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Eligibility for amyloid targeting therapies among primary care patients with cognitive symptoms

Borgström Bolmsjö, Beata LU ; Barbosa Djärf, Josef LU orcid ; van Westen, Danielle LU orcid ; Schindler, Suzanne E. ; Fawad, Ayesha LU orcid ; Collij, Lyduine LU ; Smith, Ruben LU ; Mattsson-Carlgren, Niklas LU orcid ; Stomrud, Erik LU orcid and Tideman, Pontus LU , et al. (2026) In Alzheimer's Research & Therapy 18. p.1-12
Abstract
Background
Alzheimer’s disease (AD) is the most common cause of dementia and a growing healthcare challenge. Amyloid-targeting therapies (ATT) may slow progression, but implementation is limited by logistical and economic barriers. As primary care is the first contact for most patients with cognitive concerns, quantifying treatment eligibility in this setting is essential. The purpose of this study was to estimate the proportion of primary care patients presenting with cognitive symptoms who are eligible for ATT.

Methods
This cohort study included patients presenting with cognitive symptoms in primary care across the region Skåne, in southern Sweden, recruited between January 2020 and April 2025. Stepwise exclusion... (More)
Background
Alzheimer’s disease (AD) is the most common cause of dementia and a growing healthcare challenge. Amyloid-targeting therapies (ATT) may slow progression, but implementation is limited by logistical and economic barriers. As primary care is the first contact for most patients with cognitive concerns, quantifying treatment eligibility in this setting is essential. The purpose of this study was to estimate the proportion of primary care patients presenting with cognitive symptoms who are eligible for ATT.

Methods
This cohort study included patients presenting with cognitive symptoms in primary care across the region Skåne, in southern Sweden, recruited between January 2020 and April 2025. Stepwise exclusion criteria based on clinical diagnosis, comorbidities, and treatment contraindications were applied, in alignment with appropriate use recommendations for lecanemab and donanemab, respectively. Eligibility was further refined using CSF biomarkers (Aβ42/40 ratio), cognitive performance, and MRI findings.

Results
In a full diagnostic work-up of 607 patients with sequential exclusions, 86 patients (14.2%) and 78 patients (12.8%) ultimately met the eligibility criteria for lecanemab and donanemab, respectively. Due to comorbidities, medication use, and age/BMI, around 1/3 of the original population was excluded. Most ineligible patients met more than one exclusion criterion. The eligible population was 63% female, mean age 77 years. Around 65% of the individuals had mild cognitive impairment (MCI), and 35% mild dementia.

Conclusions
About 13-14% of primary care patients evaluated for cognitive complaints were eligible for ATT. Compared with clinical trials, the eligible population was older and consisted of more women. (Less)
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author
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organization
alternative title
Lämplighet för amyloidriktade behandlingar bland primärvårdspatienter med kognitiva symtom
publishing date
type
Contribution to journal
publication status
published
subject
in
Alzheimer's Research & Therapy
volume
18
article number
77
pages
1 - 12
publisher
BioMed Central (BMC)
external identifiers
  • pmid:41865008
  • scopus:105035546580
ISSN
1758-9193
DOI
10.1186/s13195-026-02019-2
language
English
LU publication?
yes
id
6fcc66e3-ec06-4245-9e37-cb7b0b88c09e
alternative location
https://link.springer.com/article/10.1186/s13195-026-02019-2
date added to LUP
2026-04-23 09:17:07
date last changed
2026-04-24 04:01:37
@article{6fcc66e3-ec06-4245-9e37-cb7b0b88c09e,
  abstract     = {{Background<br/>Alzheimer’s disease (AD) is the most common cause of dementia and a growing healthcare challenge. Amyloid-targeting therapies (ATT) may slow progression, but implementation is limited by logistical and economic barriers. As primary care is the first contact for most patients with cognitive concerns, quantifying treatment eligibility in this setting is essential. The purpose of this study was to estimate the proportion of primary care patients presenting with cognitive symptoms who are eligible for ATT.<br/><br/>Methods<br/>This cohort study included patients presenting with cognitive symptoms in primary care across the region Skåne, in southern Sweden, recruited between January 2020 and April 2025. Stepwise exclusion criteria based on clinical diagnosis, comorbidities, and treatment contraindications were applied, in alignment with appropriate use recommendations for lecanemab and donanemab, respectively. Eligibility was further refined using CSF biomarkers (Aβ42/40 ratio), cognitive performance, and MRI findings.<br/><br/>Results<br/>In a full diagnostic work-up of 607 patients with sequential exclusions, 86 patients (14.2%) and 78 patients (12.8%) ultimately met the eligibility criteria for lecanemab and donanemab, respectively. Due to comorbidities, medication use, and age/BMI, around 1/3 of the original population was excluded. Most ineligible patients met more than one exclusion criterion. The eligible population was 63% female, mean age 77 years. Around 65% of the individuals had mild cognitive impairment (MCI), and 35% mild dementia.<br/><br/>Conclusions<br/>About 13-14% of primary care patients evaluated for cognitive complaints were eligible for ATT. Compared with clinical trials, the eligible population was older and consisted of more women.}},
  author       = {{Borgström Bolmsjö, Beata and Barbosa Djärf, Josef and van Westen, Danielle and Schindler, Suzanne E. and Fawad, Ayesha and Collij, Lyduine and Smith, Ruben and Mattsson-Carlgren, Niklas and Stomrud, Erik and Tideman, Pontus and Hansson, Oskar and Palmqvist, Sebastian}},
  issn         = {{1758-9193}},
  language     = {{eng}},
  month        = {{03}},
  pages        = {{1--12}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{Alzheimer's Research & Therapy}},
  title        = {{Eligibility for amyloid targeting therapies among primary care patients with cognitive symptoms}},
  url          = {{http://dx.doi.org/10.1186/s13195-026-02019-2}},
  doi          = {{10.1186/s13195-026-02019-2}},
  volume       = {{18}},
  year         = {{2026}},
}