Radiology and Building the Alzheimer’s Care Pathway of the Future

More than 7 million Americans are living with Alzheimer’s disease today, a number projected to nearly double by 2050 as the population ages. The statistics are sobering. Seventy-five percent of people living with dementia remain undiagnosed.¹ However, emerging therapeutic interventions demonstrating the potential to slow disease progression are causing a reshaping of the clinical landscape for diagnosis, treatment and long-term management in Alzheimer’s disease.

With growing public awareness that better outcomes are often tied to how early the disease is diagnosed, increasingly, people suffering with memory complaints and other cognitive challenges are seeking answers earlier. The Alzheimer’s Association has found that nearly four in five Americans would want to know if they had Alzheimer’s disease before symptoms significantly affected their lives, and more than 90 percent say they would take a treatment that could slow disease progression if one was available.

That combination of rising prevalence, growing patient awareness, and the emergence of disease-modifying therapies are fundamentally changing what health systems must be prepared to deliver. Alzheimer’s care is gradually moving beyond symptom management toward supporting earlier, more confident diagnosis, personalized treatment decisions and coordinated long-term monitoring, but the increased demand for diagnostic imaging, monitoring and other capabilities is already straining their existing framework.

As health systems prepare for this next chapter of coordinated care, five priorities stand out.

How Can We Facilitate Earlier and More Confident Diagnosis of Alzheimer’s Disease?

The greatest opportunity in Alzheimer’s care lies in timely and accurate diagnosis since patients are likely to benefit more from treatment interventions when diagnosed early in the course of the disease. Clinicians also need to confirm that Alzheimer’s disease pathology is present before treatment begins.

Historically, the diagnosis of Alzheimer’s disease has relied on a combination of clinical assessment, cognitive testing and, when appropriate, biomarker confirmation through approaches such as cerebrospinal fluid testing.

Today, advances across amyloid and tau PET, structural MRI and evolving biomarker science are giving clinicians more ways to estimate the Alzheimer’s pathology and characterize the underlying biology of disease. This allows clinicians to make more informed diagnostic and treatment decisions based off quantitative measurements that AI image analysis software can provide.

Essential Cornerstones of Imaging to Guide Appropriate Patient Selection and Precision Medicine for Alzheimer’s Care

Today, amyloid remains central to confirming Alzheimer’s pathology and identifying patients who may be eligible for anti-amyloid therapies. However, the field is increasingly looking beyond amyloid alone to develop a more complete picture of an individual patient’s disease. Tau pathology, neuroinflammation, glymphatic circulation, vascular characteristics, genetics, comorbidities and other patient-specific factors are becoming increasingly important areas of research and clinical understanding.

Amyloid and tau, for example, provide different insights into Alzheimer’s biology. Amyloid can help establish whether a hallmark pathology of Alzheimer’s is present while tau is more closely associated with disease stage and clinical symptoms. As science evolves, bringing these different signals together may allow clinicians to better understand not simply whether disease is present, but to predict if it is progressing and how individual patients may differ.

Patient characteristics matter as well. Age, genetics, comorbidities and racial and ethnic background can influence disease risk and biomarker interpretation, reinforcing the need to validate diagnostic approaches across diverse populations and move toward increasingly individualized care pathways. While MRI images today are generally reviewed for structural information, there is keen interest in deriving vascular and other functional measurements from these images that could potentially help in early detection and subtyping of Alzheimer’s disease.

Why MRI Monitoring Plays a Critical Role in the Alzheimer’s Care Pathway

MRI scans are also used by clinicians when determining if a patient is eligible to receive therapy, but treatment decisions don’t end there. The recently approved amyloid-targeting Alzheimer’s therapies require ongoing imaging to monitor for treatment-related side effects, including amyloid-related imaging abnormalities (ARIAs), making imaging an essential part of patient management throughout treatment.

Magnetic resonance imaging is now playing an increasingly important role throughout the treatment pathway, helping clinicians monitor patients over time and make informed decisions about continuing, adjusting or pausing therapy.However, as more patients become eligible for treatment, the challenge will not simply be performing more MRI scans. Health systems will also need intelligent digital tools that can help clinicians review the images, identify, quantify and track treatment-related imaging changes consistently over time and make timely dosing decisions based off the image review as needed.

By helping surface subtle changes, compare findings across serial exams and support more standardized assessment of ARIAs, these technologies have the potential to make monitoring more efficient and scalable while keeping clinical judgment at the center of decision-making. The emphasis on standardized and scalable monitoring will become particularly critical, especially as patient volumes continue to rise, to ensure more structured, data-driven decision-making in Alzheimer’s care.

Recognizing the Importance of Connected Care Across the Multidisciplinary Pathway for Alzheimer’s Disease

In today’s evolving landscape, Alzheimer’s care is multidisciplinary, involving neurologists, radiologists, primary care physicians, infusion centers, imaging departments and caregivers. When these teams operate in disconnected systems, delays, duplicated testing and fragmented communication can create unnecessary complexity and lapses in critical points for both clinicians and patients.

The clinical data being assessed in the Alzheimer’s care pathway comes from clinical history, cognitive assessment, genetic information, molecular imaging, structural MRI, laboratory testing, and other clinical information. The challenge is no longer simply generating data. It is having the right tools to extract insights and get clarity from the complex, voluminous data at the right moment to support confident decisions across diagnosis, treatment and ongoing monitoring in order to have the complete patient context throughout the pathway.

Blood-based biomarkers are also emerging as a potentially important part of this ecosystem although their role in routine care continues to evolve. Given that Alzheimer’s disease is a population-level disease, they could play a vital role in removing access barriers through early triaging that helps to prioritize patients needing amyloid confirmatory tests such as amyloid PET scans. They may help triage patients for more definitive evaluation, which could expand access while increasing the need for efficient confirmatory imaging and connected workflows.

Establishing a Foundation for Rapid and Safe Adoption of Future Advances

The pace of innovation in Alzheimer’s disease continues to accelerate. While amyloid targeting therapies target one aspect of Alzheimer’s disease pathophysiology, the next generation of Alzheimer’s care is likely to look beyond amyloid alone.

Researchers are increasingly studying tau, inflammation and other biological processes that may help explain why the disease progresses differently from one patient to another. At the same time, new biomarkers, imaging approaches, digital tools and therapeutic strategies are creating more ways to characterize disease and potentially personalize care. Simultaneously, there is more study of lifestyle effects that may inform preventive measures for the disease.

That means health systems cannot build care pathways around a single therapy, diagnostic test, or biomarker. They need adaptable infrastructure, scalable workflows and digitally connected imaging ecosystems that can incorporate new innovations as science evolves. Preparing for the future is about creating a foundation flexible enough to incorporate those advances quickly, safely and effectively.

Looking Ahead

For years, the conversation around Alzheimer’s disease focused primarily on finding better treatments. However, the next chapter will also have to focus on something equally important: building the coordinated care pathways and the care delivery infrastructure that allow those treatments to reach the right patients at the right time with the right diagnostic confidence and right ongoing support. As patients increasingly seek earlier answers and new treatment options, the ability to deliver that pathway at scale will become even more important.

Reference

1. Alzheimer’s Disease International. World Alzheimer Report 2022: Life after Diagnosis—Navigating Treatment, Care and Support (2022). Available at:https://www.alzint.org/resource/world-alzheimer-report-2022/