Here’s what patients, caregivers and clinicians need to know about every FDA-approved Alzheimer's treatment — and where each option fits in.
A decade ago, families confronting an Alzheimer’s diagnosis had little more than memory-boosting pills aimed at lessening symptoms but they didn’t halt disease progression. Today, the conversation has shifted from if we can slow the disease to how early we can start. With two disease-modifying antibodies now on the market in the U.S. alongside a new-format patch, an agitation drug and the long-standing symptom-relief mainstays, we have entered the most treatment-rich moment in Alzheimer’s history. Here’s what patients, caregivers and clinicians need to know — and where each option fits in.
Disease-modifying Alzheimer’s drugs: Leqembi and Kisunla
The breakthrough came in July 2023 when the FDA granted full approval to Leqembi (lecanemab), the first therapy proven to slow cognitive decline by clearing out toxic clumps of beta-amyloid called protofibrils as well as larger amyloid plaques from the brain. “We finally have clarity around amyloid’s modest effect on cognitive decline,” Alzheimer’s Drug Discovery Foundation co-founder Dr. Howard Fillit told Being Patient after the decision. “The approval of Leqembi will serve as a catalyst for driving further developments and investments in the Alzheimer’s pipeline.”
Just a year later, Kisunla (donanemab) followed suit, offering a monthly infusion schedule and the possibility of stopping treatment once scans show the brain is amyloid-free — a detail that could trim both clinic time and cost.
Both antibodies are limited to people in the disease’s earliest stages, and both carry a risk of ARIA — brain swelling or micro-bleeds that are more common in ApoE4 carriers. Medicare now covers both Leqembi and Kisunla.
Both Leqembi and Kisunla are the first drugs to change the course of Alzheimer’s, but they require amyloid confirmation (often via PET scan or blood tests) and careful MRI monitoring. Results so far show a small slowdown of disease progression but experts argue it is just the beginning of a new way of treating Alzheimer’s. “We are still in the early days of Alzheimer’s treatments,” Fillit said.
Treating symptoms of Alzheimer’s disease
More than seven million Americans living with Alzheimer’s are still treated first — and often throughout the disease — with cholinesterase inhibitors such as donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne). These drugs do not slow progression, but they can dial back confusion, attention problems and day-to-day functional loss for six to twelve months on average. Cholinesterase inhibitors block the enzyme that breaks down the neurotransmitter acetylcholine, allowing it to linger longer between brain cells and temporarily sharpen memory, attention and day-to-day function.
Zunveyl, a chemically-modified version of the cholinesterase inhibitor galantamine received FDA approval last year and is set to hit the market later this year.
For moderate-to-severe stages, doctors often add memantine (Namenda), an NMDA-receptor antagonist that tamps down excess glutamate to reduce agitation and hallucinations.
A weekly patch for Donepezil
Swallowing pills can become a chore as dementia advances. In 2022 the FDA approved Adlarity, a once-weekly skin patch that delivers donepezil through the bloodstream. “It’s a reminder that relatively small-sounding advances in therapeutic options result in more options for people — and that’s great, because this is a condition where there weren’t many options not too long ago,” said Banner Alzheimer’s Institute Director Dr. Pierre Tariot in an interview with Being Patient.
First-ever drug for Alzheimer’s-related agitation
Up to half of Alzheimer’s patients struggle with aggression or pacing severe enough to land them in the hospital or a nursing home. In 2023, the FDA broke new ground by clearing the antipsychotic Rexulti (brexpiprazole) specifically for these behaviors, after a Phase 3 trial showed a statistically significant — though modest — benefit. “Anything that is safe and effective is welcome,” neurologist Dr. Alireza Atri told Being Patient, while cautioning that quality-of-life data is still needed Rexulti doesn’t come without risks: Trial data also showed the drug increased mortality in people who were participating in clinical trials from 0.3 percent to 0.9 percent.
Testing, genetics & costs: Navigating access to Alzheimer’s antibody infusions
Getting one of the new monoclonal antibody infusions is about more than having a prescription in hand. First comes proof of amyloid. Healthcare practices still rely on amyloid PET scans — the diagnostic gold standard — but the first FDA-cleared blood tests, rolled out in 2024, now match PET scan results more than 90 percent of the time. Because the blood draw is quicker and far cheaper than brain imaging, neurologists say it is already shrinking the wait time and the price tag of the diagnostic work-up.
Patients may also be administered a cerebrospinal fluid test (CSF) that detects biomarkers in the clear liquid that circulates between the brain and the spinal cord. Unlike brain scans and blood tests, CSF tests can provide information about other potential causes of impairment, for example, in different dementias.
Genetics is the next gate. Before signing the infusion order, specialists usually order an ApoE test: carrying even one copy of ApoE4 roughly doubles the risk of ARIA brain-bleed side effects, while two copies push the risk above 30 percent. On those grounds, the FDA—and increasingly insurers—require ApoE genotyping as part of routine safety screening.
These drugs come with a high price tag. Leqembi lists for $26,500 a year (based on a person’s weight), and Kisunla’s launch price is slightly higher. Pricing depends on how long someone needs to take the drug before amyloid clearance is detected. Medicare now covers Leqembi and Kisunla in the United States under a real-world evidence registry. Private-insurance coverage remains patchy, adding another layer of uncertainty for families doing the math.
The final gate is access — many Americans, especially in counties with high rates of Alzheimer’s disease don’t live close to a specialist that can diagnose the disease and may need to travel hours each way to get a mAb infusion.
What’s next in Alzheimer’s care: Upcoming drugs and combination therapies
There is a significant pipeline of Alzheimer’s drugs in human trials — many targeting inflammation, tau protein, vascular health or synaptic resilience in addition to amyloid. Combination therapy, easier subcutaneous antibody injections and entirely new mechanisms are under study. For now, however, the 2025 playbook pairs disease-modifying antibodies for those who qualify with symptom-relief drugs — plus behavioral and lifestyle strategies — for everyone else.
As Fillit put it, “Now, it is more important than ever to double down and widen our focus to developing the next generation of drugs based on the biology of aging that can lead to a combination therapy and precision medicine approach.”
