Accelerated clinical evaluations for Alzheimer's disease: feasibility across specialty and rural care settings

Abstract INTRODUCTION Timely diagnosis of Alzheimer's disease (AD) is increasingly important given the availability of disease‐modifying therapies, yet current diagnostic pathways remain fragmented, resource‐intensive, and difficult to access. We developed the accelerated clinical evaluation for Alzheimer's disease (ACE‐AD), a nursing‐led workflow integrating a clinical interview, cognitive testing, blood biomarkers, and portable magnetic resonance imaging (MRI) to streamline dementia evaluation. METHODS ACE‐AD was evaluated in two phases. Phase 1 validated the workflow in 20 participants with standard‐of‐care (SOC) memory clinic diagnoses compared against ACE‐AD‐derived etiologic diagnosis, cognitive staging, and neuroimaging findings. Phase 2 adapted the workflow for a rural neurology practice, assessing feasibility, utility, and acceptability. RESULTS In Phase 1 ( n = 20), primary etiologic diagnoses were universally concordant between SOC and ACE‐AD evaluations, with 90% agreement on AD as a primary or contributing etiology. Cognitive stage agreed in 13 participants (65%); ACE‐AD rated all discordant cases as less impaired. Portable MRI identified clinically relevant abnormalities consistent with SOC MRI, and patients, care partners, and clinicians rated the workflow highly acceptable. In Phase 2 ( n = 7), the rural neurologist reported improved diagnostic confidence, efficiency, treatment planning, and patient communication without workflow disruption. DISCUSSION A structured, nursing‐led evaluation integrating blood biomarkers and portable MRI can capture sufficient clinical information to support specialist dementia diagnosis while shifting much of the diagnostic workup earlier in the care pathway. These findings support further evaluation of ACE‐AD as a scalable approach for expanding access to timely dementia diagnosis in both specialty and resource‐limited settings.