Advancing Early Detection and Equitable Access in Alzheimer Disease Care

At an AJMC roundtable in Boston, neurologists and geriatricians warned that while FDA‑approved amyloid‑targeting drugs lecanemab and donanemab can slow cognitive decline by roughly 25–35% in early Alzheimer’s, realizing their population benefit will require major changes in diagnosis, delivery and equity; participants flagged systemic underrecognition, primary‑care discomfort (40% report unease diagnosing, 50% feel unprepared), resource shortages (social workers, pharmacists) and capacity constraints (one center reported a 250‑person infusion waitlist) as primary barriers. Panelists endorsed AI and digital screening integrated into EHRs and brief in‑clinic tools to improve early identification but cautioned these technologies could widen disparities without supportive care pathways and literacy supports. Proposed mitigations include mid‑level triage, telehealth linkages to community centers, mobile infusion models and value‑based/population‑health approaches, signaling investment opportunities and policy priorities in diagnostics, workforce expansion, infusion capacity and equitable care coordination to capture the clinical and economic value of disease‑modifying therapies.

Analysis

An AJMC roundtable of neurologists, geriatricians and researchers in Boston focused on early identification, equitable access and delivery redesign to realize benefits of FDA‑approved amyloid‑targeting drugs lecanemab and donanemab, which the panel noted slow cognitive decline by roughly 25%–35% in early disease. Panelists emphasized Alzheimer disease remains underrecognized despite being the fifth leading cause of death in those 65+, citing clinician readiness gaps with 40% of primary care providers uncomfortable diagnosing and 50% feeling unprepared to manage cases.

Health‑system barriers highlighted include inconsistent prioritization of cognitive disorders, shortages of social workers and pharmacists, and capacity constraints for treatment delivery—one center reported a 250‑person infusion waitlist—while training a cognitive neurology workforce lags behind acquisition of diagnostic imaging. The panel argued that delayed diagnosis translates into missed opportunities for disease‑modifying therapy and increased crisis‑driven utilization.

Participants endorsed AI and brief digital screening (including a 3‑minute iPad test and EHR risk‑flagging pilots) as scalable enablers but warned these tools could exacerbate disparities if deployed without midlevel triage, community telehealth links, workforce supports and integrated care pathways; suggested mitigations included mobile infusion units and value‑based population health models to improve equitable access and capture clinical value.

Key Decisions for Investors

• Increase exposure to diagnostics, point‑of‑care cognitive screening tools and EHR‑integrated AI risk‑flagging solutions, given pilot validations and the need to expand early detection
• Prioritize investments in infusion capacity, mobile infusion delivery and facility upgrades because centers report material capacity constraints (a cited 250‑person waitlist) for amyloid‑targeting therapies
• Support companies and services that expand care coordination and clinical workforce capacity (midlevel triage, social work, pharmacy integration, telehealth) since PCP readiness (40% uncomfortable diagnosing, 50% unprepared) is a bottleneck to therapy uptake
• Monitor reimbursement, regulatory and equity initiatives closely and avoid pure consumer home‑biomarker plays unless paired with integrated clinical pathways, as the panel warned home testing and AI can widen disparities without supportive infrastructure