Abstract Details

Title Real-world Analysis of the Clinical Care Pathway of Patients Living with Alzheimer’s Disease in the United States According to Stage of Cognitive Impairment at Diagnosis

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) P1 - Poster Session 1 (11:45 AM-12:45 PM)

Poster/Presentation
Number 3-016

Objective To understand the path and barriers to Alzheimer’s disease diagnosis.

Background We analyzed the clinical care pathway of patients at varying AD stages.

Design/Methods Data were from the US Adelphi Real World Dementia Disease Specific Programme™ (December 2022-September 2023). Physicians reported patient characteristics and disease severity, and patients reported their disease experience. Patients were aged ≥50 years with probable AD based on physician diagnosis and Mini-Mental State Examination (MMSE) scores: 26-29, mild cognitive impairment (MCI) due to AD; 21-25, mild AD dementia; 11-20, moderate AD dementia; 0-10, severe AD dementia.

Results

Overall, 191 physicians (83 primary care physicians [PCPs], 108 specialists) reported data for 870 patients. Mean (SD) age was 74.7 (8.4) years and 48.3% were female. At initial diagnosis, 22% of patients had MMSE scores consistent with MCI due to AD; 49% mild, 26% moderate and 2% severe AD dementia.

Short-term memory loss prompted first physician evaluation for 83% of patients. Most patients (53.1%) delayed evaluation because they perceived memory issues as normal aging.

Median (IQR) time between symptom onset and first evaluation was 17.3 (4.4;43.4) weeks, and time from first evaluation to diagnosis was 3.0 (0.0;13.1) weeks. Before diagnosis, 47.0% of patients were referred to a secondary physician, with median time from first evaluation to referral of 8.7 (2.3;19.9) weeks. For referred patients, median time from first evaluation to diagnosis was 9.9 (3.1;26.2) weeks.

In 75.3% of cases, patients first visited a PCP (range: 71.4–76.8%, across severity subgroups). Specialists made 57.9% of initial diagnoses versus 41.8% by PCPs; 61.9% versus 38.1%, respectively, for MCI due to AD and 57.1% versus 42.9%, respectively, for severe AD dementia.

Conclusions Specialists were more likely to diagnose patients in the MCI stage. Delays in AD diagnosis are common, and new strategies to address these delays are warranted.

Authors/Disclosures
Lei Lv, PhD PRESENTER	Dr. Lv has received personal compensation for serving as an employee of Novo Nordisk .
Elnara Fazio-Eynullayeva (NNI)	Ms. Fazio-Eynullayeva has received personal compensation for serving as an employee of Novo Nordisk. Ms. Fazio-Eynullayeva has stock in Novo Nordisk.
Paul Mystkowski, MD (Novo Nordisk)	Dr. Mystkowski has received personal compensation for serving as an employee of Novo Nordisk. Dr. Mystkowski has stock in Novo Nordisk.
Sarah Cotton	Sarah Cotton has nothing to disclose.
Eddie Jones, BA	Eddie Jones, BA has nothing to disclose.
Sophie J. Kirkman, BSc	Ms. Kirkman has nothing to disclose.
Soeren Mattke, MD, PhD (USC)	Dr. Mattke has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Dr. Mattke has received personal compensation in the range of $500-$4,999 for serving as a Consultant for C2N. Dr. Mattke has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novo Nordisk. Dr. Mattke has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Senscio Systems. The institution of Dr. Mattke has received research support from various companies, CMS.

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