New Innovations in Alzheimer's Drive Earlier Screening - Yet Inequities Persist

Earlier this year, Medscape Education and Komodo explored how new Alzheimer’s disease (AD) treatments are driving unprecedented changes in screening and clinician education. Following approval of disease-modifying therapies, cognitive screening rose by 10%, biomarker testing by 23%, and amyloid pathology testing surged more than 13-fold.

But our latest analysis uncovers a troubling reality: These medical breakthroughs aren’t reaching all patients equally.

Part two of our series reveals concerning disparities in which patients receive breakthrough treatments. Dive into the full report below: 

Key Findings

• Approval of a new drug therapy, coupled with independent medical education (IME), resulted in increased cognitive screening (by 10%), gene and protein biomarker testing (by 23%), and amyloid beta pathology testing (13-fold+). 
  
  
• Gender and racial disparities persist: Men and women were screened at similar rates despite women making up 64% of Alzheimer’s disease diagnoses. Black patients were screened at a similar rate as White patients despite having a higher diagnosis rate.
  
  
• Treatment access varies dramatically by demographic: The highest treatment rates with the second approved disease-modifying therapy (DMT) were among male patients, patients aged 55 to 64, and those with commercial insurance. Black patients made up 10% of Alzheimer’s patients, but accounted for only 3% of those treated with the second approved DMT. 
  
  
• A variety of healthcare professionals (HCPs) have a role in treatment selection: Nurse practitioners and physician assistants accounted for 40% of providers prescribing the second approved DMT, and neurologists and psychiatry specialists accounted for 42%.
  
  
• Healthcare professionals (HCPs) increased their engagement in IME, which in turn increased confidence in practice patterns: Post-approval, HCPs involved in Alzheimer’s care consumed 18% more IME content, and mean confidence increased by 19%.

Executive Summary

In the U.S. today, 7.2 million people are affected by Alzheimer’s disease (AD), and this number is expected to rise to nearly 13 million by 2050. [AA 2025] By 2050, 152 million people globally will be living with AD and other dementias. [GBD 2022]

AD, which progressively impairs cognition and behavior, is the leading cause of dementia globally. While recent advances such as biomarker testing and new therapies offer hope for earlier detection and better management, a significant unmet need remains, and AD continues to be widely underdiagnosed, resulting in delayed access to optimal treatments and care. [Iaccarino 2023, AA 2025]

In 2023, the FDA approved lecanemab, a second disease-modifying therapy (DMT) but the first to show a reduced rate of disease progression in early Alzheimer’s — defined as mild cognitive impairment or mild dementia, regardless of age of onset. This marked a turning point and was followed by donanemab, which received full FDA approval in July 2024. Together, these therapies represent a new clinical pathway for slowing disease progression.

Over the years, education providers like Medscape have significantly improved clinical practice by enhancing clinician knowledge and skills, driving evidence-based care, from screening and diagnosis to the adoption of both emerging and approved pharmacotherapies. By addressing gaps in awareness and preparedness, we can help ensure timely identification and treatment to ultimately improve outcomes for those affected by AD.

Objective

To understand how care is evolving in response to innovations in Alzheimer’s treatment, we analyzed changes in patient journeys and HCP education engagement, knowledge, and confidence across the launch and first 18 months post-launch of lecanemab, the second DMT approval.

Methodology

We compared screening test utilization in the 18 months prior to approval (July 6, 2021 to January 5, 2023) and after (January 6, 2023 to July 1, 2024) with a focus on patients aged 65 and older. We examined the utilization of CPT PLA codes (0346U, 0358U, 0412U) associated with laboratory-developed tests for AD biomarkers, as well as neuropsychological testing (CPT codes 96132, 96133, 96136, 96137, 96138, and 96139) and other gene/protein analysis tests.

This analysis was powered by Komodo’s Healthcare Map®, which tracks the healthcare journeys of over 330 million de-identified patients in the U.S., Marmot™, our healthcare-native AI analytics engine, and our MapLab® platform. Medscape Education’s PULSE was used to track member engagement on Medscape.com. Engagement and response to questions were examined from January 2022 through July 2024.

We analyzed data from 3,673 unique patients who received treatment with lecanemab in the 18 months following its approval. We compared this cohort to the broader population of patients aged 65 and older with an AD diagnosis (identified using relevant ICD-10-CM codes from January 1, 2016, to July 1, 2024, which represents the eligible treatment time frame).

Results

Breakthrough therapies drive early detection gains

 Advancements in therapies and targeted medical education are driving significant increases in early detection.

Among this cohort, cognitive screening rose by 10%, gene and protein biomarker testing increased by 23%, and amyloid beta pathology testing surged more than 13-fold.

Demographic differences in screening rates

• Men and women were screened at similar rates, despite women making up 64% of AD diagnoses
  • Both before and after the approval of the second DMT, from July 2021 to July 2024, men and women aged 65 and older were screened at similar rates: 7,688 per 100,000 for women and 7,794 per 100,000 for men. These rates reflect broader underscreening patterns: The CDC reports that only 47% of primary care providers routinely assess cognitive function in patients 65 and older. However, diagnosis rates were substantially higher in females, with 2,620 diagnoses per 100,000 compared to 1,687 per 100,000 in males.

• Black patients were screened at a similar rate as White patients, despite having a significantly  higher risk of AD 
  • Looking at screening by race and ethnicity, rates were generally comparable across most groups. 
    
    
  • Black patients (10,754 per 100,000) were slightly more likely than White patients (10,473 per 100,000) to receive screening, followed by Hispanic or Latino patients (9,573 per 100,000), Asian or Pacific Islander patients (9,229 per 100,000), and those categorized as “Other” — the value assigned when the patient chose “Other” during self-attestation or identified as American Indian or Alaska Native, (9,210 per 100,000).
    
    
  • The screening rate for individuals categorized as “Other” was 14% lower than that for Black patients. 

Treatment Disparities Persist Despite Progress in Screening

• Men had a 47% higher treatment rate with the second approved DMT than women (122 vs. 83 per 100,000)
  
  • More than 3,600 patients received treatment with the second approved DMT in the 18 months after it became available. The highest treatment rates were seen among patients aged 55 to 64 and those with commercial insurance.
    
    
  • Despite comprising only 3.7% of the AD population, commercially insured individuals accounted for  11% of all patients treated, indicating a disproportionate uptake relative to coverage type. Commercially insured patients had a treatment rate of more than three times that of Medicare patients (288 vs. 91 per 100,000) and 17 times that of Medicaid patients (17 per 100,000).
    
    
  • Treatment rates for the second approved DMT varied significantly by age, from highest among ages 55 to 64 (268 per 100,000) and 65 to 75 (257 per 100,000), despite these populations representing only 2.9% and 14% of the total AD population, respectively. In contrast, the 75+ age group, which accounts for 82% of all diagnoses, had a much lower treatment rate of 62 per 100,000. Younger groups (under 55) had little to no treatment activity.    
    
    
• Black patients, who made up 10% of Alzheimer’s patients, accounted for only 3% of those treated with the second approved DMT 
  
  • The treatment rate among Black patients (27 per 100,000) was more than four times (77%) lower than that of White patients (116 per 100,000)
    

HCPs and settings of care

• Psychiatry and neurology specialists accounted for 42% of HCPs prescribing the second approved DMT, closely followed by nurse practitioners and physician assistants at 40% 
  
  • 75% of HCP referrals for AD screening were in neurology, and 75% were at ambulatory healthcare facilities 
    
    
  • Approximately 50% of screened patients were evaluated by a diagnostic radiology HCP
    
    
  • The vast majority of patients receiving the second approved DMT were treated at ambulatory healthcare facilities (73.16%) and hospitals (22.30%) 
    
    
  • Neurology (43%) and family medicine (33%) specialties accounted for the largest percentage of patients treated

HCP IME engagement, knowledge, and confidence trends on Medscape Education

Medscape matched 80% of HCPs who screen, diagnose, and treat AD with its registered membership. They are responsible for caring for 91% of the patients in the Komodo cohort. Post-approval, 57% of HCPs involved in the AD patient journey were screened for cognitive decline, 49% were referred for assessment, and 73% were involved in AD care; <1% prescribed treatment. 

Medscape Member HCPs who Screen, Diagnose, and Treat Patients With Alzheimer's Disease (Confirmed Through Komodo Claims by ZIP Code)

• Post-approval, engagement in AD-specific IME increased by 18% among HCPs involved in the patient journey (primary care, emergency medicine, radiology, neurology, and advanced practice professionals like nurse practitioners and physician assistants)
  • HCPs involved in the AD journey showed an 18% increase in IME consumption post-approval, compared to a 6% increase among those not involved in Alzheimer’s care.
    
    
  • Additionally, HCPs who were not confident in AD-related treatment and management consumed 11% more AD IME page views (PVs), and neurologists consumed 31% more than other types of HCPs.

• Post-approval, knowledge improvements increased significantly after IME engagement on several topics related to the AD patient journey  
  • Following learning in IME, knowledge scores improved by an additional 24% relative to the  post-approval baseline (from 50% to 63%)
    
    
  • Neurologists had greater levels of knowledge in diagnosis and treatment, and both neurologists  and non-neurologists benefited from IME learning

• Confidence in diagnosing AD is associated with diagnosing AD in the real world. Post-approval, confidence in several areas related to AD practice patterns increased after IME learning

• • HCP confidence in screening rose from 2.58 to 3.07 (on a 5-point scale) after IME participation in  the 18-month post-approval period — a 19% increase
    
    
  • Specialist vs. non-specialist performance: Neurologists were 11% more knowledgeable and 10% more confident in diagnosing and treating than other HCPs (primary care physicians, geriatricians, nurse practitioners, and physician assistants), though both groups were equivalent in post-IME knowledge

Discussion

Results indicate that education initiatives and new treatment approvals have enhanced HCPs’ preparedness to implement practices that support earlier diagnosis and treatment of Alzheimer’s disease.

These findings highlight key opportunities for stakeholders across the AD care continuum. Primary care physicians, nurse practitioners, emergency medicine, physician assistants, and neurologists are the top 10 HCP areas involved in one or more aspects of the AD patient journey. This signifies the importance of these audiences having the knowledge, skills, confidence, and systems to identify cognitive impairment and dementia early and deliver proper diagnoses — and, ultimately, treatment. Education, quality improvement, and outreach to those at risk and their loved ones with up-to-date, evidence-based information can improve all of those malleable factors in patient outcomes.

Dr. Soo Borson, Deputy Editor, Journal of the American Geriatrics Society and Co-Lead, BOLD Center of Excellence on Early Detection of Dementia, shared her thoughts:

“It’s often thought that continuing medical education programs don’t change clinical practice. This study provides evidence that, when properly timed, continuing medical education can have substantial effects on physician engagement and action on the detection and diagnosis of AD.

“The arrival of medical treatments that directly target a core brain pathology is a crucial milestone in clinical care for people with AD. Though not appropriate for use beyond early-stage AD or in non-AD dementias, currently approved disease-modifying therapies provide powerful impetus for improving dementia detection and diagnosis. They are changing the culture of care.” 

This analysis is part two of a two-part series, a report delving into disparities in Alzheimer's treatment and screening. 

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