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Peer-reviewedCC BYEuropean journal of neurology

Real-World Patient Eligibility for Alzheimer's Disease Anti-Amyloid Therapy in Seven Swedish Memory Clinics.

  • Anna Rosenberg1,2
  • Anna Rennie1
  • Urban Ekman1,3
  • Makrina Daniilidou1,4
  • Anette Hall1,5
  • Anna Matton1,4,6
  • Ari Solomon1,5,6
  • Lars-Olof Wahlund1
  • Miia Kivipelto1,2,6,7
  • Eric Westman1,6,7
7 affiliations
  1. 1Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
  2. 2Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
  3. 3Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden.
  4. 4FINGERS Brain Health Institute, Stockholm, Sweden.
  5. 5Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
  6. 6Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK.
  7. 7Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.
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Abstract

Background

Anti-amyloid therapies lecanemab and donanemab are the first potentially disease-modifying treatments for Alzheimer's disease (AD) approved in Europe. We estimated real-world eligibility for these treatments in a large multicenter memory clinic patient cohort in Sweden (MemClin).Methods

MemClin included patients with a first diagnostic visit between 2016 and 2022 at seven specialist memory clinics in Stockholm, Sweden. To estimate eligibility for anti-amyloid therapy, we applied key inclusion/exclusion criteria from the lecanemab and donanemab appropriate use recommendations. Eligible patients were required to have (1) a clinical diagnosis of AD-type dementia or mild cognitive impairment (MCI), (2) confirmed Aβ pathology (abnormal CSF Aβ42) and (3) no apparent medical exclusion criteria. Eligibility was calculated for different scenarios to provide both upper-bound estimates (main analysis) and more conservative, implementation-ready estimates of near-term treatable patients (sensitivity analysis).Results

Cohort consisted of 2126 patients (mean age 77.1 ± 6.6 years; 61.8% MCI, 24.2% dementia, 13.7% subjective cognitive impairment). In the main analysis, 11.5% of the whole cohort was estimated to be eligible for either treatment (lecanemab 10.6%, donanemab 11.5%). Most eligible patients had early-stage disease (61.9% MCI vs. 38.1% dementia) and an A + T- biomarker profile, that is, normal biomarker of tau (57.9%). Eligibility was markedly lower in sensitivity analyses (e.g., 2.7% when all patients without MRI were assumed ineligible).Conclusions

Even upper-bound estimates indicate that a minority of real-world memory clinic patients may currently qualify for anti-amyloid therapy. These findings provide timely evidence to inform the ongoing debate on the implementation of anti-amyloid therapy in public healthcare.

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Cite

BibTeXRIS
BibTeX
@article{rosenberg2026realworld,
  title = {{Real-World Patient Eligibility for Alzheimer's Disease Anti-Amyloid Therapy in Seven Swedish Memory Clinics.}},
  author = {Anna Rosenberg and Anna Rennie and Urban Ekman and Makrina Daniilidou and Anette Hall and Anna Matton and Ari Solomon and Lars-Olof Wahlund and Miia Kivipelto and Eric Westman},
  journal = {European journal of neurology},
  year = {2026},
  month = oct,
  doi = {10.1111/ene.70786},
  url = {https://europepmc.org/article/MED/42898005},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Real-World Patient Eligibility for Alzheimer's Disease Anti-Amyloid Therapy in Seven Swedish Memory Clinics.
AU  - Anna Rosenberg
AU  - Anna Rennie
AU  - Urban Ekman
AU  - Makrina Daniilidou
AU  - Anette Hall
AU  - Anna Matton
AU  - Ari Solomon
AU  - Lars-Olof Wahlund
AU  - Miia Kivipelto
AU  - Eric Westman
PY  - 2026
DA  - 2026/10/01
JO  - European journal of neurology
DO  - 10.1111/ene.70786
UR  - https://europepmc.org/article/MED/42898005
AB  - Background  Anti-amyloid therapies lecanemab and donanemab are the first potentially disease-modifying treatments for Alzheimer's disease (AD) approved in Europe. We estimated real-world eligibility for these treatments in a large multicenter memory clinic patient cohort in Sweden (MemClin).Methods  MemClin included patients with a first diagnostic visit between 2016 and 2022 at seven specialist memory clinics in Stockholm, Sweden. To estimate eligibility for anti-amyloid therapy, we applied key inclusion/exclusion criteria from the lecanemab and donanemab appropriate use recommendations. Eligible patients were required to have (1) a clinical diagnosis of AD-type dementia or mild cognitive impairment (MCI), (2) confirmed Aβ pathology (abnormal CSF Aβ42) and (3) no apparent medical exclusion criteria. Eligibility was calculated for different scenarios to provide both upper-bound estimates (main analysis) and more conservative, implementation-ready estimates of near-term treatable patients (sensitivity analysis).Results  Cohort consisted of 2126 patients (mean age 77.1 ± 6.6 years; 61.8% MCI, 24.2% dementia, 13.7% subjective cognitive impairment). In the main analysis, 11.5% of the whole cohort was estimated to be eligible for either treatment (lecanemab 10.6%, donanemab 11.5%). Most eligible patients had early-stage disease (61.9% MCI vs. 38.1% dementia) and an A + T- biomarker profile, that is, normal biomarker of tau (57.9%). Eligibility was markedly lower in sensitivity analyses (e.g., 2.7% when all patients without MRI were assumed ineligible).Conclusions  Even upper-bound estimates indicate that a minority of real-world memory clinic patients may currently qualify for anti-amyloid therapy. These findings provide timely evidence to inform the ongoing debate on the implementation of anti-amyloid therapy in public healthcare.
SN  - 1351-5101
SN  - 1468-1331
ER  -