Who gets Alzheimer’s drugs? Racial and socioeconomic gaps persist

Clinical Takeaway: Help potentially eligible patients navigate evaluation and treatment access for anti-amyloid therapy. Avoid assumptions about adherence based on race, ethnicity, or socioeconomic circumstances.

Anti-amyloid therapies can slow cognitive decline in early Alzheimer’s disease, but accessing treatment requires diagnostic evaluation and ongoing monitoring. A new study suggests substantial racial, ethnic, and socioeconomic differences in who receives these medications—even though race and ethnicity were not associated with initial adherence once treatment began.

Researchers analyzed electronic health records from more than 300 US medical centers, identifying nearly 1.2 million adults diagnosed with mild cognitive impairment or dementia during 2019–2024. Of these, 2,427 (0.2%) were prescribed an anti-amyloid medication, predominantly lecanemab. Investigators matched 1,696 treated patients with 1,696 untreated patients based on diagnosis timing and available follow-up.

After adjustment for demographic characteristics, comorbidities, and neighborhood-level social factors, non-Hispanic Black adults had 86% lower odds of receiving treatment than non-Hispanic White adults. Hispanic adults had 79% lower odds. Older age and greater comorbidity burden were also associated with lower treatment use.

Patients in the most socioeconomically vulnerable neighborhoods had approximately half the odds of receiving treatment compared with those in the least vulnerable neighborhoods. The vulnerability measure incorporated factors such as income, education, housing, and transportation. Racial and ethnic differences persisted after accounting for neighborhood vulnerability.

Among patients receiving lecanemab, initial adherence, estimated from recorded infusions and days supplied, was not significantly associated with race, ethnicity, age, sex, or overall neighborhood vulnerability. Greater comorbidity burden was associated with lower adherence.

The records did not establish dementia severity or amyloid status, so researchers could not determine whether untreated patients met treatment eligibility criteria. The findings therefore identify potential access disparities rather than proving that eligible patients were denied therapy.

“The association we found between race/ethnicity and anti-amyloid medication use raises important questions about how patients are identified, evaluated and ultimately selected for treatment,” said study co-first author Melissa Elafros, MD, PhD, of the University of Michigan.

Source: Reynolds EL, et al. (2026 Oct 15) Neurology. Predictors of Antiamyloid Medication Utilization and Adherence Among People With Alzheimer Disease and Mild Cognitive Impairment