Health experts have warned that the NHS is not prepared for a new generation of Alzheimer's diagnostics and treatments, cautioning that the health service risks falling behind the pace of scientific progress. The warning follows a series of papers published in The Lancet, written by a panel of forty Alzheimer's disease researchers, which examined the changes needed for patients to benefit from recent drug breakthroughs.

The two most prominent new treatments, lecanemab and donanemab, work by targeting amyloid, a protein that builds up in the brains of people with Alzheimer's disease and is thought to contribute to cognitive decline. Both drugs have been licensed for use in the United Kingdom, but neither has been approved for NHS funding by the National Institute for Health and Care Excellence, which concluded that their benefits were too modest relative to their cost and the resources required to administer them.

Dr Richard Oakley, associate director of research and innovation at the Alzheimer's Society, said the Lancet papers marked the beginning of a new era in Alzheimer's diagnosis and treatment. However, he said the reality was that the NHS was simply not ready and was not keeping pace with the science. He warned there was a genuine risk that people living with dementia would miss the opportunity to benefit from recent breakthroughs.

Oakley called for the UK government to maintain its focus on the issue so that people with dementia were not left behind, and said better access to early diagnosis was essential so that patients did not miss the narrow window in which they remained eligible for treatment.

The infrastructure challenge is significant. Diagnosing patients accurately enough to qualify for disease modifying treatment typically requires PET scans or lumbar punctures to confirm amyloid build up in the brain, procedures that are not available at scale across the NHS. The drugs themselves are administered by regular infusion rather than as tablets, adding pressure to day hospital capacity, and patients must undergo ongoing MRI monitoring to check for side effects such as brain swelling, all of which relies on radiology services that are already under strain.

NICE has previously said that lecanemab's benefits were too small to justify its cost to the NHS, a judgment echoed in its later assessment of donanemab. Officials at NICE have acknowledged that any slowing of disease progression could be meaningful for patients with mild cognitive impairment, allowing more time for independence and reducing the burden on family carers, but concluded that the scale of resources required could not be justified against the modest clinical benefit shown in trials.

Because these drugs only slow decline rather than reverse existing damage, they are effective solely in the earliest stages of the disease. Campaigners have warned that patients frequently wait months or longer for a diagnosis through NHS memory clinics, by which point their condition may have progressed beyond the point of eligibility.

Charities have called for a national delivery plan that would coordinate investment in diagnostic equipment, expand specialist workforce training and streamline referral pathways between GPs, memory clinics and specialist centres. Without such a plan, campaigners argue, access to future treatments risks depending on the resources available at individual NHS trusts rather than on clinical need, creating disparities between regions.

The government has not yet set out a timetable for a dedicated national strategy on this issue, and the extent to which forthcoming reforms will address the diagnostic and infusion capacity gaps identified by researchers remains to be seen.

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