Improving Access to Dementia Care in the Era of Monoclonal Antibody Treatments for Alzheimer’s Disease: a Pilot Clinical Protocol Using Abbreviated Neuropsychological Assessment
Bibliographic record
Abstract
OBJECTIVE: To meet the growing demand for timely diagnosis in the new era of disease-modifying medications for Alzheimer's disease (AD), the present study aimed to reduce clinic wait times by developing and refining an abbreviated neuropsychological battery to assess individuals with a suspected amnestic process (i.e., Early-Stage AD Pathway). METHOD: Early-Stage AD Pathway patients were referred by an internal neurology provider who determined that the patient had: (1) an amnestic clinical presentation, (2) a normal neurological examination, and (3) a Montreal Cognitive Assessment total score between 18 and 25. These patients were scheduled for a 2-h neuropsychological evaluation, including a brief clinical interview and an abbreviated testing battery. We evaluated n = 19 patients in the Early-Stage AD Pathway and compared them to 114 older adults referred via traditional clinic procedures (i.e., General Clinic). RESULTS: Most individuals evaluated via the Early-Stage AD Pathway were diagnosed with mild cognitive impairment (MCI; 68.4%) or mild dementia (21.1%) through the neuropsychological evaluation. Rate of diagnosis of MCI/dementia was comparable between groups. The average number of days between initial referral and completion of the neuropsychological evaluation was significantly lower (Mdiff = 145.8 days, U = 1867.500, p < 0.001) for the Early-Stage AD Pathway group than for the General Clinic group, as the former could be scheduled more flexibly. CONCLUSIONS: Implementing an abbreviated neuropsychological assessment process significantly reduced the time between referral and evaluation to identify individuals who may be eligible for emerging pharmacological treatments for AD and/or non-pharmacological interventions in a timely manner.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.010 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.005 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.012 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".