Factors relating to DMT eligibility in memory clinics in North and East London and the specialist cognitive service at the National Hospital for Neurology and Neurosurgery
| Entire memory clinic cohort (n=517) | Site 1 (n=100) | Site 2 (n=100) | Site 3 (n=100) | Site 4 (n=126) | Site 5 (n=89) | Specialist cognitive service (n=500; 177 AD included in analysis) | |
| Dementia/AD diagnosis potentially eligible for DMT | 367 (71%) | 73 (73%) | 68 (68%) | 76 (76%) | 88 (70%) | 62 (70%) | 177 |
| Formal cognitive assessment documented within 18 months | 482 (93%)* | – | – | – | – | – | 156 (88%) |
| MMSE ≥20* | 397 (77%) | 71 (71%) | 82 (82%) | 75 (75%) | 101 (80%) | 68 (76%) | 74 (47%) |
| Rockwood frailty score ≤5† | 320 (75%†) | 69 (69%) | 70 (70%) | 76 (76%) | 105 (83%) | NA | 107 (60%) |
| Potentially eligible for DMT¶ | 276 (53%) | 41 (41%) | 42 (42%) | 61 (61%) | 76 (60%) | 56 (63%) | 68 (38%) |
| Neuroimaging performed, n (%)‡ | 388 (75%) | 95 (95%) | 50 (50%) | 70 (70%) | 85 (68%) | 88 (99%) | 177 (100%) |
| MRI results available, n (%) | 239 (46%) | 73 (73%) | 23 (23%) | 55 (55%) | 29 (23%) | 59 (66%) | 174 (98%) |
| Amyloid biomarkers assessed (plasma/CSF/amyloid-PET), n (%) | 2‡ (0.4%) | 0 (0%) | NA | NA | NA | 2‡ (2%) | 109§ (62%) |
| FDG-PET | NA | NA | NA | NA | NA | NA | 4 (2%) |
*Or equivalent ACE/RUDAS.
†Data not available for site 5 so excluded from all proportions.
‡Does not capture where imaging performed from primary care prior to referral.
‡In a small proportion of memory clinics, plasma p-tau was assessed.
§In the specialist cognitive clinic, CSF or amyloid-PET was assessed.
¶Calculated as those with potentially eligible diagnosis, MMSE ≥20 and Rockwood ≤5. Where Rockwood missing for site 5, patients were included if they had a potentially eligible diagnosis and MMSE ≥20. Those patients with only MMSE available (i.e. those without Rockwood) were excluded from the cohort described in figure 2.
ACE, Addenbrooke’s Cognitive Examination; AD, Alzheimer’s disease; CSF, cerebrospinal fluid; DMT, disease-modifying therapy; FDG-PET, fluorodeoxyglucose positron emission tomography; MMSE, Mini-Mental State Examination; PET, positron emission tomography; RUDAS, Rowland Universal Dementia Assessment Scale.