{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T13:22:24Z","timestamp":1784035344342,"version":"3.55.0"},"reference-count":47,"publisher":"Cambridge University Press (CUP)","issue":"4","license":[{"start":{"date-parts":[[2023,8,18]],"date-time":"2023-08-18T00:00:00Z","timestamp":1692316800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Can. J. Neurol. Sci."],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>ABSTRACT:<\/jats:title><jats:sec id=\"S0317167123002706_as1\"><jats:title>Background:<\/jats:title><jats:p>Alzheimer\u2019s disease (AD) is experienced by &gt; 600,000 Canadians. Disease-modifying therapies (DMTs) for earlier stages of disease are in development. Existing health system capacity constraints and the need for biomarker-driven diagnostics to confirm DMT eligibility are concerning. This study aimed to characterize the capacity gap related to early AD (eAD) treatment with DMTs in Canada.<\/jats:p><\/jats:sec><jats:sec id=\"S0317167123002706_as2\"><jats:title>Methods:<\/jats:title><jats:p>A capacity model was developed to simulate the flow of a patient from screening to treatment for eAD to quantify the gap between available and required healthcare resources and qualify the bottlenecks restricting the patient journey at a provincial and national level. The model inputs (epidemiological, human resource, and clinical) were evidence-based, healthcare professional-, and patient advocate-informed.<\/jats:p><\/jats:sec><jats:sec id=\"S0317167123002706_as3\"><jats:title>Results:<\/jats:title><jats:p>The model estimated that nationally &lt; 2% of patients would have access to the required healthcare resources for treatment with a DMT. Eligibility assessment represented the step with the largest capacity gap across all provinces, with a wait list of about 382,000 Canadians one year following DMT introduction. The top three resource gaps included AD specialist time and positron emission tomography and magnetic resonance imaging exam slots. Sensitivity analysis showed that full reliance on cerebrospinal fluid for eligibility testing increased capacity for assessment by about 47,000 patients.<\/jats:p><\/jats:sec><jats:sec id=\"S0317167123002706_as4\"><jats:title>Conclusion:<\/jats:title><jats:p>This model highlights that the Canadian health system is critically under-resourced to diagnose, assess, and treat patients with eAD with DMT. It underscores an urgent need for national policy and provincial resource allocation to close the gap.<\/jats:p><\/jats:sec>","DOI":"10.1017\/cjn.2023.270","type":"journal-article","created":{"date-parts":[[2023,8,18]],"date-time":"2023-08-18T09:24:08Z","timestamp":1692350648000},"page":"487-494","source":"Crossref","is-referenced-by-count":9,"title":["A Model Predicting Healthcare Capacity Gaps For Alzheimer\u2019s Disease-Modifying Treatment in Canada"],"prefix":"10.1017","volume":"51","author":[{"given":"Sandra E.","family":"Black","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9430-4712","authenticated-orcid":false,"given":"Nathalie","family":"Budd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haakon B.","family":"Nygaard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis","family":"Verret","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shikha","family":"Virdi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Tamblyn Watts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3901-4496","authenticated-orcid":false,"given":"Melanie","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2023,8,18]]},"reference":[{"key":"S0317167123002706_ref11","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-201212"},{"key":"S0317167123002706_ref27","volume-title":"Global Status Report on the Public Health Response to Dementia","year":"2021"},{"key":"S0317167123002706_ref13","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-004023"},{"key":"S0317167123002706_ref38","doi-asserted-by":"publisher","DOI":"10.1002\/alz.12756"},{"key":"S0317167123002706_ref9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2011.03.005"},{"key":"S0317167123002706_ref36","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30181-8"},{"key":"S0317167123002706_ref31","doi-asserted-by":"publisher","DOI":"10.1002\/alz.057288"},{"key":"S0317167123002706_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2022.101337"},{"key":"S0317167123002706_ref30","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-062740"},{"key":"S0317167123002706_ref1","unstructured":"1. Navigating the Path Forward for Dementia in Canada: The Landmark Study Report #1. Alzheimer Society of Canada. http:\/\/alzheimer.ca\/en\/research\/reports-dementia\/landmark-study-report-1-path-forward. Accessed November 16, 2022."},{"key":"S0317167123002706_ref39","unstructured":"39. Government of Canada SC. Population estimate 2021; Estimated number of persons on July 1st, by 5-year age groups and sex, and median age, for Canada, provinces and territories. Published September 29, 2021. https:\/\/www150.statcan.gc.ca\/t1\/tbl1\/en\/tv.action?pid=1710000501. Accessed October 21, 2021."},{"key":"S0317167123002706_ref20","unstructured":"20. Center for Drug Evaluation and Research. FDA\u2019s Decision to Approve New Treatment for Alzheimer\u2019s Disease. US Food and Drug Administration. Published December 1, 2022. https:\/\/www.fda.gov\/drugs\/news-events-human-drugs\/fdas-decision-approve-new-treatment-alzheimers-disease. Accessed July 24, 2023."},{"key":"S0317167123002706_ref21","first-page":"648","article-title":"Alzheimer disease","volume":"28","author":"McDade","year":"2022","journal-title":"Contin Minneap Minn"},{"key":"S0317167123002706_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(21)00249-8"},{"key":"S0317167123002706_ref29","first-page":"2747","article-title":"Rural and remote dementia care challenges and needs: perspectives of formal and informal care providers residing in Saskatchewan, Canada","volume":"14","author":"Dal Bello-Haas","year":"2014","journal-title":"Rural Remote Health"},{"key":"S0317167123002706_ref46","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2022.09.008"},{"key":"S0317167123002706_ref25","volume-title":"World Alzheimer report 2021: journey through the diagnosis of dementia","author":"Gauthier","year":"2021"},{"key":"S0317167123002706_ref35","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-019-4627-7"},{"key":"S0317167123002706_ref42","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-018-5591-6"},{"key":"S0317167123002706_ref5","doi-asserted-by":"publisher","DOI":"10.1007\/s40120-022-00335-x"},{"key":"S0317167123002706_ref7","doi-asserted-by":"publisher","DOI":"10.1186\/s12963-016-0107-z"},{"key":"S0317167123002706_ref37","unstructured":"37. National Library of Medicine. ClinicalTrials.gov search: Alzheimer Disease. ClinicalTrials. Published November 30, 2022. https:\/\/clinicaltrials.gov\/ct2\/. Accessed November 30, 2022."},{"key":"S0317167123002706_ref12","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.LI21019DH1C"},{"key":"S0317167123002706_ref40","unstructured":"40. The Canadian Medical Imaging Inventory 2019 - 2020 | CADTH. https:\/\/www.cadth.ca\/canadian-medical-imaging-inventory-2019-2020. Accessed November 16, 2022."},{"key":"S0317167123002706_ref10","doi-asserted-by":"publisher","DOI":"10.1002\/alz.12105"},{"key":"S0317167123002706_ref24","doi-asserted-by":"publisher","DOI":"10.1186\/s13195-017-0312-4"},{"key":"S0317167123002706_ref18","first-page":"9","article-title":"Lecanemab in early Alzheimer\u2019s disease","volume":"0","author":"van Dyck","year":"2022","journal-title":"N Engl J Med"},{"key":"S0317167123002706_ref43","doi-asserted-by":"publisher","DOI":"10.1093\/heapro\/15.2.99"},{"key":"S0317167123002706_ref33","first-page":"1508","article-title":"Impending shortage of neurologists in Canada?","volume":"322","author":"Meloff","year":"2001","journal-title":"Br Med J"},{"key":"S0317167123002706_ref17","doi-asserted-by":"publisher","DOI":"10.1002\/trc2.12295"},{"key":"S0317167123002706_ref26","doi-asserted-by":"publisher","DOI":"10.1002\/alz.12470"},{"key":"S0317167123002706_ref45","first-page":"38","article-title":"Modelling the Pan-European economic burden of Alzheimer\u2019s disease","volume":"11","author":"Martins","year":"2022","journal-title":"JAR Life"},{"key":"S0317167123002706_ref47","doi-asserted-by":"publisher","DOI":"10.1186\/s40504-020-00106-2"},{"key":"S0317167123002706_ref44","doi-asserted-by":"publisher","DOI":"10.1007\/s40120-022-00393-1"},{"key":"S0317167123002706_ref16","doi-asserted-by":"publisher","DOI":"10.3390\/ijms23169305"},{"key":"S0317167123002706_ref23","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-020-0721-9"},{"key":"S0317167123002706_ref6","doi-asserted-by":"crossref","unstructured":"6. Canada PHA of. Prevalence and monetary costs of dementia in Canada (2016): a report by the Alzheimer Society of Canada - HPCDP: Volume 36-10, October 2016. Published October 14, 2016. https:\/\/www.canada.ca\/en\/public-health\/services\/reports-publications\/health-promotion-chronic-disease-prevention-canada-research-policy-practice\/vol-36-no-10-2016\/report-summary-prevalence-monetary-costs-dementia-canada-2016-report-alzheimer-society-canada.html. Accessed September 15, 2022.","DOI":"10.24095\/hpcdp.36.10.04"},{"key":"S0317167123002706_ref14","unstructured":"14. Cognitive Impairment (2015) \u2013 Canadian Task Force on Preventive Health Care. https:\/\/canadiantaskforce.ca\/guidelines\/published-guidelines\/cognitive-impairment\/. Accessed January 2, 2023."},{"key":"S0317167123002706_ref15","first-page":"542","article-title":"Site readiness framework to improve health system preparedness for a potential new Alzheimer\u2019s disease treatment paradigm","volume":"9","author":"Anderson","year":"2022","journal-title":"J Prev Alzheimers Dis"},{"key":"S0317167123002706_ref28","doi-asserted-by":"publisher","DOI":"10.5770\/cgj.15.42"},{"key":"S0317167123002706_ref2","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2015.56"},{"key":"S0317167123002706_ref32","doi-asserted-by":"publisher","DOI":"10.7249\/RR2744"},{"key":"S0317167123002706_ref4","unstructured":"4. Public Health Agency of Canada. Chapter 2: Mapping Connections: An understanding of neurological conditions in Canada \u2013 Health services for neurological conditions. Published September 11, 2014. https:\/\/www.canada.ca\/en\/public-health\/services\/reports-publications\/mapping-connections-understanding-neurological-conditions\/mapping-connections-understanding-neurological-conditions-canada-12.html. Accessed January 12, 2023."},{"key":"S0317167123002706_ref41","doi-asserted-by":"publisher","DOI":"10.1038\/s43587-023-00403-3"},{"key":"S0317167123002706_ref19","unstructured":"19. Office of the Commissioner. FDA Grants Accelerated Approval for Alzheimer\u2019s Disease Treatment. US Food and Drug Administration. Published January 6, 2023. https:\/\/www.fda.gov\/news-events\/press-announcements\/fda-grants-accelerated-approval-alzheimers-disease-treatment. Accessed July 24, 2023."},{"key":"S0317167123002706_ref22","doi-asserted-by":"publisher","DOI":"10.1186\/s13195-022-01117-1"},{"key":"S0317167123002706_ref34","doi-asserted-by":"publisher","DOI":"10.1186\/s43058-021-00201-1"}],"container-title":["Canadian Journal of Neurological Sciences \/ Journal Canadien des Sciences Neurologiques"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0317167123002706","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,16]],"date-time":"2024-12-16T11:09:34Z","timestamp":1734347374000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0317167123002706\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,18]]},"references-count":47,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,7]]}},"alternative-id":["S0317167123002706"],"URL":"https:\/\/doi.org\/10.1017\/cjn.2023.270","relation":{},"ISSN":["0317-1671","2057-0155"],"issn-type":[{"value":"0317-1671","type":"print"},{"value":"2057-0155","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,18]]}}}