Alzheimers disease—doesn’t say what you think it says https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2020.6432?guestAccessKey=807ca0d3-63aa-48f9-8a1d-16df0d828d42&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamainternalmedicine&utm_content=olf&utm_term=113020 Conclusions and Relevance Alzheimer disease and related dementias were associated with adverse financial events years prior to clinical diagnosis that become more prevalent after diagnosis I listen to a podcast and read articles and it seems omg this is great!! Maybe we look to see if people are missing payments or making poor financial decisions and screen them for alzheimers. Currently screening for alzheimers is difficult because we don’t have good treatment to slow or prevent the progression of the disease. Remember a few basic principles of screening are The condition should be an important health problem. There should be a treatment for the condition that can change the outcome. Total cost of finding a case should be economically balanced in relation to medical expenditure as a whole. As I say those I cant think can we apply those to covid screening?? (say it again) retrospective secondary data analysis of consumer credit report outcomes from 1999 to 2018 linked to Medicare claims data of 81 364 individuals and they were looking for Missed payments on credit accounts (30 or more days late) and subprime credit scores. Does an individual with Alzheimer disease and related dementias miss more financial payments than those individuals without alzheimers and they found “Alzheimer disease and related dementias were associated with adverse financial events years prior to clinical diagnosis that become more prevalent after diagnosis” But lets look at some of the results— Overall, 54 062 pts without the diagnoses of ADRD were included and 27 302 who had the diagnosis of ADRD were included. Those Medicare beneficiaries diagnosed with ADRD were more likely to miss payments on credit accounts at a rate of 7.7% compared to only 7.3% of missed payments in those individuals without a diagnosis of ADRD (7.7% vs 7.3%; absolute difference, 0.4 percentage points [pp]; 95% CI, 0.07-0.70:). You might say wait a second a 0.4 percent absolute difference is statistically significant?? Yes, remember the more people you have in a study the more likely even a very very very small difference is statistically significant. This study also looked at those individuals who develop subprime credit scores 2.5 years prior to diagnosis – for those individuals with ADRD this occurred 8.5% of the time compared to only 8.1% of the time in those individuals without the diagnosis of ADRD. This was an absolute difference, 0.38 pp; 95% CI, 0.04-0.72 Once again this is statistically significnat because so many people were enrolled. HOWEVER here is the problem and somehitng to notice. The authors gave you percent here, not the actual number which is what you are a question medicine individual needs to know! The reason being is because it drastically changes the outcome and results Lets look at the first outcome of miss payments on credit account, this occurred 7.7% of those with ADRD compared to only 7.3% of missed payments in those individuals without a diagnosis of ADRD. BUT REMEMBER the people that were enrolled in this study- 54 062 pts without the diagnoses of ADRD were included and 27 302 who had the diagnosis of ADRD were included This mean you have to take 7.7% of 27000 patients with a dx of ADRD And 7.3% of 54000 patients without a dx of ADRD This works out to a total of 6000 patients but it breaks down to 2000 individuals diagnosed with ADRD missed a credit card payment and 4000 individuals without a diagnosis of ADRD missed a credit card payment. So 2/3 of individuals who missed a credit card report did not have a diagnosis of ADRD!! When you look(continued)