Alzheimer’s: new treatments are transforming care, but a new organisational model is needed

For decades, treatments for Alzheimer’s disease have had a specific aim: to alleviate symptoms without being able to alter the course of the disease. Today, the landscape is changing: anti-amyloid monoclonal antibodies, such as lecanemab and donanemab, are ushering in a new era in the treatment of the disease, offering the possibility of slowing its progression in the early stages.
This is a scientific breakthrough set to transform clinical practice, but the healthcare system needs to be reorganised to ensure these treatments are truly accessible and safe.
Professor Massimo Filippi, director of the Neurology Unit, the Neurophysiology Service and the Neurorehabilitation Unit at theRCCS San Raffaele Hospital and Professor of Neurology at the Vita-Salute San Raffaele University, explains how, for the first time, it is possible to intervene in the biological mechanisms of the disease and how the success of this innovation will depend on the ability to develop new models of care.
The experience of the CARD centre at San Raffaele
This topic is the focus of the Personal View published by Prof. Filippi in The Lancet Regional Health - Europe, which recounts the experience of the Centre for Alzheimer’s and Related Disorders (CARD) at the IRCCS San Raffaele Hospital, one of the first in Europe to have introduced the new anti-amyloid therapies.
The aim was not merely to use new drugs, but to develop a new care pathway to support patients from diagnosis through to monitoring during treatment. A multidisciplinary model involving neurologists, neuroradiologists, neuropsychologists, nuclear medicine specialists, pharmacists and nursing staff, ensuring comprehensive care.
Patient selection
One of the most innovative aspects concerns the patient selection process. The process begins with a triage, including via telemedicine, followed by an in-depth assessment comprising cognitive tests, biomarkers in blood and cerebrospinal fluid, MRI, brain PET and genetic analyses.
The aim is to identify, with greater precision, those patients who may benefit from the therapy, moving beyond overly rigid criteria based solely on cognitive test scores.
“Patient selection must be based on an integrated set of clinical, functional and biological data,” emphasises the expert. Only in this way is it possible to offer a truly personalised treatment, even to those with less typical forms of the disease.”
Safety depends on organisation
New therapies also require a monitoring system that is highly rigorous. Monoclonal antibodies may be associated with so-called ARIA, changes observable on magnetic resonance imaging, which are generally manageable if recognised promptly.
For this reason, monitoring is an essential component of treatment; there is a need for regular check-ups, shared protocols, rapid access to diagnostic tests and constant communication between hospitals, GPs, specialists, patients and carers.
Safety does not depend solely on the drug, but on the existence of an organisation capable of supporting the patient throughout their entire journey.
The value of communication
Alongside the clinical aspects, the role of communication comes to the fore. Expectations regarding these new treatments are understandably high, but it is important to clarify that these are not medicines capable of curing Alzheimer’s.
The aim is to slow the progression of the disease, preserving memory, independence and quality of life for as long as possible. This is a significant achievement, considering that until a few years ago no treatment could do this.
For this reason, ongoing dialogue becomes an integral part of care, fostering shared decision-making and greater awareness of treatment objectives.
A challenge affecting the whole country
In Italia, there are over 600,000 patients suffering from Alzheimer’s, a figure set to rise.
The introduction of new therapies therefore makes it necessary to rethink the organisation of care. Networks between centres, uniform access to biomarkers, training for healthcare professionals and clinical registries will be essential tools to ensure that innovation is not confined to a handful of highly specialised hospitals.
A revolution in its infancy
The experience gained at the San Raffaele Hospital in Milan shows that it is possible to establish a rapid, multidisciplinary and personalised care pathway, but this represents only the first step in a wider change that will need to involve the entire National Health Service.
“We are learning that true innovation is not just pharmacological, but also organisational and cultural,” concludes Prof. Filippi. “For the first time, we can intervene in the mechanisms of the disease. Now we must ensure that this opportunity becomes a reality – one that is equitable and sustainable for all.”
The revolution in the treatment of Alzheimer’s has begun. For it to produce lasting results, it must be accompanied by an equally profound transformation of care models, placing at the centre not only the medication, but the entire care pathway.