The UPMC Neurological Institute’s Cognitive Therapies Program is working to provide patients with early-stage Alzheimer's disease access to infusion-based treatments that aim to slow cognitive decline. Led by Riddhi Patira, MD, a neurologist specializing in neurodegenerative conditions, the program offers two FDA-approved therapies —lecanemab and donanemab — that target amyloid protein buildup in the brain.
“The idea is that by removing amyloid, we may be able to slow disease progression,” says Dr. Patira. “While these treatments are not a cure, they represent an important step in managing Alzheimer's disease at its earliest stages.”
The program has undergone a gradual expansion to offer eligible treatments to a growing number of patients, with safety remaining the top priority. The Infusion Center at UPMC Magee-Womens Hospital, located within the MS Center, is staffed by highly trained professionals committed to delivering the highest quality care to neurological patients. In addition, UPMC Emergency Departments have been informed of the potential risks associated with cognitive infusion therapies, ensuring patients receive appropriate and timely care when needed.
As the landscape of cognitive therapies continues to evolve — from infusions to newer injectable treatments — the team also is developing a streamlined process for the rapid triage of candidates for these therapies. The UPMC team supports patients throughout the entire continuum of care, from insurance authorization to scheduling neuroimaging appointments, ensuring a seamless and patient-centered experience.
“It has taken a lot of teamwork from many people to create this program, and it would not be possible without their ongoing help and expertise,” says Dr. Patira. “From department and hospital leadership, the UPMC Magee nursing staff, both neuroradiology nuclear medicine, the neurology office staff, our authorization staff, it’s a true team effort.”
Patient Eligibility and the Evaluation Process – A Multidisciplinary Approach
Patients considered for these therapies undergo a detailed evaluation to confirm eligibility. Treatment is approved only for those in the mild stage of Alzheimer's, as research indicates that the benefits of these therapies are most effective in this population.
“This is a comprehensive process,” says Dr. Patira. “We use imaging, cognitive assessments, and clinical history to ensure the right patients are receiving these therapies.”
The diagnostic process includes confirming amyloid presence through PET imaging or cerebrospinal fluid analysis. MRI scans are also required to rule out contraindications, and each patient’s case is carefully reviewed in multidisciplinary conferences where neurology and neuroradiology teams discuss eligibility.
“Each patient’s case is carefully reviewed to ensure the criteria are met and that there are no contraindications such as cerebral microbleeds or other structural concerns,” says Dr. Patira.
Given the complexity of the evaluation and treatment initiation, patients must also have a strong support system in place. Those who live alone are not eligible for treatment due to the need for ongoing monitoring and adherence to follow-up care.
Approval for treatment can take weeks to months, depending on insurance authorization and scheduling availability for required testing and confirmation of the patient’s diagnosis and cognitive status.
“There are multiple steps involved before a patient can start therapy, including confirming insurance coverage, obtaining necessary imaging, and completing baseline assessments,” says Dr. Patira. “It is not a fast process, but it is essential to ensure safety and efficacy.”
Challenges of Infusion-Based Therapy
Unlike oral medications, these therapies require regular intravenous infusions, which must be administered in a clinical setting.
“Patients need to come to the hospital regularly for their infusions, which can be every two to four weeks depending on the drug,” says Dr. Patira. “This requires significant commitment, both from patients and their caregivers.”
Cost can also be a consideration, as these treatments are expensive. While Medicare and some insurance plans cover the therapies for eligible patients, the approval process varies, and patients may have co-pays or other financial responsibilities.
“Insurance coverage is improving, but there are still logistical and cost hurdles for many patients who meet the eligibility requirements,” says Dr. Patira. “We work closely with families to navigate these challenges.”
Ongoing Monitoring and Data Collection
Patients receiving these infusions are closely monitored with follow-up cognitive testing every six months.
“Alzheimer’s usually progresses slowly, making it difficult to determine the effect of treatment in a short period,” says Dr. Patira. “We assess patients over at least 18 months to understand how they respond to therapy. That’s another eligibility requirement – they have to commit to at least the first 18 months of therapy.”
While individual patient response can vary, the therapies are designed to slow the decline rather than reverse symptoms.
“Some patients remain stable for a period, while others may continue to decline despite treatment,” says Dr. Patira. “It is difficult to predict exactly how each individual will respond over time.”
Beyond individual patient monitoring, the program is contributing to broader research efforts by participating in national and local registries that track treatment outcomes. Medicare requires the submission of cognitive test data as part of the reimbursement process, allowing for ongoing assessment of therapy efficacy on a national scale.
Dr. Patira has also developed a local registry to collect real-world data, which will help refine treatment strategies and inform future care models.
“We need long-term data to truly understand how these therapies impact disease progression years down the road,” says Dr. Patira. “The more we can contribute to these registries, the better we can refine our approach to care and who may benefit the most from the current therapies we have to offer.”
A Multidisciplinary Approach to Alzheimer’s Care
The Cognitive Therapies Program integrates expertise across multiple specialties, ensuring patients receive comprehensive evaluation and support throughout their treatment journey. Regular case discussions between neurology and neuroradiology specialists help confirm eligibility and optimize patient selection.
“We want to make sure these therapies are being used appropriately and effectively,” says Dr. Patira. “Our approach is thoughtful and evidence-based, ensuring that patients who qualify receive the best possible care.”
The program also works closely with infusion services to coordinate treatment schedules and ensure patient safety during administration. Given the specialized nature of these infusions, careful planning is required to accommodate patients while maintaining high standards of care.
Future Work
As infusion-based treatments for Alzheimer's continuing to evolve, the Cognitive Therapies Program remains committed to expanding access and refining processes to meet patient needs. Ongoing research and data collection efforts will contribute to improving treatment strategies and potentially broadening the program’s scope in the future.
While current therapies are limited to Alzheimer’s disease, there may be opportunities to expand treatment options as new therapies emerge.
“UPMC is taking a cautious approach to these current therapies for early Alzheimer’s disease, prioritizing patient safety rather than program expansion. This ensures that eligible patients can access these therapies in a way that is safe, effective, and well-supported,” says Dr. .
For Referring Physicians
To refer a patient for screening and evaluation, please contact the UPMC Neurological Institute Dementia and Cognitive Disorders Program at 412-692-.
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