Creator: Help Dementia Editorial Team
Published: 2026-04-11T22:54:23

Reviewed by the Help Dementia Editorial Team — our editors review every article for accuracy against guidance from the National Institute on Aging, the Alzheimer’s Association, and peer-reviewed sources.

Drug utilization sits at the center of this dementia and brain health question.

Drug utilization studies are revealing critical gaps between how Alzheimer’s disease should be treated and how it actually is being treated in real-world settings. A comprehensive study of 359,801 patients in skilled nursing facilities found that 25% of those with Alzheimer’s disease and related dementias (ADRD) are not receiving guideline-recommended pharmacological treatment, exposing a significant treatment access problem across the long-term care sector. These studies track medication prescribing patterns, treatment persistence, and which patients receive medications—providing healthcare systems with data they didn’t have before about actual Alzheimer’s care delivery. For the first time, researchers can now document not just what treatments exist, but which patients actually receive them, how long they stay on medications, and why some switch to different therapies.

This data is fundamentally changing how we understand Alzheimer’s treatment in practice, especially as new anti-amyloid monoclonal antibodies like Leqembi and Kisunla expand the therapeutic landscape. The findings reveal patterns that can’t be seen in clinical trials alone—patterns that matter profoundly for patients and families deciding on care. These utilization studies matter because they expose the reality of treatment access. A patient diagnosed with mild cognitive decline at an urban memory center may have very different medication options than an identical patient in a rural skilled nursing facility or assisted living community. By tracking real-world patterns, these studies help explain why.

What Drug Utilization Studies Reveal About Alzheimer’s Treatment Persistence
The Growing Gap in Treatment Access Across Care Settings
New Anti-Amyloid Monoclonal Antibodies Changing Real-World Treatment Options
How Utilization Data Informs Clinical Decision-Making and Resource Allocation
Comorbidity Complications and Drug Interaction Concerns in Real-World Populations
Understanding Treatment Switching Patterns and Medication Tolerability
The Future of Alzheimer’s Treatment Utilization and Emerging Patterns
Conclusion

What Drug Utilization Studies Reveal About Alzheimer’s Treatment Persistence

drug utilization studies are epidemiological investigations that examine how medications are actually prescribed and used in population-based settings, rather than in controlled clinical trials. Unlike phase 3 clinical trials where researchers select specific patient populations and carefully monitor adherence, utilization studies observe entire populations of patients taking Alzheimer’s medications in clinics, hospitals, and long-term care facilities. This distinction is crucial: a drug that performs well for 60% of carefully selected trial participants may show very different real-world outcomes when given to diverse populations with multiple comorbidities and less intensive monitoring. One striking finding from recent utilization studies concerns treatment persistence. Only 15% of patients remain on their initial symptomatic Alzheimer’s treatment at 18 months post-index, according to data tracking treatment switching patterns.

This means 85% of patients have either stopped their initial medication or switched to a different therapy within the first year and a half. This low persistence rate reflects several realities: some patients experience side effects they can’t tolerate, some see minimal cognitive benefit, and some face access barriers including medication costs or logistical challenges in getting to appointments for infusions. The implication is stark—while drug efficacy matters, actual clinical utility depends heavily on whether patients can tolerate and access their medications long-term. Patient baseline severity appears to influence persistence patterns significantly. Patients with baseline mild dementia severity were substantially more likely to transition to alternative treatments rather than continue with their initial therapy. This counter-intuitive pattern may reflect clinical decision-making where neurologists feel more comfortable experimenting with different medication combinations in patients with milder disease, whereas those with moderate-to-severe dementia remain on established regimens.

What Drug Utilization Studies Reveal About Alzheimer's Treatment Persistence

The Growing Gap in Treatment Access Across Care Settings

The treatment disparity uncovered in long-term care facilities presents a sobering picture. In skilled nursing facilities serving 359,801 ADRD patients studied between January and April 2025, one-quarter lacked any guideline-recommended pharmacological Alzheimer’s treatment. For context, the Alzheimer’s Association and major neurology societies recommend pharmacological intervention for eligible patients, yet this guidance is not being followed in approximately 25% of cases. The reasons behind this gap vary—some facilities may lack prescribing neurologists, some may have patients with contraindications, and some may simply face resource constraints. This treatment gap isn’t randomly distributed. Patients with certain comorbidities were significantly less likely to receive ADRD pharmacotherapy.

Specifically, diabetes and hyperlipidemia were associated with notably lower odds of patients receiving guideline-recommended Alzheimer’s medications. This pattern likely reflects legitimate clinical concerns: physicians worry about potential drug interactions when Alzheimer’s medications are combined with diabetes treatments, or they prioritize managing cardiovascular risk factors over cognitive decline. However, it also represents a cautionary tale about competing treatment priorities—when patients have multiple chronic conditions, Alzheimer’s treatment sometimes loses out, even though cognitive decline profoundly impacts quality of life and care burden. The limitation of utilization studies themselves deserves mention: they reveal patterns in prescribing, but they cannot always explain the reasoning behind those patterns. A patient may lack Alzheimer’s medication because they refused it, because their kidney function declined and made it unsafe, or because their facility’s staffing changed. Utilization data shows the “what” but not always the complete “why.”.

New Anti-Amyloid Monoclonal Antibodies Changing Real-World Treatment Options

The FDA approval of Leqembi (lecanemab) in 2023 and Kisunla (donanemab) in 2024 represents the first meaningful expansion of Alzheimer’s pharmacotherapy in nearly two decades. Both medications target amyloid-beta accumulation in the brain through different mechanisms, and both slow cognitive decline in early-stage disease compared to placebo—though the clinical benefits are modest, typically slowing decline by about 35% over 18 months. These medications require intravenous infusion at regular intervals, which creates logistical demands on patients and care systems. Real-world data from the AD/PD 2026 conference showed that most patients who start lecanemab therapy continue it beyond 18 months, which is notable given the overall poor persistence rate for initial Alzheimer’s medications.

This suggests that patients who tolerate the infusion schedule and experience acceptance in their care team tend to persist with treatment. However, “most patients” continuing treatment is not the same as “all patients”—some discontinue due to infusion reactions (though these are often manageable with pre-medication), scheduling conflicts, or decisions made by patients and families that the cognitive benefit doesn’t justify the time commitment. A recent development—at-home injectable Leqembi—is expected to reduce access barriers significantly. Traditional Leqembi infusions require patients to visit infusion centers monthly or more frequently, which is impossible for homebound patients or those without reliable transportation. Subcutaneous injection that can be administered at home would expand eligibility dramatically, though it remains to be seen whether home administration will increase actual utilization or whether it will simply shift the access barrier from infusion center logistics to home healthcare availability.

New Anti-Amyloid Monoclonal Antibodies Changing Real-World Treatment Options

How Utilization Data Informs Clinical Decision-Making and Resource Allocation

For healthcare systems, drug utilization data serves a practical purpose: it identifies bottlenecks and informs resource allocation decisions. If a health system discovers that only 10% of its eligible patients with mild cognitive impairment are receiving any Alzheimer’s pharmacotherapy, that reveals an access problem. Perhaps there’s insufficient capacity at neurology clinics. Perhaps primary care physicians aren’t screening for cognitive decline. Perhaps patients are being identified but not referred for treatment options. Utilization studies highlight these gaps; addressing them requires targeted intervention. Resource allocation presents a tradeoff.

Anti-amyloid monoclonal antibodies are expensive—Leqembi costs approximately $26,500 annually, and Kisunla is similarly priced. Health systems must decide: do we invest in building infusion center capacity to serve more patients with these newer treatments, or do we maintain robust availability of older symptomatic medications that help more patients regardless of disease stage? For a skilled nursing facility with 500 dementia residents and a limited pharmacy budget, this becomes a real choice. The utilization data helps systems understand the magnitude of the decision—if 25% of their residents lack any pharmacological treatment, expanding access to any effective medication might be more valuable than focusing exclusively on newer, costlier options. The comparison between utilization patterns in academic medical centers versus community practices is telling. Academic centers with dedicated cognitive disorder specialists may treat 70-80% of eligible patients with Alzheimer’s medications, while rural primary care practices may treat 20-30%. Both groups are treating the same disease, but resources and specialist availability create vastly different utilization patterns. Utilization studies make these disparities visible, creating a foundation for policy discussions about equitable access.

Comorbidity Complications and Drug Interaction Concerns in Real-World Populations

The lower utilization rates observed in patients with diabetes and hyperlipidemia underscore a practical reality: Alzheimer’s patients are not hypothetical clinical trial participants. They are people with multiple chronic conditions, taking multiple medications, with complex medical histories. A patient with poorly controlled type 2 diabetes might experience worsening glycemic control if certain Alzheimer’s medications interact with insulin sensitivity. A patient on a complex regimen of cardiovascular medications might face unintended interactions with newer therapies. It’s important to note that lower utilization in comorbid patients doesn’t necessarily mean worse care—it may reflect careful clinical judgment. A neurologist might reasonably decide that adding an amyloid-targeting monoclonal antibody to a patient whose diabetes is already difficult to manage isn’t worth the risk.

The limitation of utilization studies is that they measure prescribing patterns, not outcomes. A patient without an Alzheimer’s medication may have better overall health management than one receiving Leqembi if the latter comes at the cost of worsening diabetes or drug interactions. However, the studies don’t tell us whether physicians are making these decisions explicitly and carefully, or whether they’re simply reflexively avoiding medications when comorbidities are present. A practical warning for families: if an elderly parent with Alzheimer’s also has diabetes, cardiovascular disease, or takes multiple medications, conversations with neurologists should explicitly address the potential interactions and benefits-to-risk ratio of newer pharmacological options. Don’t assume that no offer of medication means no medication exists or would help—it may reflect deliberate clinical caution. Conversely, don’t assume that comorbidities automatically preclude treatment; sometimes they require more careful monitoring, not avoidance.

Comorbidity Complications and Drug Interaction Concerns in Real-World Populations

Understanding Treatment Switching Patterns and Medication Tolerability

The 85% medication switch or discontinuation rate observed at 18 months reveals that initial medication choice often isn’t final. Some switches represent genuine therapeutic optimization—a patient tries a symptomatic medication, experiences modest benefit but also bothersome side effects, and tries something else. Some represent treatment failure—the medication simply doesn’t slow the patient’s cognitive decline, and the neurologist and family agree to try an alternative approach.

Some represent access failures—a patient could benefit but can’t maintain the infusion schedule, can’t afford the medication, or moves to a facility without prescribing capability. Real-world tolerability data shows that symptomatic medications like cholinesterase inhibitors often cause nausea, diarrhea, or bradycardia, particularly in older patients with sensitive gastrointestinal systems. The anti-amyloid monoclonal antibodies carry a different safety profile, with amyloid-related imaging abnormalities (ARIA) being a concern—these are brain MRI changes that don’t always correlate with symptoms but require careful monitoring. A patient tolerating one medication poorly may do better on another, which justifies switching, but each switch also involves a washout period where the patient is receiving no disease-directed therapy.

The Future of Alzheimer’s Treatment Utilization and Emerging Patterns

As the Alzheimer’s treatment landscape expands with the addition of anti-amyloid monoclonal antibodies, utilization patterns will likely shift. Earlier diagnosis through improved cognitive screening and biomarker testing may identify more patients in mild stages who are eligible for these newer treatments. At the same time, home-based administration options and potentially expanded insurance coverage could overcome some of the access barriers currently limiting utilization.

One emerging frontier is combination therapy—using multiple mechanisms simultaneously to slow cognitive decline. Some clinical trials are exploring anti-amyloid monoclonal antibodies combined with tau-targeting medications or symptomatic treatments. If these combinations prove beneficial, real-world utilization studies will eventually reveal whether they’re actually prescribed in practice or whether the complexity of managing multiple treatments discourages use. The next generation of utilization studies will tell us whether expanding options actually expands access or simply shifts which patients receive treatment.

Conclusion

Drug utilization studies reveal that Alzheimer’s treatment in real-world practice falls significantly short of clinical guidelines, with 25% of long-term care residents lacking any guideline-recommended pharmacotherapy. These studies show that persistence with initial medications is poor—only 15% of patients remain on their first-line treatment at 18 months—and that newer anti-amyloid monoclonal antibodies like Leqembi and Kisunla, while showing promise, still require overcome significant barriers around infusion access and cost. Comorbid conditions like diabetes and hyperlipidemia further reduce treatment utilization, reflecting genuine clinical complexities that trials cannot fully capture.

For patients and families, these findings underscore the importance of proactive conversations with neurologists about available options, potential barriers to access, and realistic expectations about treatment persistence and benefit. For healthcare systems, utilization data provides a roadmap for identifying treatment gaps and allocating resources more effectively. As newer medications become available and administration methods improve, future utilization studies will track whether these advances actually translate into broader patient access or whether structural barriers persist. The value of tracking real-world patterns is precisely that they force healthcare systems to confront the gap between what guidelines recommend and what actually happens in clinical practice.