How can we facilitate adoption and scale for early detection of Alzheimer’s disease? Insights from implementing a community‐based screening program using cognitive assessments and RetiSpec screening in Ontario, Canada

Abstract Background A critical need to increase Alzheimer’s disease (AD) screening exists given rising incidence, new disease‐modifying treatments, and ill‐equipped primary care settings. This study assessed the feasibility of a novel, community‐based AD screening program to increase cognitive and retinal‐based assessments. Methods An observational study, supported by the Davos Alzheimer’s Collaborative, assessed the utility of leveraging community‐based settings to increase rates of cognitive assessment (conducted by Alzheimer Society (AS) social workers [SWs]) and RetiSpec’s AI‐based eye test in optometry settings to detect biologic signatures of AD (plus participant survey). Eligible participants were adults aged ≥55 years with self‐reported memory concerns. Primary and secondary endpoints were to increase cognitive assessment rates and have 10% of assessments originate from optometry, respectively. A utilization‐focused evaluation explored risks, benefits, facilitators, and barriers to these settings from frontline providers’ perspectives. Results N = 916 individuals were screened (60.2% from optometry) with N = 134 participants enrolled (age: 74.3 years±7.0; 63.7% female; 39.5% minority groups). N = 124 participants received cognitive assessments: 118 Montreal Cognitive Assessment (mean score: 24.7±3.7), 124 Boston Naming Test (13.3±2.0), 6 Mini‐Mental State Exam (18.7±5.7) and 6 Clock Drawing Test (1.2±1.2). N = 120 participants discussed their results with a clinician (37.9% with the NP). N = 25 dementia specialist referrals were made, N = 52 received an AD‐related diagnosis, along with medication prescription (N = 5), further medical investigation (N = 30) and clinical monitoring (N = 27). N = 99 underwent a RetiSpec scan (N = 65 predicted positive). Surveys (N = 71) demonstrated a positive scan experience (4.2±1.3/5) and unanimous interest in sharing results with a PCP (5.0±0.0/5). Endpoint 1 was met with 13.8 assessments/month completed versus 1.8/month in the pre‐study period. Endpoint 2 was met with 29.0% of assessments originating from optometry. Evaluation findings indicate that screening programs should consider: promoting brain health awareness in community settings; utilizing clinicians with AD training for screening and follow‐up activities; leveraging optometry clinics and AS’s to enable broad access to screening; and adopting technology that leverages existing infrastructure (i.e., RetiSpec’s eye test) to enable scalable increases to AD screening. Conclusions Utilizing community‐based settings, including optometry clinics for RetiSpec screening and AS SWs for cognitive screening, led to meaningful improvements in early detection and subsequent medical care.