Virtual Review Board Brings New Alzheimer’s Drugs to Community Neurologists Safely

One of the most consequential questions in modern medicine is no longer whether new Alzheimer’s disease therapies work, but whether health systems can actually deliver them to the millions of patients who might benefit. A team at Sutter Health in Northern California believes it has found a workable answer, and the details of their experiment are now published in Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring. The report describes a multidisciplinary care model that allowed general neurologists, rather than a small cadre of subspecialists, to prescribe and monitor amyloid-targeting antibody therapies in community settings, while a centralized virtual review board supplied the specialist oversight that these demanding treatments require. The results offer one of the first real-world, health-system-scale looks at how the next generation of Alzheimer’s drugs might be scaled beyond elite memory centers.

The therapies in question, including the monoclonal antibodies lecanemab and donanemab, represent a genuine pharmacological milestone. By binding to amyloid-beta plaques in the brain and recruiting immune mechanisms to clear them, these agents can slow clinical progression in appropriately selected patients with early symptomatic Alzheimer’s disease. But their power comes with a formidable operational burden. Before a patient can receive an infusion, clinicians must confirm the diagnosis through specialized workups that may include amyloid PET imaging or cerebrospinal fluid biomarkers, exclude contraindications such as anticoagulant use or advanced atrophy on MRI, and carefully stage the disease. After treatment begins, patients require repeated MRI scans to watch for amyloid-related imaging abnormalities, or ARIA, a spectrum of brain edema and microhemorrhage that is usually asymptomatic but can, in rare cases, become serious or even fatal. Managing that risk demands fluency in neuroradiology, pharmacology and infusion nursing that most community practices have never needed to assemble.

That gap between what the drugs demand and what most health systems possess is stark at Sutter. The not-for-profit system cares for more than 3.6 million patients and employs more than 100 general neurologists, yet it has only five cognitive and behavioral neurologists, concentrated at two specialty memory centers. The arithmetic is unforgiving: if every candidate for amyloid-targeting therapy had to be evaluated, treated and monitored exclusively by those five subspecialists, access would be rationed by geography and waiting lists. Instead of funneling patients into tertiary centers, Sutter inverted the model. It created the Advanced Therapeutics for Alzheimer’s Disease, or ATAD, Review Board, a weekly virtual session that projects subspecialty expertise outward to neurologists across the entire system, keeping the patient’s care anchored in their own community.

The mechanics of the review board are deceptively simple but operationally sophisticated. Each session convenes cognitive neurologists, a neuroradiologist, a pharmacist and a registered nurse program manager, who together examine referred cases submitted by general neurologists. The board evaluates diagnostic evidence, weighs eligibility criteria, reviews MRI findings for ARIA risk and helps interpret ambiguous biomarker results. Crucially, the local neurologist retains responsibility for prescribing, follow-up and ongoing monitoring; the board functions as an advisory layer that supports eligibility decisions and can be consulted when side effects emerge during the treatment course. The design also works as a learning network: referring clinicians can join case discussions, receive the reasoning behind each eligibility determination and re-refer patients whenever new questions arise mid-treatment, so that expertise accumulates in the community over time rather than remaining locked inside the memory centers.

The published outcomes suggest the model is working at scale. From November 2023 through December 2025, the board received 574 referrals. The analysis focused on 447 fully reviewed cases submitted by 51 general neurologists, and 344 of those patients, or 77 percent, were judged eligible for treatment. Referral volume surged 148 percent year over year, from 163 cases in 2024 to 404 in 2025, a signal that community neurologists increasingly embraced the pathway as it matured. Of the eligible patients, 214 ultimately began an amyloid-targeting therapy through general neurology, meaning the majority of treated patients in this cohort never needed to rely on a subspecialist as their primary prescriber.

The safety data are the most closely watched element of the report, and they are broadly reassuring. Among treated patients, the rate of any radiographic ARIA was 17.4 percent for those receiving lecanemab and 28.8 percent for those receiving donanemab. Symptomatic ARIA, the clinically meaningful subset, occurred in just 2.6 percent and 1.7 percent of patients respectively. The authors note that these rates were lower than those observed in the pivotal phase 3 clinical trials and consistent with real-world studies emerging from specialty memory clinics, suggesting that community-based delivery did not compromise safety. They are careful, however, to flag a likely contributor to the favorable numbers: patient selection, including a lower proportion of patients carrying the higher-risk APOE epsilon 4 genotype, which is associated with elevated ARIA susceptibility, may have shaped the observed rates. The manuscript also reports two deaths among patients on treatment and explicitly acknowledges uncertainty about whether the therapies contributed, a candid note that underscores the necessity of careful counseling and vigilant monitoring regardless of where care is delivered.

What distinguishes the Sutter approach from a purely clinical observation is its institutional embedding. The ATAD Review Board sits within Sutter’s Neuroscience Service Line, which funded the program infrastructure, established a consistent workflow and disseminated updated clinical guidance across the system. The model knits together specialty memory expertise with community neurology, imaging services, pharmacy, infusion resources and nursing support into a single coordinated pathway. In an integrated delivery system, that architecture allows evidence and expertise to travel to the patient rather than requiring every patient to travel to a tertiary center for every aspect of care, a distinction that becomes decisive when the eligible population numbers in the thousands and the specialist workforce numbers in the single digits.

The leadership behind the program frames it as a proof of concept for system-level medicine. Armen Moughamian, M.D., Ph.D., the article’s lead author, chief of memory for Sutter’s Neuroscience Service Line and medical director of the Ray Dolby Brain Health Center at Sutter’s CPMC, emphasized that these therapies offer new hope but that putting them into everyday practice safely takes far more than writing a prescription, and that the model brings the right expertise to the patient’s local neurologist so more people can be evaluated closer to home while preserving rigorous review, monitoring and shared decision-making. Shawn Kile, M.D., chair of the Neuroscience Service Line and a co-author, described the service line as designed to move expertise, evidence and support across the system, noting that ATAD shows how an integrated system can translate scientific advances into coordinated, local care while keeping patient safety at the center.

The broader significance of the findings lies in reframing the challenge of Alzheimer’s innovation. The pivotal trials of lecanemab and donanemab answered whether amyloid removal slows decline; they did not answer how a nation with a severe shortage of dementia specialists can administer these regimens to a population that skews rural, elderly and geographically dispersed. The Sutter model offers one template: pair local prescribing and follow-up with centralized multidisciplinary oversight, and use the review process itself as a vehicle for training community clinicians. The authors propose that similar review boards could help other health systems expand access while maintaining specialist input, an approach that could prove especially valuable for systems that, like Sutter, have many general neurologists but few cognitive specialists.

Important caveats temper the enthusiasm. The article is a perspective describing implementation and observational outcomes, not a randomized trial, so the safety figures reflect a selected population and a self-referred cohort rather than an experimental comparison. No external funding supported the data collection or manuscript preparation, and the authors themselves caution that favorable ARIA rates may partly reflect conservative patient selection. Still, as amyloid-targeting therapies move from trial protocols into routine practice, the Sutter experience provides a concrete, quantified demonstration that the bottleneck in Alzheimer’s care is not scientific but logistical, and that a weekly virtual meeting of five kinds of expertise may be enough to break it.

Subject of Research: A multidisciplinary virtual review board model for expanding community access to amyloid-targeting Alzheimer's disease treatments

Article Title: Sutter examines how health systems can expand access to new Alzheimer’s treatments

Article References: Sutter examines how health systems can expand access to new Alzheimer’s treatments. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: Alzheimer's disease, amyloid-targeting therapies, lecanemab, donanemab, ARIA, general neurology, health system delivery, Sutter Health, cognitive neurology, virtual review board, patient safety, health care access