{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:10:27Z","timestamp":1790784627968,"version":"4.1.0"},"reference-count":44,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100004191","name":"Novo Nordisk","doi-asserted-by":"publisher","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}],"id":[{"id":"10.13039\/501100004191","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Alzheimer\u2019s Disease"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Access to high-quality and timely dementia diagnoses varies between rural and urban location.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We examined rural-urban disparities in key indicators for high-quality and timely diagnoses of mild cognitive impairment (MCI) and Alzheimer's disease (AD) dementia in Australia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>3648 patients with all-cause MCI or AD dementia were geographically classified into major cities (75.7%), inner (15.8%) and outer (8.4%) regional areas. We used regression analyses to assess rural-urban disparities in completion of key diagnostic investigations and diagnostic wait times.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants in inner regional areas were more likely (odds ratio [OR]\u2009=\u20091.55; 95% confidence interval [CI]\u2009=\u20091.14, 2.13; p\u2009=\u20090.006) to have had more basic diagnostic investigations completed (including core blood tests, cognitive assessments, functional assessments, structural neuroimaging) compared to those in major cities. However, participants in inner regional (OR\u2009=\u20090.37; 95% CI\u2009=\u20090.28, 0.48; p\u2009&lt;\u20090.001) and outer regional (OR\u2009=\u20090.32; 95% CI\u2009=\u20090.21, 0.48; p\u2009&lt;\u20090.001) areas were less likely to have functional neuroimaging completed. Median wait times for an initial appointment following referral to a memory clinic were up to 28 days longer for rural compared to urban participants (Inner regional: Beta (median)\u2009=\u200912.91; 95% CI\u2009=\u20095.15, 20.69; p\u2009=\u20090.001; Outer regional: Beta (median)\u2009=\u200927.50; 95% CI\u2009=\u200918.80, 36.20; p\u2009&lt;\u20090.001), whereas median wait times from initial appointment to diagnosis were up to 47 days shorter in rural compared to urban residents (Inner regional: Beta (median)\u2009=\u2009\u221246.83; 95% CI\u2009=\u2009\u221252.35, \u221241.32; p\u2009&lt;\u20090.001; Outer regional: Beta (median)\u2009=\u2009\u221244.42; 95% CI\u2009=\u2009\u221250.35, \u221238.49; p\u2009&lt;\u20090.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Findings suggest disparities in access to advanced diagnostic investigations and timely initial appointments in rural Australia, and increased need for enhanced workforce and diagnostic infrastructure in these areas.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13872877261489828","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T11:42:51Z","timestamp":1790682171000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Rural-urban disparities in the clinical diagnostic pathway of patients with all-cause mild cognitive impairment and dementia due to Alzheimer's disease in Australia"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8785-0694","authenticated-orcid":false,"given":"Xiaoping","family":"Lin","sequence":"first","affiliation":[{"name":"Monash University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Amin","family":"Honardoost","sequence":"additional","affiliation":[{"name":"Monash University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9413-6897","authenticated-orcid":false,"given":"Susannah","family":"Ahern","sequence":"additional","affiliation":[{"name":"Monash University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1034-0191","authenticated-orcid":false,"given":"Colman","family":"Taylor","sequence":"additional","affiliation":[{"name":"Health Technology Analysts, Surry Hills, New South Wales, Australia"},{"name":"Faculty of Medicine, UNSW, Sydney, New South Wales, Australia"},{"name":"The George Institute for Global Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1439-3373","authenticated-orcid":false,"given":"Stephanie","family":"Ward","sequence":"additional","affiliation":[{"name":"Monash University"},{"name":"Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia"},{"name":"Department of Geriatric Medicine, The Prince of Wales Hospital, Randwick, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2125-9006","authenticated-orcid":false,"given":"Elisabeth","family":"de Laguiche","sequence":"additional","affiliation":[{"name":"Sustainability Insights, Novo Nordisk A\/S"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8912-7520","authenticated-orcid":false,"given":"Elizabeth","family":"Adesanya","sequence":"additional","affiliation":[{"name":"Lane Clark & Peacock LLP"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9487-6617","authenticated-orcid":false,"given":"Henry","family":"Brodaty","sequence":"additional","affiliation":[{"name":"Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2175-9975","authenticated-orcid":false,"given":"Jonathan","family":"Pearson-Stuttard","sequence":"additional","affiliation":[{"name":"Lane Clark & Peacock LLP"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0678-4136","authenticated-orcid":false,"given":"Sara","family":"Holloway","sequence":"additional","affiliation":[{"name":"Lane Clark & Peacock LLP"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Woodward","sequence":"additional","affiliation":[{"name":"Austin Health"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/alz.12068"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/alz.12694"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2007.04.381"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13195-014-0082-1"},{"key":"e_1_3_3_6_2","unstructured":"Alzheimer\u2019s Society. Mild cognitive impairment (MCI) https:\/\/www.alzheimers.org.uk\/about-dementia\/types-dementia\/mild-cognitive-impairment-mci (accessed 6 August 2026)."},{"key":"e_1_3_3_7_2","unstructured":"Alzheimer\u2019s Society. Causes of mild cognitive impairment https:\/\/www.alzheimers.org.uk\/about-dementia\/types-dementia\/mild-cognitive-impairment-mci-causes (accessed 6 August 2026)."},{"key":"e_1_3_3_8_2","unstructured":"Alzheimer\u2019s Association. Mild Cognitive Impairment (MCI) https:\/\/www.alz.org\/alzheimers-dementia\/what-is-dementia\/related_conditions\/mild-cognitive-impairment (accessed 6 August 2026)."},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/alz.13016"},{"key":"e_1_3_3_10_2","unstructured":"World Health Organization. A blueprint for dementia research https:\/\/www.who.int\/publications\/i\/item\/9789240058248 (2022 accessed 6 August 2026)."},{"key":"e_1_3_3_11_2","unstructured":"Alzheimer\u2019s Disease International. World Alzheimer Report 2021: Journey through the diagnosis of dementia https:\/\/www.alzint.org\/resource\/world-alzheimer-report-2021\/ (21 September 2021 accessed 6 August 2026)."},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.14283\/jpad.2021.23"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gnx182"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.5694\/mja15.01339"},{"key":"e_1_3_3_15_2","article-title":"Dementia: assessment, management and support: summary of updated NICE guidance","volume":"361","author":"Pink J","year":"2018","unstructured":"Pink J, O\u2019Brien J, Robinson L, et al. Dementia: assessment, management and support: summary of updated NICE guidance. Br Med J 2018; 361: k2438.","journal-title":"Br Med J"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00259-018-4035-y"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13195-017-0297-z"},{"key":"e_1_3_3_18_2","unstructured":"Alzheimer\u2019s Society. Improving access to a timely and accurate diagnosis of dementia in England Wales and Northern Ireland https:\/\/www.alzheimers.org.uk\/what-we-do\/policy-and-influencing\/improving-access-timely-accurate-diagnosis-dementia-england-wales-northern-ireland (May 2023 accessed 6 August 2026)."},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)01296-0"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(23)00274-0"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(24)00041-3"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dys103"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.inpsyc.2025.100051"},{"key":"e_1_3_3_24_2","unstructured":"Hodgson S Hayes H Cubi-Molla P et al. Inequalities in Dementia: Unveiling the Evidence and Forging a Path Towards Greater Understanding. Contract Research 002491 Office of Health Economics https:\/\/ideas.repec.org\/\/p\/ohe\/conres\/002491.html (26 June 2024 accessed 6 August 2026)."},{"key":"e_1_3_3_25_2","article-title":"Rural\u2013urban disparities of Alzheimer\u2019s disease and related dementias: a scoping review","volume":"11","author":"Kramer M","year":"2025","unstructured":"Kramer M, Cutty M, Knox S, et al. Rural\u2013urban disparities of Alzheimer\u2019s disease and related dementias: a scoping review. Alzheimers Dement (N Y) 2025; 11: e70047.","journal-title":"Alzheimers Dement (N Y)"},{"key":"e_1_3_3_26_2","doi-asserted-by":"crossref","unstructured":"Walesby KE Shenkin SD Burton JK et al. Geographical variation in dementia: systematic review with meta-analysis. medRxiv 2025; 2023.12.11.23299178.","DOI":"10.1101\/2023.12.11.23299178"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-023-09100-8"},{"key":"e_1_3_3_28_2","unstructured":"World Health Organization. Global status report on the public health response to dementia https:\/\/www.who.int\/publications\/i\/item\/9789240033245 (1 September 2021 accessed 6 August 2026)."},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-020-01741-2"},{"key":"e_1_3_3_30_2","unstructured":"Lin X Ward SA Brodaty H et al. Australian Dementia Network Registry: 2023 Annual Report. Monash University. DOI: https:\/\/doi.org\/10.26180\/26984689."},{"key":"e_1_3_3_31_2","unstructured":"Australian Bureau of Statistics. Remoteness Areas https:\/\/www.abs.gov.au\/statistics\/standards\/australian-statistical-geography-standard-asgs\/edition-3-july-2021-june-2026\/remoteness-structure\/remoteness-areas (2023 accessed 6 August 2026)."},{"key":"e_1_3_3_32_2","unstructured":"Australian Government Department of Health Disability and Ageing. Modified Monash Model https:\/\/www.health.gov.au\/topics\/rural-health-workforce\/classifications\/mmm (2025 accessed 6 August 2026)."},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1111\/insr.12469"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-190017"},{"key":"e_1_3_3_35_2","unstructured":"Parliament of Australia. Availability and accessibility of diagnostic imaging equipment around Australia https:\/\/www.aph.gov.au\/Parliamentary_Business\/Committees\/Senate\/Community_Affairs\/Diagnosticimaging (2018 accessed 6 August 2026)."},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.32073"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djac030"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2377-10-42"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.14336\/AD.2017.0928"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare10071340"},{"key":"e_1_3_3_41_2","unstructured":"Australian Institute of Health and Welfare. Geographical variation in health service use by people living with dementia https:\/\/www.aihw.gov.au\/reports\/dementia\/geographical-variation-health-service-use-dementia\/contents\/about (2023 accessed 6 August 2026)."},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1071\/AH17167"},{"key":"e_1_3_3_43_2","unstructured":"Australian Bureau of Statistics. Patient Experiences 2023\u201324 financial year https:\/\/www.abs.gov.au\/statistics\/health\/health-services\/patient-experiences\/2023\u201324 (2024 accessed 6 August 2026)."},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.1111\/imj.16637"},{"key":"e_1_3_3_45_2","unstructured":"The ISLAND Clinic. Referral information for GPs https:\/\/islandclinic.utas.edu.au\/referral\/ (accessed 6 August 2026)."}],"container-title":["Journal of Alzheimer\u2019s Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13872877261489828","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/13872877261489828","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13872877261489828","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T15:47:08Z","timestamp":1790783228000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/13872877261489828"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":44,"alternative-id":["10.1177\/13872877261489828"],"URL":"https:\/\/doi.org\/10.1177\/13872877261489828","relation":{},"ISSN":["1387-2877","1875-8908"],"issn-type":[{"value":"1387-2877","type":"print"},{"value":"1875-8908","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]},"article-number":"13872877261489828"}}