全球智库信息集成服务系统

• Potential disease-modifying therapies could prevent or delay early-stage AD from progressing to dementia but raise challenges for health care systems in diagnosing and treating a large population.
• The authors use a simulation model to assess the preparedness of the Canadian health care system infrastructure to diagnose and treat people with MCI due to AD if a future therapy becomes available.
• If a therapy becomes available in 2021, the authors estimate that average annual wait times for diagnosis and treatment in Canada could peak at 28 months and persist for decades if there are not policies and practices to alleviate the burden on dementia specialists and increase capacity for biomarker testing and treatment delivery. Depending on policies, the authors estimate that 166,000 to 485,000 Canadians could progress from MCI due to AD to Alzheimer's dementia while on wait lists.
• The most pressing constraint is the capacity of dementia specialists to evaluate and diagnose early-stage patients. The use of both neuroimaging and cerebrospinal fluid biomarkers for diagnostic testing could decrease wait times.
• Canada faces the challenge of large geographic areas with sparse populations and limited access to specialty care, as well as potentially long lead times to add neuroimaging equipment to public facilities.
• Expanding capacity would require coordinated efforts among multiple stakeholders to increase awareness and investment, and to implement policies that ensure adequate capacity to deliver a future Alzheimer's therapy.

Alzheimer's disease (AD) is a chronic neurodegenerative disorder that leads to cognitive and functional decline, dementia, and premature death. Similar to other aging societies, Canada faces an increasing burden of this disease on patients and their caregivers, as well as on health care and long-term care resources.

The majority of disease-modifying therapies being studied in current trials target early stages of the disease — when there are symptoms of memory loss and cognitive but not functional decline, also described as mild cognitive impairment (MCI) — or even earlier, before symptoms manifest. The aim of these therapies is to delay or prevent progression of early-stage AD to Alzheimer's dementia.

The possibility of a future AD–modifying therapy for early stages of the disease has significant implications for health care delivery systems in terms of diagnosing and treating a large population. Following the authors' earlier work in the United States and Europe, they draw on publicly available data and expert insights to refine a simulation model that quantifies the capacity of the Canadian health care system to diagnose and treat people with early-stage AD.

The report presents the authors' conceptual framework, simulation model, and projections. They discuss the design of the model and show historical and projected capacity trends that affect diagnosis and treatment and show the impact of capacity constraints on wait lists, waiting times, and the number of people progressing from MCI due to AD to Alzheimer's dementia.