Date of Award

3-16-2026

Embargo Period

4-1-2029

Document Type

Dissertation

Degree Name

Doctor of Health Administration

Department

Health Administration

College

College of Health Professions

First Advisor

Kit N. Simpson

Second Advisor

Sara Knox

Third Advisor

Todd Wandstrat

Abstract

This retrospective quantitative study investigated whether Medicare beneficiaries diagnosed with Alzheimer’s disease and related dementias (ADRD) in 2022 had prior diagnoses of Mild Cognitive Impairment (MCI) and examined healthcare costs in the five years before ADRD onset. Using a 5% national Medicare sample of beneficiaries aged 65 and older from 2017–2022, the study found that only 4.58% of 3,231 ADRD patients were diagnosed with MCI, highlighting underdiagnosis nationwide. Patients with MCI were generally younger, more likely to be male, African American, and dual-eligible for Medicare and Medicaid. Additionally, 43% of patients with an MCI diagnosis also had a behavioral dementia diagnosis. After adjusting for demographics and clinical factors, those with MCI incurred higher average annual healthcare costs ($28,256 versus $15,433). These findings emphasize the need for improved early detection strategies, including the use of biomarkers and artificial intelligence (AI)-based diagnostics. Recent U.S. policies support this goal, and proposed legislation, including the Alzheimer’s Screening and Prevention Act and the Accelerating Access to Dementia and Alzheimer’s Provider Training Act, aim to expand diagnostic access and strengthen primary care. Collectively, these developments underscore the urgency of earlier MCI identification to improve patient outcomes and reduce long-term healthcare costs.

Rights

Copyright is held by the author. All rights reserved.

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