Objective:

To describe the demographic and clinical characteristics of patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) at their earliest recorded encounter in a large, integrated health system, and to identify barriers relevant to anti-amyloid therapy eligibility.

Background:

Anti-amyloid therapies require timely identification of eligible patients with MCI or mild AD. Real-world data from initial encounters are often incomplete and lack staging precision. Understanding diagnostic coding, comorbidity burden, and insurance coverage at the first point of contact can inform development of a standardized framework for early and ongoing AD management.

Design/Methods:

A retrospective electronic medical record analysis (June 2021–June 2024) included adults with ICD-10 codes for memory loss, MCI, or AD. The earliest encounter for each patient was analyzed. Variables included age, sex, race/ethnicity, insurance, comorbidities, and AD stage (MCI, mild, moderate, severe, unstaged). Comorbidities were treated as secondary variables. Descriptive statistics and group comparisons used chi-square and analysis of variance tests (p < 0.05).

Results:

Among 7,442 patients, 53.6% had MCI and 34.3% had unstaged AD. MCI patients were younger (mean 76 years) than those with AD (mean >81 years). Black patients represented 20% and White patients 76%. Comorbidities were frequent: diabetes 26%, renal disease 19%, cardiovascular disease 12%. The mean Charlson Comorbidity Index was 1.9, reflecting a moderate burden of illness. Commercial insurance was most common in MCI (45%) but declined to 30–36% in dementia. Medicare rose to 97–99% and dual eligibility peaked at 14% in severe AD.

Conclusions:

At the first encounter, most patients with cognitive diagnoses were coded as MCI or unstaged AD, and had moderate comorbidity burden and high Medicare reliance. These findings illustrate how patients appear upon entering real-world health systems and support a standardized front-door framework integrating structured staging, comorbidity assessment, and patient-reported measures to improve early identification and therapy readiness.