses, long-term
                      care levels, and prescribed medications were extracted from
                      physicians' files. Ordinal logistic regression evaluated
                      associations between predictors and severity, with average
                      marginal effects (AME) quantifying impact. Sensitivity,
                      specificity, positive predictive value (PPV), and negative
                      predictive value (NPV) were computed for key
                      predictors.Among the sample $(56\%$ female patients, mean
                      age 80), $18\%$ were in the early stages, $43\%$ mild, and
                      $39\%$ moderate to severe. Antipsychotic prescriptions (odds
                      ratio (OR) 3.40, $95\%$ confidence interval (CI) 1.94-5.95),
                      antidementia drugs (OR 2.31, $95\%$ CI 1.56-3.40), and
                      higher long-term care levels (OR 5.59, $95\%$ CI 2.23-13.99
                      for level ≥ 4) were associated with advanced severity. AME
                      analysis revealed that antipsychotic use reduced early-stage
                      probability by $14\%$ and increased severe-stage probability
                      by $21\%.$ Similarly, antidementia drugs lowered early-stage
                      probability by $9\%$ and raised severe-stage probability by
                      $13\%.$ Increasing care levels were associated with a
                      $2-16\%$ decline in early-stage probability and a $3-34\%$
                      rise in severe-stage probability. The combined model showed
                      high specificity $(99.6\%)$ and PPV $(84.6\%)$ for severe
                      dementia, but sensitivity and NPV for early stage were
                      low.Antidementia drugs, antipsychotics, and long-term care
                      level serve as robust predictors of moderate to severe
                      dementia, whereas early-stage detection remains challenging.
                      Future studies should validate these markers and explore
                      additional predictors to improve early detection in claims
                      data.},
      keywords     = {Alzheimer’s disease (Other) / Antidementia drug treatment
                      (Other) / Antipsychotics (Other) / Claims data (Other) /
                      Dementia (Other) / Dementia severity (Other) / Healthcare
                      utilization (Other) / Real-world data (Other) / Real-world
                      evidence (Other)},
      cin          = {AG Michalowsky / AG Hoffmann / AG Thyrian},
      ddc          = {610},
      cid          = {I:(DE-2719)5000067 / I:(DE-2719)1510600 /
                      I:(DE-2719)1510800},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40504345},
      pmc          = {pmc:PMC12255591},
      doi          = {10.1007/s40120-025-00778-y},
      url          = {https://pub.dzne.de/record/280975},
}