{"doi":"10.1002/alz.12400","title":"Medical and nursing home costs: From cognitively unimpaired through dementia","abstract":"INTRODUCTION: Efforts to model the cost-effectiveness of managing/modifying cognitive impairment lack reliable, objective, baseline medical, and nursing-home (NH) costs. METHODS: A stratified-random sample of Olmsted County, MN, residents ages 70-89 years (N = 3545), well-characterized as cognitively unimpaired, mild cognitive impairment (MCI), or dementia, were followed forward ≤1 year in provider-linked billing data and the Centers for Medicare & Medicaid Services NH assessments. Direct medical/nursing home/medical + NH costs were estimated. Costs were stratified by vital status and NH-use intensity (NH days/follow-up days [0%, 1% to 24%, 25% to 99%, and 100%]). Between-category mean-annual cost differences were adjusted for patient characteristics and follow-up days. RESULTS: Costs/follow-up day distributions differed significantly across cognitive categories. Mean costs/follow-up days were 2.5 to 18 times higher for decedents versus survivors. Among all persons with MCI, <9% with any NH use accounted for 18% of all total annual medical + NH costs. Adjusted-between-category comparisons revealed significantly higher medical and medical + NH costs for MCI versus cognitively unimpaired. DISCUSSION: Cost-effectiveness for managing/modifying both MCI and dementia should consider end-of-life costs and NH-use intensity. Results can help inform cost-effectiveness models, predict future-care needs, and aid decision-making by individuals/providers/payers/policymakers.","journal":"Alzheimer s & Dementia","year":2021,"id":184556,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":11,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.6615,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":315041,"name":"Carin Y. Smith","orcid":"0000-0002-3610-6945","position":1,"is_corresponding":false},{"id":27599,"name":"Ronald C. Petersen","orcid":"0000-0002-8178-6601","position":2,"is_corresponding":false},{"id":740461,"name":"Jane A. Emerson","orcid":null,"position":3,"is_corresponding":false},{"id":449673,"name":"Jeanine E. Ransom","orcid":"0000-0002-2131-1970","position":4,"is_corresponding":false},{"id":228538,"name":"Michelle M. Mielke","orcid":"0000-0001-7177-1185","position":5,"is_corresponding":false},{"id":739801,"name":"Steven Hass","orcid":"0000-0002-1686-030X","position":6,"is_corresponding":false},{"id":450557,"name":"Cynthia L. Leibson","orcid":null,"position":7,"is_corresponding":false},{"id":449672,"name":"Kirsten Hall Long","orcid":"0009-0002-8930-0626","position":0,"is_corresponding":true}],"reference_count":44,"raw_metadata":null,"created_at":"2026-07-18T23:48:30.970730Z","pmid":"34482623","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}