Organizing healthcare delivery in the era of disease-modifying therapies for Alzheimer’s Disease: an Italian RAND/UCLA consensus

Abstract

BACKGROUND: Alzheimer's disease (AD) poses a growing clinical and organizational challenge, requiring coordinated, multidisciplinary care models. In Italy, significant regional variability in resources and access to diagnostic services persists, while the implementation of community-based care models, the expanding role of biomarkers, and the advent of disease-modifying therapies (DMTs) further highlight the need for a more coordinated and equitable dementia care network. OBJECTIVE: Develop system-level recommendations to optimise the organisation of AD care delivery in Italy in anticipation of DMTs introduction. METHODS: Using the RAND/UCLA Appropriateness Method, a multidisciplinary panel rated 55 statements across nine domains, evaluating appropriateness in two rounds and priority of implementation in a third round. RESULTS: Consensus was achieved for all statements, with high appropriateness and priority ratings. The statements outline a regional, network-based model organised across territorial services, Spoke and Hub centres, with formal governance responsible for pathway definition and monitoring. Referral pathways from primary care are based on cognitive and frailty assessment, with non-frail patients referred to Spoke for clinical, neuropsychological and neuroradiological evaluation. Patients potentially eligible for DMTs are referred to Hub centres, where diagnostic confirmation is completed and multidisciplinary teams assess treatment eligibility. When authorised, Hub centres are responsible for DMTs prescription and administration. The statements emphasise the need for standardised neuropsychological and neuroradiological protocols for amyloid-related imaging abnormalities (ARIA) monitoring, alongside the progressive adoption of plasma biomarkers, telemedicine, and structured communication with patients and caregivers. CONCLUSION: This consensus provides a pragmatic framework to support the reorganisation of AD care in Italy, ensuring that every patient is directed to the most appropriate level of care across a flexible regional network.