A care model developed across Sutter Health has allowed general neurologists to offer newer Alzheimer's treatments in community settings, and the authors say the approach can be run safely. Lead author Armen Moughamian, M.D., Ph.D., and colleagues reported the results in Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring.
The drugs at the center of the work are amyloid-targeting therapies, which can slow progression in carefully selected patients with early symptomatic Alzheimer's disease. They demand more than a prescription. Patients need specialized diagnostic workups, careful selection, and repeated MRI monitoring because of a risk of amyloid-related imaging abnormalities, known as ARIA.
Sutter has more than 100 general neurologists but only five cognitive and behavioral neurologists, based at two specialty memory centers. Rather than funneling every patient to those sites, Sutter built a weekly virtual review board called the Advanced Therapeutics for Alzheimer's Disease (ATAD) Review Board. Each session includes cognitive neurologists, a neuroradiologist, a pharmacist and a registered nurse program manager. The local neurologist still prescribes, follows up and monitors the patient, while the board weighs in on eligibility and can advise when side effects appear.
From November 2023 through December 2025, the board received 574 referrals. The authors analyzed 447 fully reviewed cases from 51 general neurologists, and 344 patients (77%) were judged eligible. Annual referrals rose 148%, from 163 cases in 2024 to 404 in 2025. Of the eligible patients, 214 started an amyloid-targeting therapy through general neurology.
Among treated patients, any radiographic ARIA occurred in 17.4% receiving lecanemab and 28.8% receiving donanemab. Symptomatic ARIA was reported in 2.6% and 1.7%, respectively. The authors say these rates were lower than in the pivotal phase 3 trials and similar to real-world studies from specialty memory clinics, though they caution that patient selection, including fewer patients with a higher-risk APOE genotype, may have played a role. The manuscript also reports two deaths among treated patients and says it is uncertain whether the therapies contributed.
The findings matter because they speak to a question beyond whether a drug works in a trial: how health systems can deliver it safely and more widely at a time of national shortage of dementia specialists. The authors propose that similar review boards could help other health systems expand access while keeping specialist input in place.