Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Assessing Eligibility for Anti‐Amyloid Treatment Among Primary Care Patients with Cognitive Symptoms

Barbosa Djärf, Josef LU orcid ; Borgström Bolmsjö, Beata LU ; van Westen, Danielle LU orcid ; Tideman, Pontus LU ; Smith, Ruben LU ; Schindler, Suzanne E. ; Mattsson-Carlgren, Niklas LU orcid ; Stomrud, Erik LU orcid ; Hansson, Oskar LU orcid and Palmqvist, Sebastian LU orcid (2025) In Alzheimer's & dementia : the journal of the Alzheimer's Association
Abstract
Background
Primary care is key to early identification and referral of patients with Alzheimer’s disease (AD). Assessing eligibility for new anti-amyloid treatment may guide appropriate referrals and prevent overburdening specialized care. In this study we determined eligibility for anti-amyloid treatment in patients undergoing cognitive evaluation in primary care.

Method
Patients were selected from the BioFINDER-Primary Care study (NCT06120361), which consecutively enrolls patients undergoing cognitive evaluation at 25 primary care units in Sweden. Between January 2020 and April 2025, patients were comprehensively assessed for co-morbidities, treatments, clinical symptoms, and cognitive status. Eligibility for... (More)
Background
Primary care is key to early identification and referral of patients with Alzheimer’s disease (AD). Assessing eligibility for new anti-amyloid treatment may guide appropriate referrals and prevent overburdening specialized care. In this study we determined eligibility for anti-amyloid treatment in patients undergoing cognitive evaluation in primary care.

Method
Patients were selected from the BioFINDER-Primary Care study (NCT06120361), which consecutively enrolls patients undergoing cognitive evaluation at 25 primary care units in Sweden. Between January 2020 and April 2025, patients were comprehensively assessed for co-morbidities, treatments, clinical symptoms, and cognitive status. Eligibility for anti-amyloid treatment was evaluated based on Cummings et.al (2023). MRI was assessed by a senior neuroradiologist. Amyloid status was determined using cerebrospinal fluid (CSF) Aβ42/40 ratio or amyloid PET. All patients received a full clinical work-up at a specialized memory clinic.

Result
A total of 636 participants were examined. The prevalence of treatment contraindications is presented in Table 1. 35 individuals had contraindications for MRI and were excluded. From the remainder, 386 (60.7%) participants had treatment-appropriate cognitive status (mild cognitive impairment or mild dementia) and among these, 226 (35.5%) were amyloid positive. Of these, 37 were considered to have a non-AD etiology for their symptoms, leaving 189 for further evaluation. After excluding patients with significant comorbidities (active anticoagulant treatment, immunological disease, cancer, stroke/TIA within 12 months, or epilepsy) 124 (19.5%) remained. Excluding those with MRI abnormalities reduced the sample to 74 (11.6%). Additional exclusion criteria (BMI and age restriction) reduced the eligible participant group to 71 (11.2%). Finally, applying the EMA, but not FDA, restriction excluding APOE ε4 homozygotes (11 remaining individuals) resulted in an eligible population of 60 individuals (9.4%) (Figure 1).

Conclusion
About 9-11% of patients undergoing cognitive evaluation in primary care are potentially eligible for anti-amyloid treatment under current clinical guidelines. Major exclusion factors included neuroimaging findings, anticoagulant use, and comorbidities. These findings may guide expectations around treatment uptake and support real-world health-economic analyses based on patient eligibility. At AAIC, we will present a proposed workflow to streamline identification of treatment candidates from primary to specialist care.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and
contributor
LU orcid
organization
alternative title
Bedömning av lämplighet för anti-amyloidbehandling hos primärvårdspatienter med kognitiva symtom
publishing date
type
Contribution to journal
publication status
published
subject
in
Alzheimer's & dementia : the journal of the Alzheimer's Association
publisher
Wiley
ISSN
1552-5279
DOI
10.1002/alz70861_108336
language
English
LU publication?
yes
id
d245213a-32e8-4c7e-9814-d906441f7cd0
date added to LUP
2026-03-26 14:58:19
date last changed
2026-03-26 15:46:21
@misc{d245213a-32e8-4c7e-9814-d906441f7cd0,
  abstract     = {{Background<br/>Primary care is key to early identification and referral of patients with Alzheimer’s disease (AD). Assessing eligibility for new anti-amyloid treatment may guide appropriate referrals and prevent overburdening specialized care. In this study we determined eligibility for anti-amyloid treatment in patients undergoing cognitive evaluation in primary care.<br/><br/>Method<br/>Patients were selected from the BioFINDER-Primary Care study (NCT06120361), which consecutively enrolls patients undergoing cognitive evaluation at 25 primary care units in Sweden. Between January 2020 and April 2025, patients were comprehensively assessed for co-morbidities, treatments, clinical symptoms, and cognitive status. Eligibility for anti-amyloid treatment was evaluated based on Cummings et.al (2023). MRI was assessed by a senior neuroradiologist. Amyloid status was determined using cerebrospinal fluid (CSF) Aβ42/40 ratio or amyloid PET. All patients received a full clinical work-up at a specialized memory clinic.<br/><br/>Result<br/>A total of 636 participants were examined. The prevalence of treatment contraindications is presented in Table 1. 35 individuals had contraindications for MRI and were excluded. From the remainder, 386 (60.7%) participants had treatment-appropriate cognitive status (mild cognitive impairment or mild dementia) and among these, 226 (35.5%) were amyloid positive. Of these, 37 were considered to have a non-AD etiology for their symptoms, leaving 189 for further evaluation. After excluding patients with significant comorbidities (active anticoagulant treatment, immunological disease, cancer, stroke/TIA within 12 months, or epilepsy) 124 (19.5%) remained. Excluding those with MRI abnormalities reduced the sample to 74 (11.6%). Additional exclusion criteria (BMI and age restriction) reduced the eligible participant group to 71 (11.2%). Finally, applying the EMA, but not FDA, restriction excluding APOE ε4 homozygotes (11 remaining individuals) resulted in an eligible population of 60 individuals (9.4%) (Figure 1).<br/><br/>Conclusion<br/>About 9-11% of patients undergoing cognitive evaluation in primary care are potentially eligible for anti-amyloid treatment under current clinical guidelines. Major exclusion factors included neuroimaging findings, anticoagulant use, and comorbidities. These findings may guide expectations around treatment uptake and support real-world health-economic analyses based on patient eligibility. At AAIC, we will present a proposed workflow to streamline identification of treatment candidates from primary to specialist care.<br/><br/>}},
  author       = {{Barbosa Djärf, Josef and Borgström Bolmsjö, Beata and van Westen, Danielle and Tideman, Pontus and Smith, Ruben and Schindler, Suzanne E. and Mattsson-Carlgren, Niklas and Stomrud, Erik and Hansson, Oskar and Palmqvist, Sebastian}},
  issn         = {{1552-5279}},
  language     = {{eng}},
  month        = {{12}},
  note         = {{Conference Abstract}},
  publisher    = {{Wiley}},
  series       = {{Alzheimer's & dementia : the journal of the Alzheimer's Association}},
  title        = {{Assessing Eligibility for Anti‐Amyloid Treatment Among Primary Care Patients with Cognitive Symptoms}},
  url          = {{http://dx.doi.org/10.1002/alz70861_108336}},
  doi          = {{10.1002/alz70861_108336}},
  year         = {{2025}},
}