Abstract
Background Alzheimer’s disease-modifying drugs (DMDs) are in routine use in other countries. They will likely be available in the UK within the next year. It is not yet clear how many patients will be eligible for them or what resources are required to establish this eligibility. Methods Patients attending the out-patient memory clinic of a single geriatrician between 01/02/2022 and 12/01/2023 were identified. Information required to judge eligibility according to the lecanemab appropriate use recommendations (Cummings et al 2023) was extracted between 08/08/23 – 13/09/2023. Relevant data included: diagnosis, that is dementia or mild cognitive impairment (MCI), cognitive symptoms due to a non-dementia causing disease pathology or diagnosis unclear; Addenbrooke’s Cognitive Examination III (ACE-III) and Mini-Mental State Examination (MMSE) scores; brain MRI reports; CSF analysis results; anticoagulant/antiplatelet drug history. Results In total, 328 records for n=214 patients were identified during the audit period. Of these 214 patients, 4 were <50 years and 9 were >90 years. Of the remaining 201 patients, 122 were diagnosed with dementia, 31 with MCI due to an underlying dementia-causing disease, 45 with symptoms due to non-dementia-causing pathology and 3 had an unclear diagnosis. Of the 153 patients with dementia/MCI, 105 had an ACE ≥60 or an MMSE ≥22. Of these, 32 were on anticoagulants. Of the 73 patients therefore potentially eligible for DMDs, 26 had MRI imaging and 2 CSF analysis. With the information available at the time of audit, one patient would have fulfilled the lecanemab appropriate use recommendations. Conclusion A large proportion of patients attending a geriatrician-led memory clinic during this audit period were ineligible for DMDs at first pass assessment, mostly on the basis of diagnosis and cognitive scores. Adequate investigation of potentially eligible patients will require significant increases in MRI and CSF analysis capabilities. Of note, this audit did not consider likely aetiological diagnosis.