The path from initial cognitive concern to confirmed diagnosis and treatment initiation involves multiple steps where there are opportunities for improved care. From symptom recognition to primary care evaluation through specialty referral, there are multiple areas for enhanced coordination to ensure timely access to care.1 Recent clinical practice guideline updates reinforce frameworks to address these challenges.2
The referral gap represents a large source of patient loss. Substantial numbers of individuals screened for cognitive impairment in primary care never complete specialist evaluation.2 Factors contributing to this attrition include patient reluctance to pursue diagnosis, logistical barriers such as transportation and appointment availability, primary care uncertainty about when referral is appropriate, patient-reported lack of awareness of diagnosis, and extensive wait times for a specialist visit.1,2 Neurologists can address this through proactive primary care partnerships that establish clear referral thresholds and provide consultation support for borderline cases.2 The development of digital screening platforms has the possibility to expand testing to under-resourced populations and mitigate health disaprities.3,4 Offering care coordination services, patient and caregiver education, and expedited appointment pathways for patients with positive cognitive screening and biomarker evidence of pathology reduces the window during which patients may reconsider or deprioritize follow-through.1
Once patients reach specialty care, the interval between initial consultation and definitive diagnosis creates a second attrition opportunity.2 Traditional diagnostic pathways requiring amyloid PET imaging or lumbar puncture introduce delays and potential patient dropout.4 Blood-based biomarkers streamline this process, enabling same-visit or rapid turnaround confirmation of amyloid pathology.5 This acceleration maintains patient engagement and allows treatment discussions to occur while motivation remains high. Additionally, by minimizing visit frequency upfront, providers can help overcome transportation-related barriers to care.
Post-diagnosis treatment initiation represents a third critical juncture in the care continuum. Patients and families may express hesitancy about commencing amyloid-targeting therapy due to infusion requirements, monitoring protocols, or risk considerations.6 Transparent discussion of benefits, including data demonstrating slowed cognitive decline and prolonged functional independence, helps frame treatment decisions appropriately.6 Providing realistic expectations about treatment burden while emphasizing the time-limited nature of optimal intervention windows encourages timely decision-making. Systematically addressing attrition at each stage, clinicians maximize the proportion of eligible patients who benefit from disease-modifying approaches.
Take our Alzheimer’s disease quiz to see how your knowledge compares to your peers.
