The moment a family receives an Alzheimer's disease diagnosis, the first reaction is usually despair: this is a disease that cannot be treated, and all we can do is watch our relative slip away.
That belief needs updating. Alzheimer's disease still cannot be cured — but it can be prevented, moderated and intervened in. With proper treatment, the progression can be substantially delayed, and the patient's cognitive function and quality of life can be protected. What is more, this field is changing faster than at any point in the last twenty years.
1. First, the basics: what is Alzheimer's treatment actually treating?
It helps to picture the treatment of Alzheimer's disease as two fronts.
In mild to moderate disease, cholinesterase inhibitors (such as donepezil and rivastigmine) and the NMDA receptor antagonist memantine improve neurotransmission and ease memory loss, cognitive decline and emotional symptoms — preventing a rapid slide.
Since 2024, two new drugs directed at the pathology of Alzheimer's disease have been approved in China — the first time disease-modifying treatment has moved from journal pages into the pharmacy.
The two fronts are not alternatives. They are used together, and the combination is where most of the benefit lies.
2. The targeted drugs: clearing the pathological deposit at source
Lecanemab and donanemab both act on the core pathology of Alzheimer's disease: the abnormal accumulation of amyloid-beta plaques in the brain. Both mobilise the body's immune system to clear those deposits, slowing the disease from its source rather than compensating for its symptoms.
The pivotal data for both come from international multicentre phase III trials.
Lecanemab
Developed by Eisai and Biogen · approved by China's NMPA in January 2024 · launched in China in June 2024In the Clarity-AD study, published in the New England Journal of Medicine in 2023, patients with early Alzheimer's disease treated for 18 months showed a 27% slower rate of cognitive decline than the placebo group. In the latest follow-up from the study's open-label extension, after four years of continuous treatment 81.4% of patients remained in the early stages — mild cognitive impairment or mild dementia.
In September 2026, a subcutaneous autoinjector formulation was approved by the NMPA: one weekly dose, delivered in about 15 seconds. Treatment moves out of the infusion suite and into the home.
Donanemab
Developed by Eli Lilly · approved by China's NMPA in December 2024 · launched in China in March 2025In the TRAILBLAZER-ALZ 2 study, published in JAMA in 2023, patients at an earlier stage of disease showed a 35% slower rate of cognitive decline, and a 39% lower risk of progressing to the next disease stage. After 18 months of treatment, brain amyloid plaques were reduced by a mean of 84%.
It is also the only therapy with evidence supporting stopping treatment once plaque clearance has been achieved — a genuinely different proposition for patients who would rather not infuse indefinitely.
Two conditions apply to both drugs, and they are not negotiable. First, they are indicated only for patients in the early stage — mild cognitive impairment due to Alzheimer's disease, or mild dementia. Second, before treatment, testing must confirm that amyloid pathology is present.
This is why early screening and early diagnosis matter so much. However good the drug, it is only available to people who act early. Our earlier article on the p-tau217 blood test covers how that confirmation is reached.
3. Choosing between them: no best drug, only the most suitable one
| Lecanemab | Donanemab | |
|---|---|---|
| Developer | Eisai / Biogen | Eli Lilly |
| Approved in China | January 2024 | December 2024 |
| Administration | Intravenous infusion every 2 weeks; since September 2026 a subcutaneous autoinjector is approved — once weekly, self-administered at home | Intravenous infusion every 4 weeks |
| Clinical data | 27% slower cognitive decline at 18 months; 81.4% still in the early stage at 4-year follow-up | 35% slower decline in earlier-stage patients; strong evidence of plaque clearance, with the option to stop once the target is met |
| In practice | Longer real-world experience and more mature data; widely used first-line; flexible dosing route | Fewer infusions; more potent clearance |
Put simply: lecanemab has been in use longer, has the deeper evidence base, and offers a choice of route — intravenous or subcutaneous. Donanemab needs fewer infusions, clears plaques more aggressively, and is the only option with evidence for stopping after clearance.
There is no absolute better and worse, only fit and misfit. The decision rests on plaque burden, the patient's general condition, APOE genotype, and how practical the schedule is for the family — which is precisely what a specialist assessment is for.
4. The drugs are good; the safety discipline has to be equally good
One adverse effect needs to be stated plainly: ARIA — amyloid-related imaging abnormalities — appearing as brain oedema or microhaemorrhage on MRI. A proportion of patients have no symptoms at all.
The Chinese figure comes from a real-world study led by Huashan Hospital, Fudan University, across six centres nationwide and published in Brain in 2025 (407 patients). ARIA occurred in about 12.15% of Chinese patients treated with lecanemab — in line with international data, and in the great majority asymptomatic or mild to moderate.
What this means in practice
Brain MRI is required before treatment starts and at defined intervals during the course, with the whole pathway running under specialist assessment and follow-up. Extra caution — and a careful weighing of benefit against risk — applies to patients with uncontrolled hypertension, those on anticoagulation, and those carrying particular genotypes.
Strict indication assessment and protocolised monitoring are the two preconditions for using these drugs safely. Neither works without the other. It is also why comparing drugs on the internet is a poor substitute for handing the decision to a full specialist assessment.
5. Do not forget the other half of treatment
Whether or not a targeted drug is used, lifestyle intervention runs through the whole course as baseline treatment: regular aerobic exercise, a healthy diet, adequate sleep, social and cognitive engagement, control of blood pressure, blood glucose and lipids, and management of mood.
The World Health Organization's updated guidance on reducing the risk of cognitive decline and dementia, issued in July 2026, states that as much as 45% of dementia risk is linked to modifiable factors. Stopping smoking, increasing physical activity, controlling hypertension and diabetes, and reducing social isolation are all listed as evidence-based recommendations.
For a family living with Alzheimer's disease, treatment was never a single act of taking a pill. It is a sustainable way of living, and a support system around it.
6. Delay and resignation are the real dangers
Twenty years ago this field had almost nothing to offer. Today a complete chain is taking shape: early screening from a blood sample, staged assessment, symptomatic drugs, and disease-modifying drugs.
Payment is beginning to move as well. Under the first Commercial Health Insurance Innovative Drug Catalogue issued by China's National Healthcare Security Administration, effective 1 January 2026, lecanemab has been included — the first crack in the cost barrier for families paying out of pocket.
Early screening, early diagnosis, early intervention, disciplined prescribing and structured follow-up are what allow a family to keep memory, and dignity, for longer. SinoUnited Health aims to be a dependable link in that chain: rigorous indication assessment, an individualised treatment plan, and long-term follow-up management — holding on to every day that can still be won.
About Dr. Feng Wang
Dr. Feng Wang is a neurologist and associate chief physician at SinoUnited Health. She graduated from Shanghai Jiao Tong University School of Medicine with a master's degree and a doctorate in neurology, has more than 20 years of clinical experience in Shanghai tertiary A hospitals, and spent a year as a visiting scholar at the Brain Research Centre of the Royal Melbourne Hospital in Australia.
Her work has long centred on stroke green-channel development at Shanghai tertiary A hospitals — acute cerebrovascular rescue and standardised, full-course management of cerebrovascular disease — and she has extensive experience in cerebral infarction, cerebral small vessel disease and secondary prevention of stroke recurrence. She focuses on the overlap between cerebrovascular disease and cognitive impairment: screening high-risk vascular patients, systematic assessment and individualised intervention for memory decline, slowed thinking and post-stroke cognitive decline, and differentiating vascular cognitive impairment from Alzheimer's disease and other dementias. She also manages vascular risk factors such as diabetes, hypertension and hyperlipidaemia as an integrated whole, and provides long-term care for cerebral small vessel disease, recurrent dizziness and chronic neurological conditions in older adults. She works alongside sleep specialists to offer middle-aged and older patients a continuous pathway across cerebrovascular, cognitive and sleep health.
She is a council member of the Second Youth Council of the Chinese Stroke Association; secretary of the Cerebrovascular Disease Group, Neurology Branch, Shanghai Medical Association (10th committee); secretary of the Neurology Branch of the Shanghai Stroke Association; a member of the 10th Youth Committee of the Neurology Branch of the Shanghai Medical Association; and a member of the Youth Committee of the Fourth Shanghai Medical Association Stroke Branch.
References
- van Dyck CH, et al. Lecanemab in Early Alzheimer's Disease (Clarity-AD). New England Journal of Medicine. 2023.
- Eisai. Clarity-AD open-label extension: 48-month follow-up data. Reported 2026.
- Sims JR, et al. Donanemab in Early Symptomatic Alzheimer's Disease (TRAILBLAZER-ALZ 2). JAMA. 2023.
- Li LL, et al. Safety and short-term outcomes of lecanemab for Alzheimer's disease in China: a multicentre study. Brain. 2025.
- National Medical Products Administration: lecanemab approved January 2024; donanemab approved December 2024; lecanemab subcutaneous autoinjector approved September 2026.
- National Healthcare Security Administration. Commercial Health Insurance Innovative Drug Catalogue (first edition), effective 1 January 2026.
- World Health Organization. Guidelines for reducing the risk of cognitive decline and dementia (updated edition). July 2026.
This article is health education for international patients and their families and does not replace an individual consultation, examination or diagnosis. Indication, drug selection and monitoring decisions must be made by a qualified clinician after a full assessment.