Redefinition of dementia care in Italy in the era of anti‐amyloid agents for Alzheimer’s disease: an Expert Opinion and practical guideline

Abstract Background Current evidence from clinical trials testing anti‐beta amyloid (Aβ) monoclonal antibodies (mAbs) in patients with early Alzheimer’s disease (AD) suggests a likely authorization in Europe in the next years, requiring a huge change of dementia care in all countries. Method A group of prominent AD clinical experts in Italy met to discuss patients’ selection for immunotherapies and management strategies. The current diagnostic‐therapeutical standards in Italy were taken as the starting‐point. Result Immunotherapies’ prescription must follow a biological diagnosis of AD, defined through the assessment of both amyloidopathy and tauopathy biomarkers. Their high risk/benefit ratio, moreover, needs a highly specialized diagnostic assessment, which should be dispensed by a neurologist. The Expert Panel suggests a reorganization of dementia and cognitive decline centers (CDCD) for the diagnosis of AD in Italy into 3 levels of increasing complexity, with specific tasks and requirements/resources: 1) community centers, with at least 1 neurologist / geriatrician / psychiatrist, with global screening purposes; 2) first‐level centers, deputed to biological diagnosis; and 3) second‐level centers, requiring the presence of on‐site facilities for the biological diagnosis and of at least one neurologist with expertise also in rarer neurodegenerative syndromes. Finally, specific characteristics of a center deputed to prescribe anti‐Aβ mAbs were discussed, highlighting the need for clinical and neuroradiological management protocols. Conclusion The number of potentially treatable patients in Italy will be tens of thousands. To successfully face such a breakthrough, a quick reorganization of Italian CDCDs will be required, together with the allocation of the necessary resources. Funding: Unrestricted grants from Biogen.