Emotional Reactivity to Daily Physical Symptoms in Adulthood and Old Age: The Role of Different Facets of Social Support.

A timely diagnosis of dementia may play an important role in efforts to slow the degeneration of cognition, function, or quality of life caused by the development of dementia, by providing valuable time for treatment and/or planning. This requires healthcare providers to recognize the symptoms of dementia and diagnose the clinical syndrome at early stages; however, in clinical settings, only half of dementia cases are diagnosed by healthcare providers in a timely fashion. Of note, while the efficacy of current therapeutics for dementia is still being debated, there is overall consensus that any eventual disease-modifying intervention will be more effective if implemented earlier in the course of disease, making timely diagnosis especially important. Several demographic and clinical factors have been related to underdiagnosis of dementia in healthcare settings, including race, education, sex, marital status, and level of impairment. However, not much is known about how dementia subtype is related to timeliness of diagnosis, in large part because subtyping dementia based on clinical syndrome alone can be difficult. In characterizing patterns of underdiagnosis, insufficient attention has been paid to the biological complexity of dementia, which, rather than being a single disease, is better viewed as a syndrome, where a constellation of symptoms that define the condition can be caused by multiple, often coexisting pathologic processes. Determining whether certain underlying pathologies or combinations of pathologies result in dementia that is more likely to be diagnosed by clinicians in a timely fashion compared with others could prove useful in understanding patterns of underdiagnosis. Nevertheless, most studies of dementia lack the data sources required to link underlying pathologies to healthcare diagnoses, including multiple and granular measures of both neurodegenerative and cerebrovascular pathologies, and robust assessment of dementia onset linked to administrative claims records or electronic health records to observe timing of a clinical dementia diagnosis by providers. Previously, by linking rigorous dementia assessments in the Rush Alzheimer's Disease Center (RADC) cohorts to Medicare claims, we examined demographic and clinical correlates of timely diagnosis. Here, we extend these findings to pathologic correlates of timely diagnosis, by incorporating postmortem pathologic examinations in these cohorts. Specifically, among deceased participants, we investigated how presence of common postmortem dementia pathologies (AD, limbic-predominant age-related TDP-43 encephalopathy neuropathologic change [LATE-NC], vascular pathologies, and Lewy bodies) was related to receipt of a timely diagnosis of dementia from healthcare providers. These findings may offer novel insights into drives of underdiagnosis in clinical practice and inform strategies for more sensitive detection of dementia.