Eligibility for antiamyloid treatment: preparing for disease-modifying therapies for Alzheimer's disease.

BACKGROUND: Disease-modifying therapies (DMTs) for Alzheimer's disease (AD) have early evidence of efficacy. Widespread delivery of DMTs will require major service reconfiguration. Treatment pathways will need to include triaging for eligibility, regular infusions and baseline and follow-up MRI scanning. A critical step in planning is provision of real-world estimates of patients likely to be eligible for triaging, but these are challenging to obtain. METHODS: We performed a retrospective service evaluation of patients attending five memory services across North and East London and a national specialist cognitive disorders service. We examined the likely proportion of patients who would (1) be referred for triaging for DMTs and (2) potentially be suitable for treatments. RESULTS: Data from a total of 1017 patients were included, 517 of whom were seen in community memory services and 500 in a specialist clinic. In the memory services, 367/517 (71%) were diagnosed with possible AD. After exclusions of those in whom cognitive and frailty scores, MRI contraindications or anticoagulant use indicated they would be unlikely to be suitable, an estimated 32% would be eligible for triaging. In the specialist cognitive clinic, where additional investigations are available, 14% of those seen (70/500) would be potentially eligible for treatment. CONCLUSIONS: While a sizeable proportion of patients attending memory clinics may be referred for triaging for DMTs for AD, only a minority are likely to be suitable for these, as demonstrated in patients seen in specialist cognitive services. This will need to be considered when designing pathways for DMT delivery.

Disrupted attentional learning in high schizotypy: Evidence of aberrant salience.

The relationship between learned variations in attention and schizotypy was examined in two experiments. In Experiment 1, participants low on a negative subscale of schizotypy exhibited an explicit bias in overt attention towards stimuli that were established as predictive of a trial outcome, relative to stimuli that were irrelevant. The same participants also showed a bias in learning about these stimuli when they presented in a novel context. Neither of these effects was observed in participants high in schizotypy. In Experiment 2, participants low on the negative subscale of schizotypy exhibited faster reaction times towards a target that was cued by a stimulus that had a history of predictive validity relative to a stimulus that had a history of irrelevance. Again, this effect was not present in participants high in schizotypy. These results imply a disruption in the normal allocation of attention to cues that have predictive significance in schizotypy.