{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T17:11:25Z","timestamp":1780333885307,"version":"3.54.1"},"reference-count":27,"publisher":"SAGE Publications","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAD"],"published-print":{"date-parts":[[2024,10,8]]},"abstract":"<jats:p>Background: Amyloid-targeting therapies for Alzheimer\u2019s disease (AD) might become available in Germany soon. The combination of a large pool of prevalent cases and a complex diagnostic process to determine eligibility for these treatments is likely to challenge health systems\u2019 capacity. Objective: To analyze Germany\u2019s healthcare system capacity to identify treatment-eligible patients in a timely and equitable manner. Methods: We modeled patients\u2019 diagnostic journey and projects wait times due to capacity constraints for AD specialist visits and PET scans from 2024 to 2043. Model parameters were derived from published data and expert input. Results: Wait times would be \u223c50 months over the model horizon, if patients were referred to specialists based on a brief cognitive assessment in primary care. Wait times for patients with social health insurance are projected to be 1.9 times those of patients with private insurance, with peak wait times of around 76 and 40 months, respectively. Adding a blood test for the AD pathology as additional triage step would reduce wait times to below 24 months. Conclusions: In spite of having a well-resourced health system, Germany is projected to be unable to cope with the demand for biomarker-based AD diagnosis, if a disease-modifying AD treatment were introduced. As these treatments might become available by the end of 2024, decisive action, in particular dissemination of high-performing AD blood tests for triage in primary care, will be needed to prevent delays in access and potentially avoidable and inequitable disease progression.<\/jats:p>","DOI":"10.3233\/jad-240728","type":"journal-article","created":{"date-parts":[[2024,10,8]],"date-time":"2024-10-08T13:12:24Z","timestamp":1728393144000},"page":"1249-1259","source":"Crossref","is-referenced-by-count":6,"title":["Current Capacity for Diagnosing Alzheimer\u2019s Disease in Germany and Implications for Wait Times"],"prefix":"10.1177","volume":"101","author":[{"given":"Soeren","family":"Mattke","sequence":"first","affiliation":[{"name":"The USC Brain Health Observatory, USC Dornsife, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Tang","sequence":"additional","affiliation":[{"name":"The USC Brain Health Observatory, USC Dornsife, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Hanson","sequence":"additional","affiliation":[{"name":"The USC Brain Health Observatory, USC Dornsife, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine A.F.","family":"von Arnim","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, University Medical Center Goettingen, Goettingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lutz","family":"Fr\u00f6lich","sequence":"additional","affiliation":[{"name":"Department of Geriatric Psychiatry, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo","family":"Grimmer","sequence":"additional","affiliation":[{"name":"Technical University of Munich, School of Medicine and Health, Klinikum rechts der Isar, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oezguer A.","family":"Onur","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Perneczky","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, LMU Hospital, Ludwig-Maximilians-Universit\u00e4t Munich, Munich, Germany"},{"name":"German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany"},{"name":"Munich Cluster for Systems Neurology (SyNergy), Munich, Germany"},{"name":"Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK"},{"name":"School of Public Health, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Teipel","sequence":"additional","affiliation":[{"name":"Deutsches Zentrum f\u00fcr Neurodegenerative Erkrankungen (DZNE) Rostock, Rostock, Germany"},{"name":"Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jochen Ren\u00e9","family":"Thyrian","sequence":"additional","affiliation":[{"name":"Deutsches Zentrum f\u00fcr Neurodegenerative Erkrankungen (DZNE) Rostock, Rostock, Germany"},{"name":"Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany"},{"name":"Faculty V, University of Siegen, Siegen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","reference":[{"key":"10.3233\/JAD-240728_ref1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1056\/NEJMoa2212948","article-title":"Lecanemab in early Alzheimer\u2019s disease","volume":"388","author":"Van Dyck","year":"2023","journal-title":"N Engl J Med"},{"key":"10.3233\/JAD-240728_ref2","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1001\/jama.2023.13239","article-title":"Donanemab in early symptomatic Alzheimer disease","volume":"330","author":"Sims","year":"2023","journal-title":"JAMA"},{"key":"10.3233\/JAD-240728_ref4","unstructured":"European Medicines Agency. From laboratory to patient: The journey of a medicine assessed by EMA. European Medicines Agency, 2019."},{"key":"10.3233\/JAD-240728_ref5","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1002\/alz.12470","article-title":"Expected wait times for access to a disease-modifying Alzheimer\u2019s treatment in the United States","volume":"18","author":"Mattke","year":"2022","journal-title":"Alzheimers Dement"},{"key":"10.3233\/JAD-240728_ref6","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1002\/alz.12778","article-title":"Preparedness of the Brazilian health-care system to provide access to a disease-modifying Alzheimer\u2019s disease treatment","volume":"19","author":"Mattke","year":"2023","journal-title":"Alzheimers Dement"},{"key":"10.3233\/JAD-240728_ref7","doi-asserted-by":"crossref","first-page":"5596","DOI":"10.1002\/alz.13348","article-title":"Preparedness of China\u2019s health care system to provide access to a disease-modifying Alzheimer\u2019s treatment","volume":"19","author":"Mattke","year":"2023","journal-title":"Alzheimers Dement"},{"key":"10.3233\/JAD-240728_ref8","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1177\/13558196231211141","article-title":"Expected wait times for access to a disease-modifying Alzheimer\u2019s treatment in England: A modelling study","volume":"29","author":"Mattke","year":"2024","journal-title":"J Health Serv Res Policy"},{"key":"10.3233\/JAD-240728_ref9","first-page":"155","article-title":"Estimates of current capacity for diagnosing Alzheimer\u2019s disease in Sweden and the need to expand specialist numbers","volume":"11","author":"Mattke","year":"2024","journal-title":"J Prev Alzheimers Dis"},{"key":"10.3233\/JAD-240728_ref11","doi-asserted-by":"crossref","first-page":"2255","DOI":"10.1016\/S0140-6736(15)60461-5","article-title":"A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): A randomised controlled trial","volume":"385","author":"Ngandu","year":"2015","journal-title":"Lancet"},{"key":"10.3233\/JAD-240728_ref12","doi-asserted-by":"crossref","first-page":"617","DOI":"10.3233\/JAD-150692","article-title":"Timely diagnosis for Alzheimer\u2019s disease: A literature review on benefits and challenges","volume":"49","author":"Dubois","year":"2015","journal-title":"J Alzheimers Dis"},{"issue":"Suppl 1","key":"10.3233\/JAD-240728_ref13","first-page":"S9","article-title":"Lecanemab for early Alzheimer\u2019s disease: Long-term outcomes, predictive biomarkers and novel subcutaneous administration","volume":"10","author":"Van Dyck","year":"2023","journal-title":"J Prev Alzheimers Dis"},{"issue":"Suppl 1","key":"10.3233\/JAD-240728_ref14","first-page":"S6","article-title":"Donanemab in early symptomatic Alzheimer\u2019s disease: Additional insights from TRAILBLAZER-ALZ 2","volume":"10","author":"Sims","year":"2023","journal-title":"J Prev Alzheimers Dis"},{"key":"10.3233\/JAD-240728_ref16","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1007\/s00103-010-1119-7","article-title":"[Morbidity and healthcare differences between insured in the statutory (\u201cGKV\u201d) and private health insurance (\u201cPKV\u201d) in Germany. Review of empirical studies]","volume":"53","author":"Huber","year":"2010","journal-title":"Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz"},{"key":"10.3233\/JAD-240728_ref17","first-page":"e12081","article-title":"Blood-based biomarkers for Alzheimer\u2019s pathology and the diagnostic process for a disease-modifying treatment: Projecting the impact on the cost and wait times","volume":"12","author":"Mattke","year":"2020","journal-title":"Alzheimers Dement (Amst)"},{"key":"10.3233\/JAD-240728_ref18","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1287\/mnsc.9.3.458","article-title":"An Experimental Application of the DELPHI Method to the Use of Experts","volume":"9","author":"Dalkey","year":"1963","journal-title":"Manag Sci"},{"key":"10.3233\/JAD-240728_ref20","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.dadm.2019.01.004","article-title":"The incidence of mild cognitive impairment: A systematic review and data synthesis","volume":"11","author":"Gillis","year":"2019","journal-title":"Alzheimers Dement (Amst)"},{"key":"10.3233\/JAD-240728_ref21","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1212\/WNL.0000000000004826","article-title":"Practice guideline update summary: Mild cognitive impairment: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology","volume":"90","author":"Petersen","year":"2018","journal-title":"Neurology"},{"key":"10.3233\/JAD-240728_ref22","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1007\/s00115-020-00923-y","article-title":"Die Pr\u00e4valenz an Demenz erkrankter Menschen in Deutschland \u2013 eine bundesweite Analyse auf Kreisebene","volume":"91","author":"Thyrian","year":"2020","journal-title":"Der Nervenarzt"},{"key":"10.3233\/JAD-240728_ref24","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1055\/a-1871-9889","article-title":"[The Cost of Early Diagnosis of Cognitive Decline in German Memory Clinics]","volume":"90","author":"Onur","year":"2022","journal-title":"Fortschr Neurol Psychiatr"},{"key":"10.3233\/JAD-240728_ref25","unstructured":"Robinson JC , Ex P and Panteli D. 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