Diagnosis and management of mild cognitive impairment and mild Alzheimer's disease dementia: Findings from an Italian real-world survey
Stefania Ippati, Federico Torelli, Giovanna Zamboni, Alessandro Iavarone, Alessandro Martorana, Brenda Botello, Sarah Cotton, Chloe Walker, Zoe Phillips, Arianna AvitabileBackground
The identification and early diagnosis of mild cognitive impairment (MCI) and mild Alzheimer's disease (AD) dementia are critical for timely intervention, yet implementation of biomarker-based diagnostics in the Italian healthcare system remains limited.
Objective
To characterize the real-world diagnostic journey, barriers, and management pathways of MCI and mild AD dementia patients in Italy.
Methods
Data were drawn from the Adelphi Real World Dementia Disease Specific Programme™, a cross-sectional survey of Italian primary care physicians and specialists. Physicians reported on diagnostic assessments, biomarker testing, and treatment initiation for consulting patients with MCI/mild AD dementia.
Results
Physicians provided data on 325 patients (mean age: 74.1 years; 48.3% female). Patients aged ≥75 had lower Mini-Mental State Examination scores at survey (p = 0.0028) and diagnosis (p = 0.0223) than patients aged <75 years. Short-term memory loss (87.6%) was the most common symptom. Delays in diagnosis were most commonly attributed to limited specialist access (55.8%), prolonged interval between consultations (27.0%), and restricted diagnostic resources (20.4%). Magnetic resonance imaging was the primary imaging modality (65.7%), while biomarker testing such as cerebrospinal fluid and amyloid positron emission tomography were performed in 15.9% and 16.3% of cases, likely hindered by patient's reluctance and cost, respectively, as indicated by specialist-perceived challenges in using biomarkers for early symptomatic AD diagnosis. Patients whose treatment was initiated by specialists were commonly prescribed acetylcholinesterase inhibitors (72.8%).
Conclusions
Delays in MCI and mild AD dementia diagnosis persist alongside systemic barriers and limited biomarker use. Improving referral pathways and biomarker access is essential for timely diagnosis and management.