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

作者：Brant Mittler, Xavier Cambi, Morgan Biskach, Joel I. Reisman, Ying Wang, Dan R. Berlowitz, Peter J. Morin, Donald R. Miller, Karla Brandao-Viruet, Sophie J. Clare, K. Xia, Amir Abbas Tahami Monfared, Michael C. Irizarry, Quanwu Zhang, Weiming Xia · 发表于：Journal of Neurology · 年份：2025 · DOI：10.1007/s00415-025-13059-3 · 被引用次数：6 · 研究领域：Dementia and Cognitive Impairment Research、Alzheimer's disease research and treatments、Intracerebral and Subarachnoid Hemorrhage Research

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.