The patient pathway for mild cognitive impairment due to Alzheimer's disease in Asia: Current practices, barriers, and expert recommendations for optimization.

Abstract

Background: The age-standardized prevalence of Alzheimer's disease in Asia has increased rapidly in recent years. Disease-modifying treatments that can slow disease progression are now becoming available for patients with early-stage Alzheimer's disease, including those with mild cognitive impairment. However, challenges in diagnosis and assessment for these patients remain.

Objectives: This study characterized the care pathway for mild cognitive impairment due to Alzheimer's disease in Asia, including barriers to care, and considered the future treatment landscape, with the aim of making recommendations for optimizing the care pathway in readiness for the availability of new disease-modifying treatments.

Design: Qualitative study based on semi-structured interviews.

Setting: Interviews were conducted with physicians in general/tertiary hospitals in Hong Kong, India, Indonesia, Korea, Malaysia, the Philippines, Singapore, Taiwan, and Thailand. Physicians from mainland China and Japan were not included.

Participants: Physicians managing patients with mild cognitive impairment.

Measurements: Number and/or proportion of participants providing a given response, and numerical estimates provided by interview participants.

Results: Forty-four physicians, primarily neurologists (n = 31; 70.5 %), were interviewed. Participants managed a median of 67.5 patients with mild cognitive impairment per month, of whom 24.0-87.5 % had mild cognitive impairment due to Alzheimer's disease. Clinical investigations routinely comprised brief neuropsychological assessments, such as the Mini-Mental State Examination (n = 41), as well as neurological tests (n = 39) and magnetic resonance imaging (n = 40). Except in Korea, comprehensive neuropsychological test batteries and amyloid positron emission tomography were seldom conducted in Asia. Most patients with mild cognitive impairment due to Alzheimer's disease were treated with nootropics and/or acetylcholinesterase inhibitors (Korea, 96 %; all other regions, 69 %), and almost all were recommended a non-pharmacological treatment (Korea, 93 %; all other regions, 100 %). Detection of mild cognitive impairment due to Alzheimer's disease was considered prompt in Korea but suboptimal in other regions (n = 16) owing to low disease awareness among patients. Barriers to assessment and diagnosis included delayed healthcare visits for initial assessment (n = 7), neuroimaging backlogs (n = 6), and insufficient neuropsychology resources (n = 13). Access to amyloid biomarker tests, including amyloid positron emission tomography, cerebrospinal fluid analysis, and blood tests, was limited in regions other than Korea.

Conclusions: The survey findings showed that screening and diagnostic processes for mild cognitive impairment due to Alzheimer's disease in Asia require further optimization. Efforts should also be made to educate patients and caregivers, improve the diagnostic capabilities of primary and secondary healthcare providers, and reinforce cognitive screening services. The provision and reimbursement of confirmatory tests of amyloid burden should be expanded across the region to facilitate access to innovative disease-modifying therapies.