Identifying Factors that Influence Timely Initiation of Antiamyloid Therapies in Early AD: Michael Rosenbloom, MD, FAAN

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"The big picture from this research is that door-to-treatment time is significantly slowed for patients who do not have Medicare insurance. This often refers to a younger-onset population who may benefit from these treatments the most, and we need to be mindful of this and advocate for that patient population."

Antiamyloid therapies are FDA-approved, disease-modifying treatments for early-stage Alzheimer disease (AD), with evidence suggesting improved outcomes when initiated earlier in the disease course. However, findings from a new retrospective study suggested that real-world barriers may delay treatment access for patients. The study, presented at the 2026 American Academy of Neurology (AAN) Annual Meeting, held April 18–22 in Chicago, Illinois, evaluated factors associated with delays in antiamyloid therapies initiation among 154 patients with AD treated at an academic center.¹

Presented by lead author Michael Rosenbloom, MD, FAAN, the analysis showed that the median time from diagnosis to treatment initiation decreased for both approved antiamyloid therapies, lecanemab (Leqembi; Eisai) and donanemab (Kisulna; Eli Lilly) over the course of program implementation. Results also revealed longer delays among patients referred from external practices, those with dementia compared with mild cognitive impairment, and those without Medicare insurance. Additionally, APOE ε4 homozygotes experienced modest but statistically significant delays, whereas distance to the treatment center was not associated with the timing of therapy initiation.

At AAN 2026, Rosenbloom, an associate professor of neurology at University of Washington, sat down with NeurologyLive^® to discuss the implications of the findings from the presented study. He highlighted that patients without Medicare, often younger-onset individuals, may experience significant delays because of insurance-related administrative burdens. Rosenbloom also emphasized that increased clinical experience and optimized workflows can reduce time to treatment. Moreover, he noted that the use of blood-based biomarkers was associated with shorter diagnostic timelines compared with amyloid PET or CSF analysis.

Editor’s Note: Rosenbloom has disclosed that he has received personal compensation for serving as a consultant and on a Speakers Bureau for Esai.

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REFERENCES
1. Rosenbloom M, Singh D, Schnee A. Real-world Delays in Anti-amyloid Therapy Initiation Following Diagnosis of Early-stage Alzheimer’s Disease. Presented at: 2026 AAN Annual Meeting; April 18-22; Chicago, Illinois.