Employment, volunteering, and health-related resource use in pre-symptomatic AD: Results from the Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease (A4) study.

INTRODUCTION: Little is known about productive time use and health-related resource use during "pre-symptomatic" AD, defined by the presence of brain amyloid in the absence of cognitive symptoms. We compared changes in resource use and participation in paid employment and/or volunteering in cognitively unimpaired older adults with amyloid accumulation (Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease [A4] study, N = 1165) to otherwise matched participants without amyloid accumulation (Longitudinal Evaluation of Amyloid Risk and Neurodegeneration [LEARN] study, N = 507). METHODS: Health-related resource use was self-reported using the Resource Use Inventory (RUI). Longitudinal analyses examined effect on RUI from study (A4 vs LEARN), time, and their interaction, controlling for Alzheimer's Disease Cooperative Study-Preclinical Alzheimer's Cognitive Composite (ADCS-PACC) and the Clinical Dementia Rating (CDR) scale, and their change scores from baseline. RESULTS: Over time, paid employment and volunteering decreased, and unpaid help and hospitalization increased. Results showed clear associations between ADCS-PACC and CDR with RUI. DISCUSSION: Little detectable impact of amyloid levels on RUI was found in pre-symptomatic AD that has been identified as an ideal stage to target for dementia prevention. HIGHLIGHTS: Using data from a cohort of cognitively unimpaired older adults with evidence of amyloid accumulation enrolled in the Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease (A4) study and otherwise matched participants who did not meet subthreshold levels of amyloid accumulation enrolled in the Longitudinal Evaluation of Amyloid Risk and Neurodegeneration (LEARN) study, this study showed clear associations between clinical variables and resource use and participation in paid employment and volunteering but suggested little detectable impact of amyloid levels on rate of change during the preclinical stage. Our results suggest that economic benefits from currently available treatment that effectively removes amyloid may not be immediately or concurrently observed during the short timeline of clinical trials. It is critical that our examination of economic consequence of treatment include broad ranges of items on resource use and productivity loss, longer time horizon, and that we balance between cost of detection, treatment, and burden and benefit.