Primary driver of ineligibility was bedside cognitive threshold, accounting for 50 to 67 percent of exclusions
FRIDAY, Aug. 14, 2026 (HealthDay News) — Many people with atypical Alzheimer disease (AD) do not meet eligibility criteria for anti-amyloid therapies (AAT), according to a study published online Aug. 5 in Neurology.
Dror Shir, M.D., from the Mayo Clinic in Jacksonville, Florida, and colleagues conducted a retrospective eligibility analysis of patients with atypical AD. Theoretical eligibility for AAT was assessed by applying inclusion and exclusion criteria from landmark clinical trials and appropriate use criteria for lecanemab and donanemab.
The cohort included 184 patients with biomarker-confirmed atypical AD: 53.3 percent with posterior cortical atrophy (PCA), 22.8 percent with logopenic variant primary progressive aphasia (lvPPA), 20.1 percent with dysexecutive AD (dAD), and 3.8 percent with corticobasal syndrome because of AD (CBS-AD). The researchers found a difference in functional impairment by phenotype, with lvPPA more often diagnosed at the mild cognitive impairment/very mild stage and PCA and dAD more often presenting with mild dementia; no difference was seen in the time from symptom onset to diagnosis. Differences were seen in the Mini-Mental State Examination scores, with lower scores in PCA and lvPPA than in CBS-AD (median, 21, 21, and 27, respectively). Overall, 70 to 85 percent of patients would not meet treatment criteria, depending on the eligibility framework applied. The primary drivers of ineligibility were bedside cognitive thresholds (50 to 67 percent of exclusions), despite most patients having early symptomatic disease. In addition, imaging-based exclusions and severity thresholds were common (22 to 27 percent and 19 to 23 percent, respectively). Across phenotypes, reasons for ineligibility were similar.
“Our findings suggest that treatment criteria may unintentionally exclude many of these patients, even when they are in the early stages of disease,” Shir said in a statement.
Several authors disclosed ties to the biopharmaceutical industry.
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