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. 2025 Jun 26;17(1):142.
doi: 10.1186/s13195-025-01785-9.

The economic burden of subjective cognitive decline, mild cognitive impairment and Alzheimer's dementia: excess costs and associated clinical and risk factors

Eva Gläser  1 , Ingo Kilimann  2   3 , Moritz Platen  4 , Wolfgang Hoffmann  4   5 , Frederic Brosseron  6 , Katharina Buerger  7   8 , Marie Coenjaerts  6 , Emrah Düzel  9   10 , Michael Ewers  7   8 , Klaus Fliessbach  6   11 , Ingo Frommann  6   11 , Maria Gemenetzi  12   13 , Wenzel Glanz  9 , Julian Hellmann-Regen  12   14   15 , Enise I Incesoy  9 , Daniel Janowitz  8 , Frank Jessen  6   16   17 , Oliver Peters  12   13 , Josef Priller  12   18   19   20 , Alfredo Ramirez  6   11   17   21   22 , Anja Schneider  6   11 , Annika Spottke  6   23 , Eike Jakob Spruth  12   13 , Stefan Teipel  2   3 , Michael Wagner  6   11 , Bernhard Michalowsky  4
Affiliations

The economic burden of subjective cognitive decline, mild cognitive impairment and Alzheimer's dementia: excess costs and associated clinical and risk factors

Eva Gläser et al. Alzheimers Res Ther. .

Abstract

Background: With the availability of first disease-modifying treatments, evidence on costs across the entire Alzheimer's Continuum, especially for early disease stages, becomes increasingly important to inform healthcare planning, resource allocation, and policy decisions. This study assessed costs and cost-associated factors in patients with subjective cognitive decline (SCD), mild cognitive impairment (MCI) and Alzheimer's Disease (AD) dementia compared to healthy controls.

Methods: The German DELCODE cohort study assessed clinical data, healthcare resource use, and informal care provision. Costs were calculated from payer and societal perspectives using standardized unit costs, and multivariate regression analyses identified cost-associated factors.

Results: From a payer perspective, costs were elevated by 26% for SCD (adjusted mean 5,976€ [95%CI 4,598-7,355€]), 85% for MCI (8,795€ [6,200-11,391€]) and 36% for AD (6,454€ [2,796-10,111€]) compared to controls (4,754€ [3,586-5,922€]). Societal costs were elevated by 52% for SCD (adjusted mean 8,377€ [95%CI 6,009-10,746€]), 170% for MCI (14,886€ [9,524-20,248€]) and 307% for AD (22,481€ [9,994-34,969€]) compared to controls (5,522€ [3,814-7,230€]). APOE e4 negative patients showed higher costs compared to APOE e4 positive patients. Hypertension was associated with higher costs.

Conclusions: Healthcare costs are already elevated in early subjective and objective cognitive impairment, driven by formal and informal care. The study emphasizes the importance of early interventions to reduce the economic burden and delay progression.

Keywords: Alzheimer’s disease; Apolipoprotein E; Cognition; Cost; Dementia; Economics; Mild cognitive impairment; Subjective cognitive decline; Utilization.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study protocol was approved by the ethical committees of the medical faculties of all participating sites: the ethical committees of Berlin (Charité, Universitätsmedizin Berlin), Bonn, Cologne, Göttingen, Magdeburg, Munich (Ludwig-Maximilians-University), Rostock, and Tübingen. The process was led and coordinated by the ethical committee of the medical faculty of the University of Bonn. The trial registration number at the ethical committee in Bonn is 117/13. All participants or their representatives provided written informed consent. DELCODE was conducted in accordance with the Helsinki Declaration of 1975. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Adjusted mean annual cost from payer and societal perspective per disease stage. Costs are adjusted for age, sex, functional impairment and comorbidities. Additionally, subgroups for APOE and Aβ status are presented. Note that Aβ status was only available for a subsample (total sample size for which information on Aβ-status was available: n=51 for controls, n=77 for SCD, n=42 for MCI and n=27 for ADD)
See this image and copyright information in PMC

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