Patient journey and decision processes for anti-amyloid therapy in Alzheimer's disease

Abstract

Introduction: We utilized the Veterans Affairs Healthcare System administrative database to study the clinical decision-making processes for anti-amyloid therapy (AAT).

Methods: Patients with clinical notes mentioning lecanemab were identified (March 2023-June 2024) for manual review and structured database queries.

Results: From an initial sample (N = 2499), 1064 patients (55,000 notes) were reviewed manually (mean age 76 years; 7.3% women; 9.2% Black; 3.9% Hispanic). The AAT group (n = 56) had lower rates of common comorbidities, except post-traumatic stress disorder, than patients excluded from AAT (n = 528). The documented notes including "Lack of patient interest/resource constraints" (24.6% vs 3.6%), "anticoagulant use" (23.1% vs 10.7%), and "advanced AD" (18.6% vs 0), supplied partial explanations on exclusion vs inclusion.

Discussion: Only 5.3% of patients reached the point of care of being a candidate, scheduled for, or receiving AAT infusion. Patient preference and clinician discretion, especially regarding modifiable factors (e.g., medication regimens), appreciably influence the patient journey to AAT.

Keywords: Alzheimer’s disease; Anti-amyloid therapy; Electronic health records; Lecanemab; Mild cognitive impairment.