Alzheimer Disease Infusion Service

New disease modifying therapies for Alzheimer Disease:

The Alzheimer Disease Infusion Service brings recent advances in science to the clinic, providing more options for treating people with early Alzheimer disease. Some large trials have shown benefit for immune therapies that target amyloid, one of the abnormal proteins that causes Alzheimer disease.

These treatments have the potential to slow the rate of progression in some patients. The treatments do not cure Alzheimer disease but they do seem to slow down the disease by around 6 months.

The doctors at Neurology Network Melbourne have access to this treatment and it is provided through the Alzheimer Disease Infusion Service.

Who can directly access this service?

This service is open to patients referred by a specialist neurologist, geriatrician or psychiatrist for consideration of Alzheimer Disease modifying therapies. All other patients will first need to see one of our neurologists.

Please note, for this direct access service patients, at a minimum, need to:

• Have mild cognitive impairment or mild dementia due to Alzheimer disease.
• Have had a recent brain MRI done within 6 months of our assessment. Scans importantly need to exclude evidence of previous stroke or other issues
• Be able to have further MRIs (e.g not have a pacemaker incompatable with MRI).
• Have no unstable medical conditions including active cancer, liver, renal or heart disease.

You need a specialist referral.

If you have not seen a psychiatrist, geriatrician or neurologist you cannot be seen by our Alzheimer Disease Infusion Service. You will be able to book an appiontment to see one of our neurologists with your GP referral. You will be assessed for your cognitive impairment and progress towards a diagnosis. Your neurologist will consider all of the different treatment and management options for patients with cognitive impairment. If your Neurologist assesses that you are eligible, they can make an internal referral for the Alzheimer’s Disease Infusion Service.

The new infusion treatments for Alzheimer’s disease

Only about 10-15% of patients referred to Alzheimer’s Disease Infusion Service will actually be eligible for this treatment. Careful assessment considering the eligibility criteria are important because the treatment is very risky in some patients. Please review the detailed eligibility criteria below carefully before considering requesting an appointment.

We offer two therapies by infusion.

• Donanemab (Kisunla) – approved by the Australian TGA on 22/05/25
• Lecanemab (Leqembi) – approved by teh Australian TGA on 24/09/25 

Patients: Qualifying for our Alzheimer’s Disease Infusion Service

• You have mild cognitive impairment or mild dementia due to Alzheimer disease
• You are not older than 89 years
• Your MMSE is equal to or greater than 20/30
• You are willing to pay for the assessment:
  • The one-off genetic test for ApoE status test does not attract a Medicare subsidy and costs around $200.
  • Amyloid-PET scans performed every six months and cost around $2000 per scan.
  • MRI scans performed three to four times per year and cost around $1500 per scan.
• Your are willing to pay for the treatment:
  • Once per month infusions cost approximately $180 per visit
  • Medications cost approximatley $4700 per monthly treatmen. The PBS do not subsidise the treatment and for many patients the cost exceeds $75,000 for teh full course of treatment. Private Health Insurance does not cover this medication.
• Patients DO NOT need to have private health cover.
• Participants on treatment should consider wearing a Medi-Alert bracelet (or similar) all the time in case they need urgent medical care (to warn doctors about using clot-busting drugs).
• Patients have a reliable partner or support person to ensure attendance at visits and reporting of possible side effects.

For Doctors: eligibility criteria

• MMSE ≥ 20 (using serial subtraction, not reverse spelling)
• Laboratory studies: minimum U&E, Cr, LFTs, Ca, Mg, TSH, FBE, ESR, HbA1c, RPR, HIV, clotting profile
• MRI scan (3T): with 3D MPRAGE (or equivalent) with coronal reconstructions, axial FLAIR, axial GRE/SWI sequences minimum within 6 months of referral.
• FDG-PET scan: to show typical symptomatic Alzheimer disease regional changes and must include a NeuroStat quantitative analysis (Medicare subsidised).
• Preferred, but not essential:
  • Apolipoprotein E status testing: Required to assess E4 status – homozygous E4E4 are ineligible for donanemab and lecanamab (Dorevitch or Melbourne Pathology cost approx. $154)
  • Amyloid-PET scan: within 2 years of assessment, demontrating excess amyloid (private cost is $2000)

For Doctors: exclusion criteria

• E4/E4 homozygotes
• Other brain disease causing the symptoms (e.g. FTD, DLB, PDD, vascular dementia, etc)
• Laboratory studies desmonstrate the presence of other significant contributing conditions
• MRI FLAIR sequences show severe small vessel ischaemic disease (Fazekas 3)
• MRI GRE/SWI sequences show 3 or more cortical microhaemorrhages, ≥ 1 area of superficial siderosis, prior lobar haemorrhage or ≥ 3 lacunar or cortical infarctions