Preparedness and quality of dementia care in an Italian health authority when introducing anti-Aβ therapies.

INTRODUCTION

We aimed to assess dementia care organizations within a southern Italian local health authority (Azienda Sanitaria Locale di Barletta Andria Trani) and to propose an equitable implementation framework for anti-amyloid therapies.

METHODS

We performed a retrospective analysis of dementia-related outpatient activity in 2024 patients across 18 district clinics (primary care clinics) and three specialized centers for cognitive disorders and dementia (specialized memory centers), integrating booking, clinical, imaging, and prescribing data.

RESULTS

Among 1158 initial evaluations, specialized memory centers showed substantially higher quality indicators than district clinics: Mini-Mental State Examination documentation (80.0% vs. 6.6%, p < 0.001), full clinical documentation (95.5% vs. 10.0%), higher use of magnetic resonance imaging and amyloid positron emission tomography, and 5-fold higher rate of prescribing acetylcholinesterase inhibitors. Validated radiological scoring and biomarker facilities (cerebrospinal fluid, apolipoprotein E genotyping) were largely unavailable.

DISCUSSION: Major organizational gaps limit readiness for disease-modifying Alzheimer's disease therapies. A four-tier hub-and-spoke model may improve equity, efficiency, and safe implementation.