Updated Early Alzheimer Care Pathway Aims to Improve Timely Diagnosis and Treatment in the US

Key Clinical Summary

• New Early AD Patient Care Pathway outlines scalable processes for identification, assessment, diagnosis, treatment, and monitoring of early Alzheimer disease.
• Evidence scan and expert panel highlight major needs: long wait times, limited specialist capacity, need for PCP involvement, and system-level coordination for biomarker testing and anti-amyloid therapy.
• Pathway includes operational readiness guidance covering technology, staffing, reimbursement, imaging access, and care coordination.

An updated Early Alzheimer’s Disease (AD) Patient Care Pathway has been developed to improve timely diagnosis, treatment, and care coordination across US health systems. The pathway—based on a published literature scan and an expert panel of clinicians and health system leaders—integrates emerging diagnostics, blood-based biomarkers, and anti-amyloid monoclonal antibody (mAb) therapies into a streamlined, adaptable model for early AD care.

Study Findings

The project combined a review of 74 publications with insights from 8 US advisors, including neurologists, geriatric specialists, a neuroradiologist, and health system directors. The evidence scan found persistent underdiagnosis of early AD despite rising prevalence—currently affecting 6.9 million Americans aged ≥65, with cases expected to double by 2050. Limited specialist capacity and wait times up to 50 months contribute to diagnostic delays, during which many patients progress from mild cognitive impairment (MCI) to AD.

The pathway emphasizes first-line evaluation by primary care providers (PCPs), who may conduct initial cognitive testing, order laboratory assessments, and rule out reversible causes before referral. Advisors agreed this approach could lessen burden on memory clinics, provided PCPs receive additional training and system support.

New diagnostic tools—including blood-based biomarker (BBM) assays—may refine patient selection and reduce reliance on amyloid PET or lumbar puncture. Advisors noted emerging guidance on BBM use and highlighted the need for radiology training to standardize identification of amyloid-related imaging abnormalities (ARIA), a key safety issue during mAb therapy.

The pathway outlines coordinated processes for imaging, infusion scheduling, prior authorization, and patient navigation. System-level challenges include shortages of social workers and care coordinators, fragmented electronic medical records, and complex insurance requirements for testing and treatment. Advisors recommended standardized quality measures such as referral-to-visit time, satisfaction metrics, and hospitalization rates.

Clinical Implications

The Early AD Patient Care Pathway offers a structured, scalable framework for integrating new diagnostic and therapeutic advances into routine care. By positioning PCPs at the front line of early evaluation, health systems may accelerate identification and reduce delays that diminish treatment effectiveness. The model also addresses operational readiness, urging health systems to evaluate imaging capacity, staffing needs, electronic medical record functionality, and reimbursement processes.

Given rapid growth in anti-amyloid therapies, robust ARIA monitoring protocols and coordinated radiology-infusion workflows are increasingly essential. The pathway’s emphasis on shared decision-making and patient education acknowledges the complexity of treatment choices and aims to support families navigating diagnosis, monitoring, and long-term care. Importantly, scalable, adaptable components enable application in diverse care settings, including rural and underserved areas where delays are most pronounced.

Conclusion

The Early AD Patient Care Pathway provides a comprehensive, adaptable guide for improving early detection, diagnosis, and management of Alzheimer disease. As health systems confront increasing demand and emerging therapies, implementing and refining this pathway may enhance operational efficiency, treatment access, and patient outcomes.

Reference

Nasrallah IM, Polacek C, Frech FH, et al. Early Alzheimer's disease patient care pathway and health system readiness: A framework for integrated care. Alzheimers Dement (N Y). 2025;11(4):e70162. doi:10.1002/trc2.70162