The Hidden Geography of Alzheimer's: Data-Driven Insights for Clinical Trial Site Selection
Data-driven insights reveal geographic inequities in Alzheimer's trial access. How to optimize site selection for better patient reach.
Smarter Clinical Trial Site Selection for a Fairer Future in Alzheimer's Research
This analysis is the result of research conducted by Kitsa, leveraging a dataset of more than 230 million patient records.
Introduction
Alzheimer's disease continues to escalate as one of the most pressing unmet healthcare challenges in the United States. Today, more than 7 million Americans aged 65 and older live with Alzheimer's (Alzheimer's Association, 2025), an all-time high, and this number is projected to nearly double by 2050.
Yet, despite the growing patient burden, trial infrastructure remains poorly aligned with need. In the past five years, more than 2,200 sites across the U.S. have participated in Alzheimer's trials. Currently, over 200 studies at various phases are recruiting patients across 1,000+ sites in the US. While site distribution generally mirrors wealth and population density, many high-prevalence regions—particularly rural and minority communities—remain underserved. Counties such as Cater (OK), Dubois (IN), Boyd (KY) lack a proportional trial presence.
This mismatch slows recruitment, increases costs, and limits access for patients who most need new therapies.
Kitsa's mission is to expose these inequities and help Pharma, CROs, and providers better align clinical trial site selection with true patient need. By mapping prevalence against trial site availability and layering socio-demographic factors, we enable smarter, patient-centric clinical trial site selection - accelerating trials, reducing recruitment costs, and creating competitive advantage.
How can data improve clinical trial site selection for Alzheimer's disease?
Uneven Geographic Distribution
A 2023 study presented at AAIC (Alzheimer's Association International Conference) unveiled the first-ever county-level estimates of Alzheimer's prevalence. It confirmed that eastern and southeastern counties bear disproportionately higher rates of Alzheimer's among adults 65+, driven by demographic risk factors like age, race, and ethnicity.
Kitsa extended this work, analyzing records from 230M+ patients, representative of the U.S. population. Using Census data, we calculated prevalence as the percentage of seniors (65+) diagnosed with Alzheimer's at the county level. Since 97% of all Alzheimer's patients in the U.S. are 65 or older, this is a reasonable approximation. Note: Counties are represented by treatment location, not necessarily by residence.
What does Alzheimer's prevalence look like at the state level?
At the state level, the number of diagnosed Alzheimer's patients generally aligns with the overall population size:
Number of Diagnosed Alzheimer Patients (2024)
| Rank | State | Rank | State | Rank | State |
|---|---|---|---|---|---|
| 1 | California | 6 | Michigan | 11 | Indiana |
| 2 | Texas | 7 | North Carolina | 12 | New Jersey |
| 3 | Florida | 8 | Pennsylvania | 13 | Tennessee |
| 4 | Ohio | 9 | Georgia | 14 | Virginia |
| 5 | New York | 10 | Illinois | 15 | Massachusetts |
However, a closer look reveals stark disparities. Many counties with the highest concentrations of Alzheimer's patients, often rural, high-minority, or lower-income communities, lack trial infrastructure.
Which County-level Hotspots provide opportunities for Alzheimer's trials?
Kitsa's analysis highlights the top 15 counties with the highest prevalence of Alzheimer's among seniors (65+). These findings are intended to guide clinical trial site selection strategy and create a heat map of underserved regions—not as academic estimates.
County-Level Alzheimer's Prevalence by Population Size
| Pop > 1M | Percent | 1M>Pop>500K | Percent | 500K>Pop>50K | Percent |
|---|---|---|---|---|---|
| Oakland, MI | 6% | Kent, MI | 7% | Orange, NC | 15%+ |
| Cuyahoga, OH | 4% | Hamilton, OH | 6% | Clarke, GA | 15%+ |
| Tarrant, TX | 4% | Lake, IN | 5% | Clermont, OH | 10% |
| Miami-Dade, FL | 4% | Knox, TN | 4% | Coffee, TN | 9% |
| Fulton, GA | 4% | Polk, IA | 4% | Boone, MO | 8% |
| Hennepin, MN | 4% | Montgomery, OH | 4% | Olmsted, MN | 8% |
| Collin, TX | 3% | Douglas, NE | 4% | Yolo, CA | 8% |
| Dallas, TX | 3% | Hidalgo, TX | 3% | Allen, IN | 7% |
| Mecklenburg, NC | 3% | Providence, RI | 3% | Story, IA | 7% |
| New York, NY | 3% | Davidson, TN | 3% | Albany, NY | 7% |
| Fresno, CA | 3% | Camden, NJ | 3% | Washtenaw, MI | 7% |
| Orange, CA | 2% | Summit, OH | 3% | Wyandotte, KS | 7% |
| Franklin, OH | 2% | Bergen, NJ | 3% | Lauderdale, AL | 6% |
| Wayne, MI | 2% | Ramsey, MN | 3% | Hendricks, IN | 6% |
| Gwinnett, GA | 2% | Fort Bend, TX | 3% | Seminole, FL | 6% |
These hotspots illustrate the hidden opportunities for Pharma and CROs to accelerate recruitment by activating clinical trial site selection where patients actually are.
Where are Alzheimer's trials currently concentrated?
In contrast, Alzheimer's trial infrastructure is heavily concentrated in academic and research hubs—Boston, New York, San Francisco, Los Angeles, Houston, and similar metros. National Institute on Aging–funded Alzheimer's Disease Research Centers (ADRCs) are clustered in these cities, leaving many high-prevalence rural areas without access.
This imbalance delays recruitment, inflates trial costs, and produces unrepresentative cohorts that fail to reflect the diversity and burden of the U.S. Alzheimer's population.
What steps can improve clinical trial site selection for Alzheimer's research?
The rising prevalence of Alzheimer's demands smarter, more targeted trial design, and geographically optimized clinical trial site selection. Public data makes the trend clear: while the East and Southeast show the highest prevalence overall, there are pockets of high disease concentration among older adults that remain overlooked.
Kitsa's Clinical Trial Site Selection bridges this divide by overlaying patient incidence data with trial site availability and social determinants of health (SDOH). The result: faster recruitment, fairer access, and more efficient trial execution.
What You Can Do
Sites: Boost visibility by becoming a Verified Site in Kitsa.
Pharma sponsors: Use Kitsa to identify diverse, underserved patient populations and optimize trial site placement.
Community providers: Partner with Kitsa to bring trials directly into your communities.
Patients and caregivers: Explore Kitsa to find trial opportunities near you.
FAQs
Q1. Why does clinical trial site selection matter in Alzheimer's research?+
Accurate site selection ensures trials are located where patients are, improving recruitment speed, lowering costs, and increasing diversity in Alzheimer's trial participation.
Q2. How can Kitsa's research improve Alzheimer's trial outcomes?+
By mapping county-level prevalence and trial infrastructure, Kitsa enables sponsors to identify underserved regions and make data-driven decisions about clinical trial site selection. This ensures faster, fairer, and more efficient execution.
Q3. What role can community providers play in expanding access to Alzheimer's trials?+
Community hospitals and providers in high-prevalence counties are well-positioned to host trials but are often overlooked. Partnering with them can broaden access, diversify cohorts, and make clinical trial site selection more inclusive.
Disclaimer
The insights shared here are derived from public data sources and Kitsa's proprietary analysis. While they highlight important trends in Alzheimer's prevalence and trial site distribution, figures are approximate and intended to guide discussion rather than serve as definitive research or medical advice.
Related Posts
Alzheimer's Trial Watch: October 2025
A comprehensive roundup of the latest Alzheimer's clinical trials, key updates, regulatory milestones, and emerging therapies shaping the future of dementia care.
Read More →
GLP-1 Changed Obesity Treatment. The Next Challenge May Be Clinical Trial Capacity
Over the past few years, very few drug classes have reshaped both medicine and the pharmaceutical industry as dramatically as GLP-1 receptor agonists. Originally developed for type 2 diabetes, drugs like semaglutide and tirzepatide have now become central to modern weight management.
Read More →
4 AI Misconceptions in Clinical Trials That Are Easy to Miss, but Costly to Ignore
AI is already influencing clinical trial design, but misconceptions delay its use until protocols are finalized, when preventable risk is already locked in.
Read More →