Resources of Austrian hospital-based departments of neurology and psychiatry for new amyloid-antibody therapies in early Alzheimer dementia : A survey of the Austrian Alzheimer Society.

Abstract

Background: Disease-modifying therapies with amyloid-antibodies will soon be available for patients with early Alzheimer's disease, which necessitates diagnostic and therapeutic resources in hospital and outpatient settings.

Methods: The Austrian Alzheimer Society developed an online questionnaire to survey Austrian hospital-based departments of neurology and psychiatry regarding resources for amyloid-antibody therapies.

Results: Between May and October 2023, 30 out of 41 neurology (73%) and 12 out of 33 psychiatry departments (36%) responded. The number of first examinations per year and center ranges between 0 in centers accepting only secondary referrals and 500, median 100. Of the patients 30% (median; range 0-80%) achieve a mini-mental state examination sum score ≥ 22 constituting an early disease stage. First visits comprise medical history, clinical examination, routine blood sampling and neurocognitive screening in 90-100% of patients, magnetic resonance imaging in 90% (median; range 10-100%), amyloid-PET in 5% (0-70%), cerebrospinal fluid analysis (Aß42, Aß40, tau, phospho-tau) in 25% (0-90%) and Apo‑E testing in 2.5% (0-100%). To assess the amyloid status 18 centers (44%) prefer amyloid-PET to lumbar puncture, 20 (49%) vice versa and 15 centers intend to offer amyloid-antibody therapy. Differences between centers and federal states were observed regarding hospital-based resources for amyloid-antibody therapies. A substantial need exists for early dementia diagnosis, medical, neuropsychological, nursing and administrative resources, adequate space, access to amyloid-PET and MRI. All centers highlighted the need for structured patient pathways and multidisciplinary care networks, including neurologists, psychiatrists, radiologists, neuropsychologists operating in clinical practice, rehabilitation and dementia care settings.