{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T06:58:42Z","timestamp":1791269922130,"version":"4.1.0"},"reference-count":33,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,9,5]],"date-time":"2022-09-05T00:00:00Z","timestamp":1662336000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["alz-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Alzheimer's &amp;amp; Dementia"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>While the majority of patients with Alzheimer's disease resides in low and middle\u2010income countries, little is known of their preparedness for emerging disease\u2010modifying treatments. We analyze the preparedness of Brazil, one of the most populous middle\u2010income countries, from a capacity and institutional preparedness perspective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Desk research and 12 interviews for background and capacity data. Markov model to estimate wait times for access to treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Brazil has no national dementia strategy or established pathway for evaluation of cognitive concerns, and dementia is typically diagnosed late if at all. While members of private health plans have ready access to elective specialty care, wait times in the public sector are long. Assuming potentially treatment\u2010eligible patients are referred from primary to specialty care based on a brief cognitive exam and a blood test for the Alzheimer's pathology, available capacity will not be sufficient to match the projected demand. The biggest obstacle is availability of dementia specialist visits, and the effect of population growth and ageing means that the wait list for specialist appointment will continue to grow from around 400,000 in 2022 to over 2.2 million in 2040. We do not project substantial wait times for confirmatory biomarker testing and treatment delivery but note that this is a consequence of patients waiting for their specialist appointments. These queues will result in estimated persistent wait times for treatment of around two years on average with substantial differences between the public and private sectors, as capacity growth is insufficient to keep up with increasing demand.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Our findings suggest that Brazil is ill\u2010prepared to provide timely access to an Alzheimer's treatment with predicted wait times of about two years, largely because of a limited number of dementia specialists.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alz.12778","type":"journal-article","created":{"date-parts":[[2022,9,5]],"date-time":"2022-09-05T14:36:10Z","timestamp":1662388570000},"page":"375-381","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Preparedness of the Brazilian health\u2010care system to provide access to a disease\u2010modifying Alzheimer's disease treatment"],"prefix":"10.1002","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4666-9132","authenticated-orcid":false,"given":"Soeren","family":"Mattke","sequence":"first","affiliation":[{"name":"University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Otelo","family":"Corr\u00eaa dos Santos Filho","sequence":"additional","affiliation":[{"name":"GRIS \u2013 INLAGS Instituto Latino Americano de Gest\u00e3o em Sa\u00fade  Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Hanson","sequence":"additional","affiliation":[{"name":"University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine Fernandes","family":"Mateus","sequence":"additional","affiliation":[{"name":"Febraz \u2010 Brazilian Federation of Alzheimer's Associations Brazil and Londrina State University  Londrina Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o Paulo Reis","family":"Neto","sequence":"additional","affiliation":[{"name":"CAPESESP \u2013 Caixa de Previd\u00eancia e Assist\u00eancia dos Servidores da Funda\u00e7\u00e3o Nacional de Sa\u00fade  Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo Cruz","family":"de Souza","sequence":"additional","affiliation":[{"name":"School of Medicine Universidade Federal de Minas Gerais  Minas Gerais Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigo","family":"Rizek Schultz","sequence":"additional","affiliation":[{"name":"Discipline of Clinical Medicine Santo Amaro University \u2013 Unisa  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roney","family":"Pereira Pinto","sequence":"additional","affiliation":[{"name":"Programa Ci\u00eancias da Sa\u00fade da Faculdade de Medicina Federal University of Goias  Goi\u00e2nia Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,9,5]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1912954116"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.12688\/f1000research.14506.1"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.14283\/jpad.2022.30"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13195\u2010021\u201000813\u20108"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa2100708"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.12470"},{"key":"e_1_2_7_8_1","unstructured":"MattkeHJ YoongJ WangM GotoR.https:\/\/cesr.usc.edu\/sites\/default\/files\/CESR%202019\u2010101.pdf"},{"issue":"3","key":"e_1_2_7_9_1","first-page":"2","article-title":"Assessing the preparedness of the health care system infrastructure in six european countries for an Alzheimer's Treatment","volume":"8","author":"Hlavka JP","year":"2019","journal-title":"Rand Health Q"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.7249\/RR2744"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2012.11.006"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/dad2.12081"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2019.1632"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.2000"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh\u20102018\u2010000829"},{"key":"e_1_2_7_16_1","doi-asserted-by":"crossref","unstructured":"CastroMC MassudaA AlmeidaG et\u00a0al.Brazil's unified health system: the first 30 years and prospects for the future.2019:345\u2010356. doi:10.1016\/s0140\u20106736(19)31243\u20107","DOI":"10.1016\/S0140-6736(19)31243-7"},{"key":"e_1_2_7_17_1","unstructured":"Adriano MassudaMVA AtunRifat CastroMarciaC International health care system profiles \u2010 Brazil. 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