Healthcare providers are accelerating efforts to connect Alzheimer's patients to novel anti-amyloid therapies such as lecanemab and donanemab before early treatment windows close. To overcome a shortage of specialized cognitive neurologists, Sutter Health established a weekly review board that evaluated 447 referrals and expanded patient access. Advances in plasma p-tau217 blood testing and at-home diagnostic models further streamline early identification, though careful monitoring for amyloid-related imaging abnormalities (ARIA) remains critical.
Sutter Health review board operations and results
- ▪Between November 2023 and December 2025, Sutter Health's review board evaluated 447 referrals, identifying 334 eligible patients and resulting in 214 prescriptions for anti-amyloid therapy.
- ▪Sutter Health experienced a 148% increase in anti-amyloid therapy referrals from 2024 to 2025 following the implementation of its review board.
- ▪Sutter Health implemented the Advanced Therapy for Alzheimer's Disease Review Board to enable general neurologists to evaluate referrals and expand access to anti-amyloid therapies across its system.
- ▪The Sutter Health review board meets weekly virtual sessions with at least two cognitive neurologists, a pharmacist, an RN program manager, and a neuroradiologist, reviewing 12 to 14 cases per week.
Amyloid-related imaging abnormalities monitoring and occurrence
- ▪In Sutter Health's review of anti-amyloid therapy patients, 27 patients on lecanemab experienced ARIA (2.6% symptomatic) and 17 on donanemab experienced ARIA (1.7% symptomatic).
- ▪Anti-amyloid treatments carry boxed warnings for amyloid-related imaging abnormalities (ARIA), which involve brain swelling or microhemorrhages and require baseline and follow-up MRI monitoring.
Anti-amyloid therapy eligibility and clinical efficacy
- ▪In clinical trials, lecanemab slowed cognitive decline by 27% over 18 months, while donanemab slowed decline by 22% overall and 35% in low-to-medium tau groups over 76 weeks.
- ▪Anti-amyloid treatments like lecanemab and donanemab are initiated strictly in patients with mild cognitive impairment or mild dementia due to Alzheimer's with confirmed amyloid pathology.
Importance and low rates of early diagnosis
- ▪Dr. Cara Leahy of Memorial Healthcare Institute stated that early diagnosis of Alzheimer's disease is now as critical as early diagnosis in cancer due to the availability of disease-modifying therapies.
- ▪A Medicare-based study examining primary care practices from 2017 to 2019 estimated that only about 8% of expected mild cognitive impairment cases were officially diagnosed.
Blood tests for Alzheimer's diagnosis
- ▪Plasma p-tau217 is a blood biomarker measuring tau protein that helps identify Alzheimer's-related pathology, providing an accessible alternative to amyloid PET scans or spinal fluid testing.
- ▪The Alzheimer's Association guidelines support using accurate blood tests to triage symptomatic patients with objective cognitive impairment in specialty care settings.
Neurogen Biomarking diagnostic workflow
- ▪Neurogen Biomarking, founded by Dr. Rany Aburashed, offers an at-home blood collection kit for p-tau217 testing paired with digital cognitive assessments and neurologist consultation.
- ▪Neurogen's diagnostic model routes patients with positive or intermediate blood test results to specialist consultations, while sending negative results alongside educational summaries to primary care physicians.
Sutter Health expansion and reach
- ▪Sutter Health employs approximately 100 general neurologists and only five cognitive specialists to serve 3.5 million patients across California.
- ▪Sutter Health signed a definitive agreement to integrate with Minnesota-based Allina Health, with the transaction expected to close by the end of 2026 pending regulatory review.
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