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The following is a summary of “Patient journey and decision processes for anti-amyloid therapy in Alzheimer’s disease,” published in the April 2025 issue of Journal of Neurology by Mittler et al. 

Researchers conducted a retrospective study using the Veterans Affairs Healthcare System database to examine clinical decision-making for anti-amyloid therapy.  

They identified patients with clinical notes mentioning lecanemab (March 2023–June 2024) through manual review and structured database queries. They used a 7-point categorization scheme to classify AAT journey and assigned each patient to the highest category achieved; categories 2, 3, 4, 6, and 7 formed the AAT group, category 5 was excluded, and category 1 was AAT status not yet determined. 

The results showed that out of 2,499 patients, 1,064 (mean age 76; 7.3% women; 9.2% Black; 3.9% Hispanic) were manually reviewed. The AAT group (n = 56) had fewer comorbidities than those excluded (n = 528), with higher documentation of “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). 

Investigators found that only 5.3% of patients reached the point of care for AAT infusion. They noted that patient preference and clinician discretion influenced the journey, particularly around modifiable factors. 

Source: link.springer.com/article/10.1007/s00415-025-13059-3