Researchers built an Alzheimer's disease microsimulation model from an amyloid-positive memory clinic population to extrapolate amyloid-targeting therapy trials. Stages were MCI, community dementia, institutionalisation and death, with transitions tied to Mini-Mental State Examination (MMSE) scores through joint models. Predicted and observed cumulative incidence curves overlapped, and an untreated cohort starting with MCI lived 10.0 years in total. A 30% slowing of MMSE decline lengthened MCI by 0.4 years and mild dementia by 1.0 years. It delayed institutionalisation by 1.1 years, while time spent institutionalised stayed similar. The 30% slowing, applied only during MCI and mild dementia, was an assumed scenario.
Why it is interesting: Trials of amyloid-targeting therapies showed slower cognitive and functional decline over eighteen months. This model converts slower cognitive decline into years per functional stage, for assessing cost-effectiveness, the authors say.
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