Meeting the demand: A pilot study to optimize service delivery for early Alzheimer’s disease using brief neuropsychological assessment
Bibliographic record
Abstract
Abstract Background The increasing population of older adults and growing number of disease‐modifying therapies for Alzheimer’s disease (AD) highlight the need for timely differential diagnosis of neurodegenerative disorders despite high referral volumes. This study aimed to develop and pilot a brief neuropsychological battery to evaluate cognitive functioning in adults with suspected AD and improve service delivery by reducing the time between referral and diagnosis. Methods Patients were referred to the “early AD pathway” by their neurologist or geriatrician after an initial evaluation in an outpatient multidisciplinary dementia clinic. Eligible patients scored 18‐25/30 on a brief cognitive screening measure (Montreal Cognitive Assessment [MoCA]), had an amnestic clinical presentation, and were thought to have mild cognitive impairment (MCI) or mild dementia. The “early AD pathway” involved chart review, a brief clinical interview, and an abbreviated clinical test battery based on the NACC Uniform Data Set (UDS) Version 3 neuropsychological battery. Patients were provided feedback shortly after the assessment, and referring providers followed up with patients to discuss additional neurodiagnostic workup and/or possible treatments. Nine patients referred for the “early AD pathway” pilot were compared to general memory/cognitive referrals seen by the neuropsychology clinic during fall 2023 (n = 95). Retrospective data collection included demographic characteristics and relevant clinical information, including the time between referral and evaluation, MoCA total score, and post‐evaluation diagnosis. Non‐parametric analyses were used to compare the “early AD pathway” patients to those undergoing traditional clinic procedures. Results Preliminary results indicated significantly reduced wait times compared to traditional neuropsychological referrals (Mdiff = 155.17 days, p<.001) and successful identification of individuals with MCI or mild dementia. Moreover, 8/9 participants had an amnestic cognitive profile, suggesting high sensitivity for identifying a likely neurodegenerative process (i.e., suspected AD) in this pathway. Importantly, this pilot sample was small and racially homogenous, indicating the need for broader recruitment going forward. Conclusions This pilot study demonstrated preliminary evidence for how to optimize neuropsychological service delivery to guide patients efficiently through an early AD identification process in a multidisciplinary clinic. This will be increasingly important as service demands and the number of pharmacological treatments increase over time.
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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 | 0.004 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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".