Overview of French memory centers’ care pathway for patients with early-stage Alzheimer’s disease
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77
The growing prevalence of Alzheimer’s disease (AD) is an increasing public health concern, which has led to recommendations for timely AD diagnosis and patient management, as well as a national network of specialized structures (i.e., memory centers including Resources and Research Memory Centers [RRMCs] and memory consultations [MCs]). In view of the potential availability of disease modifying therapies (DMTs), this study aimed to describe the current organization of memory centers, and the care pathway of patients suffering from early-stage AD. Overall, 12 of the 28 RRMCs and 44 of the 250 MCs requested by the Federation of Memory Centers participated in this study. RRMCs and MCs differed in terms of the specialisms of their staff (neurologists represented 100% and 41% of staff at these facilities, respectively; geriatricians 58% and 95%), and in terms of the median yearly number of patients with early-stage AD (192 and 99). The majority of patients were referred to RRMCs and MCs by a general practitioner (42% and 51%, respectively) or a private neurologist (19% and 6%). The time between referral and the first visit to the memory center was shorter in MCs compared to in RRMCs (<3 months: 51% versus 34%). Cerebrospinal fluid biomarkers were measured in the majority of patients in 75% of RRMCs and 14% of MCs. A care plan was proposed for the majority of patients, whichever memory center they attended (RRMCs: 91%, MCs: 84%), while others were offered psychological support (21% and 29%, respectively) and therapeutic education (14% and 9%). According to more than two-thirds of RRMCs, the potential availability of DMTs would have a major impact on referral waiting times, the number of patients with early-stage AD, and the frequency of patient follow-up appointments (including MRIs and clinical assessments). A similar impact was only perceived by around half of MCs. This study highlighted the key challenges raised by these new therapies.
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