Adnkronos (Adnkronos) – Making Alzheimer's disease diagnosis quicker, supporting patients throughout their treatment journey, and providing organizational guidance for introducing new therapies into the National Health Service: these are the objectives of the consensus document of the RAPID project (Revolutionizing Alzheimer's Patient Care Model. Initiatives Driving the Future), published in the international journal 'Neurological Sciences'.
The project, carried out with the support of Eisai Italia and methodological coordination by Iqvia, according to a statement, brought together a multidisciplinary panel of 13 experts with expertise in neurology, geriatrics, neuroradiology, general medicine, and healthcare planning, along with patient representatives. The work led to consensus on all 55 proposed recommendations for reorganizing care for people with Alzheimer's disease in Italy, outlining a three-tier network model—community services, spoke centers, and hub centers—coordinated by a dedicated governance body.
In Italy, according to 2025 estimates by Alzheimer Europe, approximately 1,4 million people live with dementia, of which approximately 600 have Alzheimer's disease.
Costs are estimated at approximately €15,6 billion annually, approximately 80% of which is borne directly by families, the statement continues. Diagnosis and management are handled by the Centers for Cognitive Disorders and Dementia (CDCs), but significant variability persists among regions in terms of resources, multidisciplinary integration, and access to advanced diagnostics.
This scenario includes the implementation of Ministerial Decree 77/2022, which reorganizes community care around community centers, and the introduction of new disease-modifying therapies, which require biological confirmation of the diagnosis, a multidisciplinary assessment of eligibility, and structured monitoring with magnetic resonance imaging. Without a rethinking of the network, the authors warn, regional inequalities risk worsening.
The RAPID project began with an organizational analysis conducted at seven Italian centers in various geographical areas. Through interviews with clinical and management staff, the analysis reconstructed the current care pathways and the centers' level of organizational preparedness. This analysis was accompanied by a review of national and international recommendations and care models adopted in other countries. The recommendations were assessed using the Rand/UCLA Appropriateness Method, an internationally validated consensus methodology, by a panel of 13 experts from across the country: six neurologists, two geriatricians, a neuroradiologist, a general practitioner, two healthcare planning experts, and a representative of the Italian Alzheimer's Association (AIMA).
"Alzheimer's disease is a growing healthcare challenge, and the arrival of new therapies makes it urgent to evolve diagnostic and care models," says Mario Zappia, professor at the University of Catania and president of the Italian Society of Neurology. "Early intervention requires timely diagnosis, appropriate patient selection, and structured monitoring. With the Rapid project, we have translated the exchange of expertise and available evidence into concrete recommendations, to consistently support the evolution of the care network across the country."
The consensus document proposes the establishment of a regional multidisciplinary governance body, with a network coordinator responsible for the diagnostic and therapeutic pathway, demand-based network sizing, and monitoring through shared indicators. The network is structured on three levels. The first involves community services, with the general practitioner performing an initial cognitive and frailty assessment and referring the patient to Spoke centers for mild frailty and cognitive decline, or to Multidimensional Assessment Units (MVAs), located in community homes or equivalent district facilities, preferably for severe frailty and advanced dementia. The second level consists of Spoke centers, where clinical, neuropsychological, and neuroradiological assessments are performed and all individuals with mild cognitive impairment and dementia are maintained over time, regardless of eligibility for new therapies. Finally, the Hub centers complete the diagnosis and assess eligibility for treatment as part of a multidisciplinary team. If formally authorized, they are responsible for prescribing, administering, and monitoring therapies. The model is integrated into the existing network: each CDCD can act as a spoke or hub based on its expertise, organizational maturity, and available resources.
"The proposed model does not introduce new structures. It enhances existing ones, clearly defining roles, referral criteria, and coordination mechanisms between the different levels of care," emphasizes Alessandro Padovani, professor at the University of Brescia and director of Neurology at the Asst Spedali Civili di Brescia. "The goal is to ensure that each patient is directed to the most appropriate level of care and reduce variability between regions. We wanted to offer the Regions a flexible framework, adaptable to different organizational contexts."
Regarding new therapies, the document recommends that Regions, in consultation with the Ministry of Health, define clear and verifiable structural, organizational, and professional requirements for Hub centers. It also proposes scheduling volumes based on the centers' declared treatment capacity, in terms of infusions, follow-up visits, and MRI monitoring, and ensuring patient access to the Hub in their area of residence. To promote consistent care, the recommendations include the adoption of common MRI and neuropsychological assessment protocols, uniform biomarker reporting formats, and the progressive introduction of plasma biomarkers. The use of telemedicine can support collaboration between network levels and the gradual transfer of some activities to services closer to the patient. In addition to clinical and organizational aspects, the document provides structured information and counseling pathways for patients and caregivers, promoting ongoing communication and involvement in treatment decisions, while respecting the patient's wishes.
"Families need clear pathways and stable support over time," emphasizes Patrizia Spadin of Aima. "Today, approximately 80% of the costs of illness fall on families, who often find themselves alone managing a very heavy financial and emotional burden of care. Furthermore, the quality and timing of diagnosis and care still depend too much on the region in which a person lives: an inequity we cannot accept. The Rapid project fits into this context, supporting patients and caregivers throughout the entire course of the illness, from diagnosis to the most advanced stages, and helps reduce inequalities in access."
The document, the statement concludes, is intended as an operational guideline for regional health authorities and decision-makers engaged in reorganizing care. The 55 recommendations thus provide a shared basis for guiding organizational decisions and combining the introduction of innovation with continuous and more consistent care across the territory. The model's flexibility allows for the number and location of UVMs, Spokes, and Hubs to be adjusted based on available facilities, population density, and local epidemiological characteristics. To implement it, the authors emphasize the need for coordinated interventions at the national and regional levels: the formal designation of Hub and Spoke centers, the adoption of shared diagnostic and therapeutic pathways, and the strengthening of community-based services.
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