"Real-world" eligibility for anti-amyloid treatment in a tertiary memory clinic setting

The societal impact of anti-amyloid treatment (AAT) for Alzheimer's disease (AD) depends largely on patient eligibility. Estimates suggest that 1% to 18% of individuals with AD may qualify for AAT; however, data from everyday clinical practice remain limited. This study assessed AAT eligibility in patients at a tertiary memory clinic.

We included 1309 new patients (63 ± 8 years, 45% women, Mini-Mental State Examination [MMSE] 25 ± 5) who presented to the Alzheimer Center Amsterdam (2020-2022) for standardized diagnostic workup. Eligibility for AAT was based on lecanemab's approved label guidelines.

Of 1309 new patients, 514 (39% of new patients) had clinical mild cognitive impairment (MCI) or AD. Of these, 108 (8% new patients/21% clinical MCI/AD) met Clinical Dementia Rating/MMSE criteria, were amyloid positive, and had < 4 microbleeds/superficial siderosis. After further excluding apolipoprotein E ε4/ε4 homozygotes and anticoagulant users, 79 patients (6% new patients/15% clinical MCI/AD) remained eligible.

Findings indicate limited eligibility for AAT in tertiary memory clinics.

Initial eligibility for lecanemab was 8% of all patients and 21% of those with clinical mild cognitive impairment (MCI) or Alzheimer's disease (AD) based on approved guidelines in a tertiary memory clinic population. After strict exclusions (such as apolipoprotein E ε4/ε4 homozygosity and anticoagulant use), eligibility dropped to 6% of all patients and 15% of those with clinical MCI or AD. The study highlights the limited real-world applicability of anti-amyloid treatment under current guidelines.