Sutter Health care model safely expands local Alzheimer's treatment

A multidisciplinary care model developed across Sutter Health helped general neurologists address a practical challenge facing health systems nationwide: how to safely offer newer Alzheimer's disease treatments in community settings to more patients. The results of their discoveries were published today in Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring.

Amyloid-targeting therapies can slow progression in appropriately selected patients with early symptomatic Alzheimer's disease, but they require specialized diagnostic workups, careful patient selection and repeated MRI monitoring because of potentially serious side effects known as amyloid-related imaging abnormalities, or ARIA. The publication describes how Sutter's Advanced Therapeutics for Alzheimer's Disease (ATAD) Review Board draws on the expertise of cognitive neurologists, neuroradiology, pharmacy and nursing to bridge those gaps.

Sutter cares for more than 3.6 million patients and has more than 100 general neurologists, but only five cognitive and behavioral neurologists concentrated at two specialty memory centers. Instead of limiting treatment to those centers, Sutter built a weekly virtual review board that extends specialty expertise to neurologists across its system. Each session includes cognitive neurologists, a neuroradiologist, a pharmacist and a registered nurse program manager. The local neurologist remains responsible for prescribing, follow-up and monitoring, while the board supports eligibility decisions and can advise when side effects arise.

These therapies offer new hope, but putting them into everyday practice safely takes much more than writing a prescription. Our model brings the right expertise to the patient's local neurologist, helping more people be evaluated closer to home while preserving rigorous review, monitoring and shared decision-making."

Armen Moughamian, M.D., Ph.D., the article's lead author, chief of memory for Sutter's Neuroscience Service Line and medical director, Ray Dolby Brain Health Center at Sutter's CPMC

Real-world results at health-system scale

From November 2023 through December 2025, the board received 574 referrals. Dr. Moughamian and his collaborators analyzed 447 fully reviewed cases submitted by 51 general neurologists; 344 patients, or 77%, were considered eligible for treatment. Annual referral volume rose 148%, from 163 cases in 2024 to 404 in 2025, suggesting growing use of the model by community neurologists. Of the eligible patients, 214 began an amyloid-targeting therapy through general neurology.

Among those treated, the rate of any radiographic ARIA was 17.4% for lecanemab and 28.8% for donanemab. Symptomatic ARIA occurred in 2.6% and 1.7% of patients, respectively. The authors report these rates were lower than those in the pivotal phase 3 trials and consistent with real-world studies from specialty memory clinics. They also caution that patient selection, including a lower proportion of patients with a higher-risk APOE genotype, may have contributed to the observed rates. The manuscript reports two deaths among patients on treatment and notes uncertainty about whether the therapies contributed, underscoring the need for careful counseling and monitoring.

From research findings to care across Sutter Neuroscience Services

The ATAD Review Board is embedded in Sutter's Neuroscience Service Line, which funded program infrastructure, helped establish a consistent workflow and disseminated updated guidance across the system. The model connects specialty memory expertise with community neurology, imaging, pharmacy, infusion resources and nursing support. It is also designed as a learning network: referring clinicians can join case discussions, receive the rationale behind eligibility decisions and re-refer patients when questions arise during treatment.

"Sutter's Neuroscience Service Line is designed to move expertise, evidence and support across our system, rather than requiring every patient to travel to a tertiary center for every aspect of care," said Shawn Kile, M.D., chair of Sutter's Neuroscience Service Line and a co-author of the paper. "ATAD shows how an integrated system can translate scientific advances into coordinated, local care while keeping patient safety at the center."

The findings offer a real-world look at the next challenge in Alzheimer's innovation: not simply whether a therapy works in a clinical trial, but how health systems can deliver it safely and more broadly amid a national shortage of dementia specialists. The model differs from an exclusively specialty-center approach by pairing local prescribing and follow-up with centralized multidisciplinary oversight. The authors propose similar review boards could help other health systems expand access while maintaining specialist input.