Rural Alzheimer's Disease Education: Overcoming Outdated Beliefs and Building Infrastructure

In this episode, 'Rural Alzheimer's Disease Education: Overcoming Outdated Beliefs and Building Infrastructure,' the expert neurology and primary care panelists explored the following question:

What are challenges in education that you face in a more rural setting?

The panelists examined the hurdles of practicing without local backup. Joshua Oaks, MD, described colleagues citing ARIA risk and a modest 22%–37% slowing of cognitive decline as reasons to avoid offering treatment at all, along with medical training that taught Alzheimer's disease could only be diagnosed at autopsy and couldn't be treated — a mindset he still hears echoed by medical students on rotation today. Beyond changing that mindset, he detailed the infrastructure he had to build from scratch: negotiating with the local hospital's leadership and radiology director to secure regular MRI monitoring, training the radiology group to recognize ARIA, partnering with an infusion center, and designating a nurse navigator for Alzheimer's patients. He noted that as more of his primary care colleagues — now seven in his group — began prescribing amyloid-targeted therapies themselves, having a peer to ask questions made others progressively more comfortable adopting the same approach.

Throughout the conversation, the experts provided a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

The next episode in this series, 'Blood-Based Biomarkers: Reshaping the Alzheimer's Disease Diagnostic Toolkit,' features the panelists advancing their conversation on Alzheimer's disease and focusing on how plasma biomarkers like p-tau217 are sequenced alongside cognitive screening, confirmatory PET, and cerebrospinal fluid (CSF) testing.