Improving Access to Dementia Care in the Era of Monoclonal Antibody Treatments for Alzheimer’s Disease: a Pilot Clinical Protocol Using Abbreviated Neuropsychological Assessment
Savana M Naini, Ryan C Thompson, Maria Agustina Rossetti, Virginia T Gallagher, Carol A Manning, Kathleen Fuchs, Anelyssa D’Abreu, Tanya Prachar, Shannon E ReillyABSTRACT
Objective
To meet the growing demand for timely diagnosis in the new era of disease-modifying medications for Alzheimer’s disease (AD), the present study aimed to reduce clinic wait times by developing and refining an abbreviated neuropsychological battery to assess individuals with a suspected amnestic process (i.e., Early-Stage AD Pathway).
Method
Early-Stage AD Pathway patients were referred by an internal neurology provider who determined that the patient had: (1) an amnestic clinical presentation, (2) a normal neurological examination, and (3) a Montreal Cognitive Assessment total score between 18 and 25. These patients were scheduled for a 2-h neuropsychological evaluation, including a brief clinical interview and an abbreviated testing battery. We evaluated n = 19 patients in the Early-Stage AD Pathway and compared them to 114 older adults referred via traditional clinic procedures (i.e., General Clinic).
Results
Most individuals evaluated via the Early-Stage AD Pathway were diagnosed with mild cognitive impairment (MCI; 68.4%) or mild dementia (21.1%) through the neuropsychological evaluation. Rate of diagnosis of MCI/dementia was comparable between groups. The average number of days between initial referral and completion of the neuropsychological evaluation was significantly lower (Mdiff = 145.8 days, U = 1867.500, p < 0.001) for the Early-Stage AD Pathway group than for the General Clinic group, as the former could be scheduled more flexibly.
Conclusions
Implementing an abbreviated neuropsychological assessment process significantly reduced the time between referral and evaluation to identify individuals who may be eligible for emerging pharmacological treatments for AD and/or non-pharmacological interventions in a timely manner.