Status of diagnosis, treatment, and care of Alzheimer's disease continuum in China: A survey-based analysis

BackgroundThe 2018 NIA-AA framework outlines a six-stage continuum from asymptomatic individuals to severe Alzheimer's disease (AD) dementia, but most Chinese research still focuses on dementia or broad diagnostic categories.ObjectiveTo map diagnosis, treatment, and care patterns across all six AD clinical stages in China and identify demographic, clinical, treatment and care-related factors associated with disease stage.MethodsWe conducted a nationwide, open online survey via official media channels targeting patients with clinician-confirmed AD and their caregivers. Data were collected via Questionnaire Star. Descriptive analyses, group comparisons, and ordinal logistic regression were performed to examine factors associated with NIA-AA stage.ResultsA total of 1116 valid responses were analyzed. Most participants were at Stage 2 or higher, with distribution of 0.4%, 9.1%, 16.0%, 24.8%, 26.6%, and 23.0%, across Stage 1-6. Overall, 64.5% had been diagnosed within five years. Neurology (66.4%) and memory clinics (19.2%) were the most frequently visited departments. Donepezil (52.2%) and Memantine (38.8%) were the most common medications, while 34.5% reported engaging in non-pharmacological interventions. Only 1.9% of patients receiving professional dementia institutional care. In logistic regression, disease duration (OR = 0.724, p = 0.006), stage at first outpatient visit (OR= 1.843, p < 0.001), and Donepezil use (OR = 1.394, p = 0.003) were independently associated with current NIA-AA stage.ConclusionsThis study provides the first nationwide, real-world description of diagnosis, treatment, and care across all NIA-AA stages in China. The findings highlight the need for improved primary-care screening, expanded memory-clinic access, and structured caregiver support to promote earlier detection and more equitable, stage-appropriate management of AD.