A new era in Alzheimer's disease management – are we ready?

The availability of new diagnostics and new amyloid-targeting therapies as well as the shift in approach from symptom management to targeting disease pathology mark a truly new era in Alzheimer’s disease (AD) management, according to Professor Jeffrey Burns of the Alzheimer's Disease Research Centre, The University of Kansas, Kansas, US, who spoke at the 29^th Hong Kong Medical Forum. 

“Delivering this specialized care requires significant changes, as it is reliant on careful patient selection through use of biomarkers, and a system needs to be in place for careful monitoring of eligible patients,” said Burns. “However, critical questions are: what are the [real] benefits and are our systems ready?”

Biomarker testing enables early diagnosis & Tx

For over a century, definitive diagnosis of AD required postmortem detection of amyloid plaques and tau tangles. “Now, accessible blood tests with 90 percent sensitivity or specificity in detecting amyloid are available, enabling early detection in patients with clear history of cognitive decline. Integrating biomarker testing into diagnostic pathways allows us to identify eligible patients for amyloid-reducing therapies,” said Burns. [eBioMedicine 2024;109:105405; JAMA 2024;332:1240-1241]

A recent clinical trial demonstrated that anti-amyloid therapy (with lecanemab) brought about a significant reduction in amyloid plaques on PET scan over 18 months, which corresponded with a 30 percent slowing of cognitive decline vs placebo in patients with early AD. [N Engl J Med 2023;388:9-21]

“While these therapies offer clinically significant benefits [the pros], it is important for us to weigh the cons of starting these drugs, such as treatment burden, costs and safety,” Burns advised.

Anti-amyloid Tx clinic addresses system gaps

Despite these advances in AD diagnosis and treatment, significant challenges remain. “With the ageing population, shortage of neurologists, limited primary care training in cognitive assessment tools, and inefficient workflows, our systems are not yet ready to deliver this kind of care,” said Burns.

To address these gaps and find ways to cope with the growing and complex demands of AD treatment, Burns and colleagues started the Anti-Amyloid Treatment Clinic at the University of Kansas (KU-AATC) Health System. The team explored the feasibility of a dedicated clinic model designed to streamline the process of selecting patients, initiating and supporting anti-amyloid therapies, and optimizing safety through monitoring and addressing treatment-related adverse events, using a multidisciplinary team approach. [J Am Geriatr Soc 2025;doi: 10.1111/jgs.19461]  

Data from the clinic’s first 18 months of operation, with about 140 patients having been treated to date, suggest that the specialized clinic model can support safe, accessible, and efficient care for AD patients. “The model could be scalable for healthcare systems in adapting to the demands of emerging AD treatments. Expanding similar clinics may address neurologist shortages and improve equitable access to advanced therapies,” suggested Burns.

“Empowering primary care physicians is also essential in expanding access to dementia care,” Burns emphasized. “They need to be provided with tools as well as training to use those tools. They also require support through co-management clinics like our AATC and cognitive support clinic.”