Health Disparities and Diagnostic Challenges in Anti-Amyloid Therapy Implementation: A Rural Texas Experience
Elisabeth Burnett1, Haylee Voyles1, Satwant Kumar2, Khushboo Verma1
1The University of Texas at Tyler, 2NeuroReef Labs
Objective:
To examine diagnostic alignment, treatment outcomes, and health system disparities related to anti-amyloid monoclonal antibody therapy implemented in rural East Texas.
Background:
Anti-amyloid monoclonal antibodies such as lecanemab and donanemab mark a new era of disease-modifying therapy in Alzheimer’s disease. However, most clinical guidelines and appropriate-use recommendations are developed in larger academic or urban centers, which may not be fully aligned with rural practice. A lack of educational resources and implementation support for community neurologists contributes to a lack of diagnostic accuracy and treatment safety. An understanding of these disparities is essential to ensuring equitable access to and outcomes in rural memory care.
Design/Methods:
This is a retrospective analysis of patient charts (n = 6, April 2024 - October 2025) treated with either Lecanemab or Donanemab. All the patients were initiated on anti-amyloid therapies by general neurologists and transferred for care at the memory disorders clinic at the tertiary care center.
Results:
Four of six (67%) had mixed etiologies of vascular cognitive impairment (Fazekas 3) and/or Lewy body disease, despite anti-amyloid initiation. One patient received Lecanemab while on Apixaban; therapy was suspended pending Watchman placement. Two of six (33%) developed symptomatic ARIA-E: one was discharged from the ED without MRI (diagnosed as sinusitis); the other had severe ARIA-E/ARIA-H on donanemab without prior APOE genotyping.
Conclusions:
In this early rural implementation cohort, diagnostic overlap, limited biomarker access, and insufficient local education on anti-amyloid prescribing contributed to non-guideline-concordant therapy and preventable ARIA events. Targeted education for community neurologists, structured diagnostic pathways, and improved access to MRI and APOE testing are needed to promote safer, more equitable deployment of anti-amyloid therapies across rural populations.
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