• Ruth Dobson, Katherine Patterson, Reshad Malik, Uttara Mandal, Hina Asif, Ros Humphreys, Michael Payne, Eng O-Charoenrat, Lauren Huzzey, Adam Clare, Kate Green, Maija Morton, Catrin Sohrabi, Navreen Singh, Amirtha Pasupathy, Milan Patel, Sam Whiteman, Kate Maxmin, Nicholas Bass, Bhavya Gupta, Claudia Cooper, Charles Marshall, Rimona Sharon Weil, and Catherine J Mummery.
• Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
• J. Neurol. Neurosurg. Psychiatr. 2024 Aug 16; 95 (9): 796803796-803.

BackgroundDisease-modifying therapies (DMTs) for Alzheimer's disease (AD) have early evidence of efficacy. Widespread delivery of DMTs will require major service reconfiguration. Treatment pathways will need to include triaging for eligibility, regular infusions and baseline and follow-up MRI scanning. A critical step in planning is provision of real-world estimates of patients likely to be eligible for triaging, but these are challenging to obtain.MethodsWe performed a retrospective service evaluation of patients attending five memory services across North and East London and a national specialist cognitive disorders service. We examined the likely proportion of patients who would (1) be referred for triaging for DMTs and (2) potentially be suitable for treatments.ResultsData from a total of 1017 patients were included, 517 of whom were seen in community memory services and 500 in a specialist clinic. In the memory services, 367/517 (71%) were diagnosed with possible AD. After exclusions of those in whom cognitive and frailty scores, MRI contraindications or anticoagulant use indicated they would be unlikely to be suitable, an estimated 32% would be eligible for triaging. In the specialist cognitive clinic, where additional investigations are available, 14% of those seen (70/500) would be potentially eligible for treatment.ConclusionsWhile a sizeable proportion of patients attending memory clinics may be referred for triaging for DMTs for AD, only a minority are likely to be suitable for these, as demonstrated in patients seen in specialist cognitive services. This will need to be considered when designing pathways for DMT delivery.© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.

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