Study Reveals Significant Gaps in Early Alzheimer Disease Diagnosis and Management

A retrospective chart review published in the Journal of Alzheimer's Disease highlights gaps in diagnosing and managing early Alzheimer disease (AD) in US community-based practices. Researchers found that nearly 1 in 5 patients (16.1%) with early AD did not receive standard neurocognitive assessments and approximately 1 in 4 (23.1%) did not undergo AD-specific biomarker or structural imaging tests.

The study analyzed data from 324 community-based primary care physicians and neurologists across the US who abstracted the medical records of 1284 patients newly diagnosed with early AD, defined as mild cognitive impairment (MCI) due to AD and mild dementia due to AD. Data were collected from August to September 2023, and key metrics included the use of neurocognitive assessments, structural imaging and biomarker tests, referrals, and treatments.

Other key results provided insight into trends in the diagnosis and management of AD, including:

• Neurocognitive assessments: 48.1% of patients received the Mini-Mental State Examination (MMSE), while only 10.8% received the Mini-Cog.
• Structural imaging tests: 63.4% of MCI patients and 63.6% of mild AD patients received an MRI.
• AD-specific biomarker tests: 8.1% of MCI patients and 8.6% of mild AD patients received an amyloid PET scan; 84.6% were not tested for AD-specific biomarkers.
• Genetic testing: 18.3% of patients were tested for apolipoprotein E (APOE) ε4; among that group, 52.8% had the gene variant.
• Referrals: 22.8% of patients received referrals to other physicians.
• Treatment: 75.6% of MCI patients and 89.5% of mild AD patients were prescribed AD medications; Aricept (donepezil; Eisai, Tokyo, Japan) was the most frequently prescribed, while monoclonal antibody treatments were prescribed to fewer than 6% of patients.

Given the emergence of new therapies to slow AD progression in the early stages, researchers noted the need for improved early detection and management of AD in community settings, including the expanded use of diagnostic tools and referrals to reduce the time to treatment, better patient and caregiver education on recognizing symptoms, and increased physician training on new technologies.