OBJECTIVES: Alzheimer’s disease is projected to affect 13.8 million individuals in the US by 2060. A TLR was conducted to characterize contemporary estimates of the clinical, humanistic and economic burden of mild-to-moderate AD (including mild cognitive impairment [MCI]). This included patient characteristics, prognosis, risk factors for greater severity and/or disease progression, and key factors influencing patient and caregiver quality of life (QoL) and health care resource use (HCRU).

METHODS: A search strategy involving disease-specific keywords (AD or MCI), along with prognostic, QoL, caregiver burden, and HCRU terms, was implemented in August 2023, using the Embase database via Ovid. US studies published in the English language and within the past five years were prioritized.

RESULTS: This TLR summarized 65 studies, and highlighted cardiometabolic conditions and depression as common comorbidities among patients with MCI/AD. Rates of progression from MCI to AD varied given differing MCI definitions and baseline cognitive level, ranging from 23% to 79% (over 18 months to 6 years of follow-up). Older age, lower education, male sex, and antipsychotic treatment were associated with greater functional impairment and consequently lower QoL. Persistence with acetylcholinesterase inhibitor use decreased over time, indicating current treatment challenges. Higher caregiver burden was correlated with increased patient disease severity, lower income, and urban residence. Caregivers of MCI/AD patients exhibited lower EQ-5D scores, higher anxiety, and depression than non-caregivers. AD patients exhibited higher HCRU (inpatient, outpatient, and emergency department visits, and longer lengths of stay) compared to non-AD patients. Increased disease severity correlated with higher HCRU, rate of institutionalization, and costs, with mean total annual healthcare costs per patient ranging from $19,245 for mild AD to $69,493 for severe AD (2015 USD).

CONCLUSIONS: Compared with cognitively normal individuals, the burden of MCI and AD for patients, caregivers, and the healthcare system is substantial and increases with disease severity.