Background Alzheimer’s disease (AD) is the most common neurodegenerative disease worldwide, and an updated quantification of its impact on morbidity, disability, and mortality is warranted. We conducted a systematic literature review, focusing on the past decade, to characterize AD and assess its impact on affected individuals. Methods Searches of Embase, MEDLINE, and the Cochrane Library were conducted on August 7, 2020 and updated on November 10, 2021. Observational studies from any country reporting incidence, prevalence, comorbidities, and/or outcomes related to disability and mortality/life expectancy, in people with mild cognitive impairment (MCI) due to AD, or mild, moderate, or severe AD dementia, were considered relevant. Results Data were extracted from 88 studies (46 incidence/prevalence; 44 comorbidities; 25 mortality-/disability-related outcomes), mostly from Europe, the USA, and Asia. AD dementia diagnosis was confirmed using biomarkers in only 6 studies. Estimated 5-year mortality in AD was 35%, and comorbidity prevalence estimates varied widely (hypertension: 30.2–73.9%; diabetes: 6.0–24.3%; stroke: 2.7–13.7%). Overall, people with AD dementia were more likely to have cardiovascular disease or diabetes than controls, and 5-year mortality in people with AD dementia was double that in the age- and year-matched general population (115.0 vs 60.6 per 1,000 person-years). Conclusions AD is associated with excess morbidity and mortality. Future longitudinal studies of population aging, incorporating biomarker assessment to confirm AD diagnoses, are needed to better characterize the course of MCI due to AD and AD dementia. Electronic Supplementary Material Supplementary material is available in the online version of this article at 10.14283/jpad.2023.61.

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BackgroundAlzheimer’s Disease (AD) has significant impact on care partners. We conducted a systematic literature review to assess the economic impact of AD with special attention to care partners and disease progression.MethodA protocol was developed before searches in PubMed, Embase and PsycINFO were run November 2021 via the Silvi.ai‐platform. Conduct of the systematic literature review followed standard guidelines. Eligible studies were in English and provided data from earliest Jan 2011 – Nov 2021.ResultOf 1043 identified hits, 25 studies were relevant for data extraction. AD costs were defined heterogeneously between studies, however most studies included AD drugs, out‐ and inpatient visits as well as non‐AD drugs (anti‐psychotics, supplements etc).7 of the 25 studies specifically explored the cost burden of AD for care partners; hours needed to support the partner, loss of work productivity, and implications for future employability.Monthly cost of caretaking was similar across studies and countries and varied between €643 ‐ €1050 for mild AD in Germany and Spain, €804‐ €1329 for moderate AD in France and Germany, to €1515 ‐ €2376 for severe AD in UK and Germany, respectively. The major cost driver was severity of the clinical status of the patient.Only few studies reported on work impairment of care partners. A study comparing matched care partners vs. non‐care partner demonstrated significantly higher activity impairment (25.4% vs. 21.8%), greater absenteeism (5.4% vs.3.1%), presenteeism‐related impairment (22.7% vs. 18.4%), and overall work impairment (25.8% vs. 20.4%). Same pattern, showing an increase in work impairment with AD severity was seen across countries (US, Japan and EU5).ConclusionMost identified studies focused on the cost burden on society or patients. In 7 studies reporting cost impact on care partners, the cost burden was very similar across countries and health care systems. Cost impact on care partners increased from early to severe AD. In particular, work impairment increased significantly with AD severity. However, more research is needed to identify the true cost burden for care partners.

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