[Overview of the French Memory Centres healthcare pathway for patients with early Alzheimer disease].

Abstract

The growing prevalence of the Alzheimer's disease (AD) is an increasing public health concern that led to French recommendations for timely AD diagnosis and patient management as well as a territorial coverage of specialized structures [Memory Centers including Resources and Memory Research Centers (RMRC) and Memory Consultations (MC)]. In view of the potential availability of Disease Modifying Therapies (DMTs), this French observatory aimed to describe the current organization of the Memory Centers, and the care pathway of patients suffering from early AD. Overall, 12 of the 28 RMRC and 44 of the 250 MC solicited by the Federation of Memory Centers participated in this study. RMRC and MC differed in the practicing specialists (neurologists in 100 % and 41 % of the structures, respectively; geriatricians in 58 % and 95 %), and in the median yearly number of patients with early AD (192 and 99). The majority of patients were referred to RMRC and MC 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 MC compared to RMRC (<3 months: 51 % versus 34 %). Cerebrospinal fluid biomarkers were assessed in the majority of patients in 75 % of RMRC and 14 % of MC. A care plan was proposed for the majority of patients whatever the Memory Center was (RMRC: 91 %, MC: 84 %) unlike psychological support (21 % and 29 %, respectively) and therapeutic education (14 % and 9 %). According to more than 2/3 of the RMRC the referral delays, the number of patients with early AD, and the monitoring schedule (including MRIs and clinical assessments) will be very impacted by the potential availability of DMTs. A similar impact was only perceived by around half of the MC. This study highlighted the key challenges raised by these new therapies.