Clinical Scorecard: Wait Times for Neurology Appointments in the Cognitive Care Pathway

At a Glance

Key Highlights

• A cross-sectional telephone survey of 150 purposefully selected US clinics found a mean wait of 17.9 weeks for the earliest available neurologist appointment for a memory concern.
• Mean waits were 21.1 weeks at specialized clinics and 15.6 weeks at community clinics; the difference was reported as statistically significant.
• Earlier claims-based studies reported an average interval of about 50 days after clinician referral, but differences in methods may partly explain the longer waits estimated in this survey.
• The article describes strategies to address neurology access at clinic, workforce, and policy levels, alongside barriers earlier in the cognitive care pathway.

Guideline-Based Recommendations

Diagnosis

• The article describes obtaining blood test and structural imaging results before referral as an approach that may limit repeat visits.
• It identifies insufficient clinician confidence in discussing cognitive impairment and limited implementation of standardized cognitive testing as factors in delayed detection.

Management

• The American Academy of Neurology's three strategies described in the article are shaping neurologist demand, strengthening the neurology workforce, and advocating for neurologist value.
• The article describes advanced practice providers as a way to expand the neurology workforce in the short term and attracting additional trainees as a longer-term approach.
• The article notes that AD blood tests and digital cognitive assessments may assist in prioritizing patients who could be eligible for amyloid-targeting treatments.

Monitoring & Follow-up

Risks

• The article states that prompt specialist evaluation may permit earlier treatment initiation among eligible patients.
• The article identifies stigma, denial, insufficient clinician confidence, limited implementation of standardized cognitive testing, and time and financial constraints as contributors to delayed detection.

Patient & Prescribing Data

People seeking an initial neurology appointment for a memory concern; the survey also modeled circumstances in which patients self-refer.

The article discusses amyloid-targeting treatments for Alzheimer disease and states that prompt specialist evaluation may permit earlier treatment initiation among eligible patients. It provides no prescribing regimen or patient-level treatment data.

Clinical Best Practices

• The article describes obtaining blood test and structural imaging results before referral as an approach that may limit repeat visits.
• The article describes AD blood tests and digital cognitive assessments as possible tools to help prioritize patients who could be eligible for amyloid-targeting treatments.
• The article identifies stigma, denial, insufficient clinician confidence, limited implementation of standardized testing, and time and financial constraints as factors in delayed detection.
• The article reports that the AAN advocates greater funding for community outreach and research and higher compensation for neurology services.

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