Yesterday’s announcement from NICE that it has not recommended the disease-modifying Alzheimer’s treatments Donanemab and Lecanemab for use in the NHS marks a moment of both opportunity and disappointment.
As the first treatments shown to modify the course of early Alzheimer’s disease, these medicines represent a significant scientific breakthrough. While their current clinical benefits are modest and risks are non-negligible, their approval by regulatory bodies, including the MHRA, signals the beginning of a new era in dementia therapeutics.
However, scientific progress alone is not enough. As geriatricians and clinicians working closely with people living with dementia, we are acutely aware of the ongoing gaps in diagnosis, service capacity, and long-term care infrastructure. Nearly a third of people with dementia never receive a formal diagnosis. Post-diagnostic support is uneven and often unavailable. Even if these novel treatments were funded by the NHS, most patients would not yet be able to access them.
Instead, this should be a call to action. We need to invest in fair and practical ways to diagnose dementia and neurodegenerative disease early. We need to build up the teams and services that support people, in particular older people, with cognitive problems, and ensure that person-centred care remains at the heart of any new developments.
We urge the UK government and NHS to commit to the strategic planning and funding needed to prepare our healthcare system, not just for these treatments, but for the many others in development. Dementia is not a niche issue; it is a defining challenge of our ageing population.
Now more than ever, we need to align clinical ambition with systems transformation. The future is approaching fast – let us be ready for it.
