Italian intersocietal recommendations for restructuring the diagnostic-therapeutic pathway for the implementation and appropriate use of anti-amyloid monoclonal antibodies in Alzheimer’s disease
Alberto Benussi, Federica Agosta, Alba Rosa Alfano, Antonio Antico, Giuseppe Bellelli, Laura Bonanni, Gabriella Bottini, Marco Bozzali, Ovidio Brignoli, Giuseppe Bruno, Annachiara Cagnin, Sonia Francesca Calloni, Diego Cecchin, Marcello Ciaccio, Sirio Cocozza, Mirco Cosottini, Diego De Leo, Andrea Falini, Lorenzo Gaetani, Fabio Gotta, María Infantino, Raffaele Lodi, Giancarlo Logroscino, Elena Marcello, Camillo Marra, Walter Marrocco, Patrizia Mecocci, Enrico Mossello, Alessandro Padovani, Lorenzo Palleschi, Leonardo Pantoni, Lucilla Parnetti, Sandro Sorbi, Alessandro Tessitore, Andrea Ungar
Abstract
This joint Position Paper, developed by the Italian Expert Panel on Alzheimer convened by the Italian Society of Neurology with participation from multiple scientific societies, outlines strategic guidelines for reorganizing the patient journey in the era of anti-amyloid monoclonal antibodies for Alzheimer's disease. Emphasizing a multidisciplinary and integrated approach, the document recommends a patient journey that begins with early identification of cognitive impairment by General Practitioners, continues with specialized assessments at Memory and Dementia Centres, and leads, in carefully selected cases, to initiation of anti-amyloid monoclonal antibody therapy. It advocates the rational use of diagnostic tools, including plasma and cerebrospinal fluid biomarkers, advanced neuroimaging (MRI and PET), and genetic profiling (ApoE genotyping), not only to identify eligible patients but also to stratify those requiring alternative care strategies. The paper further defines minimum requirements for the accreditation of prescribing and infusion centres, highlighting the clinical competencies, structural resources, and inter-professional communication protocols necessary to ensure safety and appropriateness. Recognizing both the therapeutic potential and the organizational challenges associated with anti-amyloid monoclonal antibodies, the document aims to guide healthcare policymakers, institutions, and practitioners toward a coordinated reorganization of the diagnostic-therapeutic pathway, ensuring the safe and effective use of these treatments and ultimately improving outcomes and quality of care for individuals with Alzheimer's disease.