EMBARGOED FOR RELEASE UNTIL 4 PM ET, August 05, 2026
Most people with atypical Alzheimer’s may be ineligible for new therapies
Up to 85% would not meet treatment criteria, researchers find
Highlights:
- A new study found that up to
85% of people with atypical Alzheimer’s, variants of the disease that affect
thinking, language or vision rather than memory first, may not qualify for newer treatments.
- The study looked at whether people
with posterior cortical atrophy, logopenic variant primary progressive aphasia,
dysexecutive Alzheimer’s disease and corticobasal syndrome would qualify.
- Many of these people were still in early stages of their disease.
- The study found that current criteria for anti-amyloid therapies may not fit atypical forms of Alzheimer’s disease.
- Researchers say treatment
criteria for anti-amyloid therapies should better reflect different Alzheimer’s
symptoms.
MINNEAPOLIS — Many people with less common forms of Alzheimer's disease may not qualify for newer anti-amyloid treatments designed to slow the disease, according to a study published August 5, 2026, in Neurology®, the medical journal of the American Academy of Neurology.
Researchers found that the majority of people with atypical
Alzheimer’s disease, or forms that affect thinking, language or vision rather
than memory first, would not meet eligibility criteria for treatment for
Alzheimer’s disease called anti-amyloid therapies. These therapies are given
early in the disease, often at the first sign of memory problems.
“Atypical Alzheimer’s disease is often underrecognized and
underrepresented in clinical trials,” said study author Dror Shir, MD, of the Mayo
Clinic in Jacksonville, Florida and a member of the American Academy of
Neurology. “Our findings suggest that treatment criteria may unintentionally
exclude many of these patients, even when they are in the early stages of
disease.”
For the study, researchers looked at 184 people with
atypical Alzheimer’s disease confirmed by medical tests. Their first symptoms
were not mainly memory problems.
Participants had one of the following types of atypical
Alzheimer’s disease: posterior cortical atrophy, which affects vision and spacial
awareness; logopenic variant primary progressive aphasia, which affects communication
and language; dysexecutive Alzheimer’s disease, which affects planning and
problem-solving; or corticobasal syndrome, which affects movement and thinking.
Researchers evaluated whether participants would qualify for
the anti-amyloid therapies lecanemab and donanemab based on criteria used in
major clinical trials and recommendations created for these drugs.
Researchers found that between 70% and 85% of participants
with atypical Alzheimer’s disease would not meet eligibility requirements.
The most common reason for exclusion was poor performance on
cognitive screening tests, accounting for 50–67% of exclusions. Shir noted that
people with atypical Alzheimer’s disease may have lower scores on tests of
visual-spatial abilities or executive functioning even though they are still
functioning relatively well with daily activities.
Even though most people in the study were still in the early
stages of the disease and could do many daily activities, many did not qualify
for the treatments because they scored poorly on thinking tests.
The study found most patients did not meet eligibility
criteria due to poor scores on the Mini-Mental State Examination, a 11-question
screening test. Other reasons for exclusion included brain imaging findings,
excluding 22% to 27% of participants, and disease severity, with 19% to 23%
having moderate or severe dementia.
“These results suggest a mismatch between how we measure
disease severity and how atypical Alzheimer’s disease presents,” Shir said. “Current
tools might overestimate the functional stage of the disease.”
A limitation of the study
was that it was retrospective and based on existing clinical data, meaning
researchers estimated eligibility rather than evaluating patients directly.
The study was supported by
the National Institutes of Health and the Alzheimer’s Association.
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