Executive function, episodic memory, and Medicare expenditures.
BACKGROUND
We examined the relationship between health care expenditures and cognition, focusing on differences across cognitive systems defined by global cognition, executive function, or episodic memory.


METHODS
We used linear regression models to compare annual health expenditures by cognitive status in 8125 Nurses' Health Study participants who completed a cognitive battery and were enrolled in Medicare parts A and B.


RESULTS
Adjusting for demographics and comorbidity, executive impairment was associated with higher total annual expenditures of $1488 per person (P < .01) compared with those without impairment. No association for episodic memory impairment was found. Expenditures exhibited a linear relationship with executive function, but not episodic memory ($584 higher for every 1 standard deviation decrement in executive function; P < .01).


CONCLUSIONS
Impairment in executive function is specifically and linearly associated with higher health care expenditures. Focusing on management strategies that address early losses in executive function may be effective in reducing costly services.
Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
Alex C
AC
Bender
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
Andrea M
AM
Austin
Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Francine
F
Grodstein
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA. Electronic address: julie.pw.bynum@dartmouth.edu.
Julie P W
JPW
Bynum
D000368:Aged; D000375:Aging / Q000523:psychology; D003704:Dementia / Q000175:diagnosis; D056344:Executive Function / Q000502:physiology*; D005260:Female; D005102:Health Expenditures; D006801:Humans; D006278:Medicare; D061212:Memory, Episodic; D014481:United States
Aging; Cognition; Dementia; Episodic memory; Executive function; Health care spending; Medicare