Rural Georgians may find it difficult to access medication that could slow the progression of Alzheimer's disease, according to a new study from the University of Georgia.
That's especially concerning because rural counties experience a significantly higher burden of the disease.
The researchers analyzed the availability of facilities that offered the IV medication lecanemab and the accessibility of PET scans, which are used to diagnose Alzheimer's, in all of Georgia's 159 counties.
The study found that none of Georgia's rural counties had a PET scan facility. Only one had an infusion center.
Georgians in rural counties faced drive times of over an hour to reach a facility that provided PET scans. Drive times to lecanemab infusion sites were even longer, sometimes more than three hours.
Niying Li
"It's hard for people to find a trained, capable physician in Alzheimer's disease to be able to make a diagnosis," said Niying Li, lead author of the study and an assistant professor in the UGA College of Pharmacy.
"Once you get that diagnosis and are ready to start the drug, you need to be connected to an infusion center. And once you're connected to the center, you will need to have a family caregiver go with you for infusions every two weeks because you cannot drive yourself due to potential side effects of the medication."
For many rural Georgians, those barriers put care out of reach.
Rural counties face heavy burden of Alzheimer's disease, lack resources
More than 188,000 Georgians are living with Alzheimer's disease. Hundreds of thousands more are providing unpaid care to loved ones with the condition, according to the Alzheimer's Association.
The researchers found most of the state's 28 lecanemab infusion centers are clustered around the Atlanta area. Only one is located in a rural county.
Of the six Memory Assessment Clinics that offer or refer patients out for PET scans, none are located in rural counties.
Rural patients with Alzheimer's disease … are lacking support." -Niying Li, College of Pharmacy
People with early Alzheimer's disease can become agitated when taken out of their normal routines. The long drive to reach the facility coupled with sitting for over an hour to receive an infusion and then making the long trip back home is not just a hassle for these patients and their caregivers.
It's often impossible, Li said.
"I think that this study really points out that rural patients with Alzheimer's disease are lacking resources," Li said. "They are lacking support."
A new UGA study found that infusion centers for a drug that treats Alzheimer's disease are clustered around Atlanta, leaving rural Georgians with long drive times to access care (left). Meanwhile, there are only six places in the state to access amyloid PET scans, which are needed to diagnose the disease. (Illustration by Lindsay Robinson)
Shortage of health care providers, medical knowledge another barrier to care
But it's not just long drive times that prevent Alzheimer's patients from accessing care.
"We also have a shortage of health professionals who are able to make you a diagnosis that will make you potentially eligible for the drug," Li said. "And we have a shortage of health care professionals who are familiar with the use of this drug."
Eighteen Georgia counties lack a family medicine doctor. And those counties are almost exclusively rural.
For Georgians in these areas, just getting an Alzheimer's diagnosis requires access to reliable transportation and to someone who can take time off work to get patients to their appointment.
Few options to treat Alzheimer's disease
While the drug does have its drawbacks - it's exorbitantly expensive and requires extensive follow-up imaging due to potentially life-threatening side effects - lecanemab is one of few breakthroughs in the treatment of Alzheimer's disease.
For many years, Alzheimer's treatments focused only on easing symptoms. Over the past few years, the Food and Drug Administration approved only three medications to delay the progression of the disease. And one of them was pulled off the market last year.
The remaining two drugs have the potential to transform care for early Alzheimer's disease patients, the researchers said. But only if patients can access them.
Published in Alzheimer's Disease and Dementia, the Journal of the Alzheimer's Association, the study was co-authored by Samruddhi Borate and Mohammed Zuber of UGA's College of Pharmacy, Darshan Chudasama of UGA's College of Public Health, and Stephen Correia and Lisa Renzi-Hammond of UGA's Institute of Gerontology. Other co-authors include Kai Zhang and Yiran Han.
