Transforming Alzheimer Disease Research Into Real-World Care: Q&A With B. Joy Snider, MD, PhD

Am J Manag Care. 2025;31(Spec. No. 15):SP1133-SP1135

In 2025, each issue of Population Health, Equity & Outcomes (PHEO) has featured a profile of a health system leader transforming care in their area of expertise. This issue spotlights a conversation with B. Joy Snider, MD, PhD, professor of neurology at the Center for Advanced Medicine Memory Diagnostic Center at WashU Medicine in Missouri. This interview has been edited for length and clarity.

PHEO: Could you tell me about your typical workday at the Memory Diagnostic Center?

SNIDER: My work at Memory Diagnostic Center, which is our clinic, is primarily in person for 2 half days a week when I see patients. It’s pretty typical that I see a new patient for an hour and follow-up a patient for half an hour. We see only patients with dementia, so it is a very specialized practice. But then a lot of my other time is spent doing clinical research, running clinical trials, doing education, and trying to get more people interested in dementia practice and research, so a lot of other things go on. It is very good at keeping one interested when there’s always something different to do.

I spend time advocating and educating at the managed care level because, particularly with dementia being an up-and-coming disease in prevalence and an evolving field, there’s a lot we need to do to change and be better prepared to take care of patients with dementia and hopefully slow it down enough that it doesn’t bankrupt our managed care system and the rest of us along the way.

PHEO: What led you to specialize in the diagnosis and treatment of patients with memory disorders and dementias?

SNIDER: It was sort of a circuitous path. I didn’t really know I was going into medicine. I went to college and was passing my neuroscience and biology classes, and then after getting my undergraduate degree, I said, “I think I’ll go to medical school.” And then in medical school, I became interested in research, which led me to do a neurology residency and then a fellowship. I was very interested in how we could keep brain cells from being damaged by diseases like stroke and Alzheimer disease. I started as a basic scientist, but eventually I began working more on the clinical research side of things and was very fortunate to interact with our dementia center here and some really super people, like John Morris, MD, who led the center then and still does.

I became fascinated by dementia, initially from the research perspective. But after I started working with patients and their families, I realized that was something I really enjoyed, and it seemed to be a better fit for me than sitting at the lab bench all day, talking to brain cells. I came into it from a different direction, but I’ve been working in dementia and caring for patients with dementia for almost 30 years, and it’s been great.

PHEO: What sets your clinic apart as an innovator in the memory care field?

SNIDER: Our clinic has the good fortune of being affiliated with the [Charles F. and Joanne] Knight Alzheimer Disease Research Center, which has been a leader in the field in a number of ways that are particularly important now. The first one is that we have always focused on identifying memory problems when they first begin and differentiating abnormal memory from normal aging. That’s become critically important now, as we have these new treatments that work when the disease is in the mildest stages, but that’s also when it’s the hardest to recognize. Along with that, [there has been the development of] biomarkers—initially imaging biomarkers, but also spinal fluid and now blood based—and some of my colleagues played a leading role in those areas. Biomarkers revolutionized how we can identify people with Alzheimer disease to make a more specific diagnosis, and also, eventually, to diagnose presymptomatically, so that’s going to be very exciting.

Our center is one of the largest and is highly collaborative, and I’m fortunate to work with leaders in these different fields. On the patient care side, we’ve been very fortunate. We’re in a medical school, but we are partnered with Barnes-Jewish Hospital, which is next to us. They want to be leaders in the field, providing this care in the community, so they’ve been very supportive and worked with us both to support our clinic and to make sure we have enough infusion centers and MRI scanners. I think that that partnership has been critical because, when it’s a dementia clinic, you can’t do this on your own; it’s not financially viable. Taking care of patients with dementia does not make anybody any money at the clinic level, so it needs to be something that’s done at a systemwide level, where we can all work together and pool our resources to provide the best care.

PHEO: What’s an initiative your team is working on that you’re passionate about?

SNIDER: What we’re all excited about right now are the new therapies that we have, the amyloid immunotherapies, and we’ve been working for several years now to make them available to our patients, which is step one. [The first thing] is to make them available to all the patients who need them, and even in our clinic, it’s a pretty select population. It’s people who have insurance who can come to our clinic. So we’re working on a number of measures in the community to bring more people in and to provide education so people who aren’t in the highest socioeconomic levels understand they need to come into care. Then we’re working to try to incorporate advanced practice providers into our models so that we can, again, increase access. There are not enough physician specialists around to take care of these patients. Finally, we are trying to understand how to partner with our primary care colleagues to identify those patients who have very mild disease and would benefit from this treatment. A lot of times, people don’t come in to seek medical attention until their memory is really bad, and so helping our primary care providers understand how to screen people and who to refer in a very timely way, because they don’t have a lot of time, is critical. We’re not at all good at that yet, but I think we’re making progress.

PHEO: Are there any novel avenues of research on memory disorders that you’re most excited to investigate?

SNIDER: I’m very interested in new treatments, so part of what I do is clinical trials. Having these amyloid immunotherapies is amazing: We have disease-modifying therapies, the first new therapies in 20 years.^1,2 That’s all fantastic, but they’re not a cure. They, at most, slow down disease progression. So looking at combination therapies, I’m very excited. There are new treatments coming along directed at tau, other than amyloid, and treatments directed at inflammatory processes, some of which may be drugs that are already approved. That would be great if they work. We don’t know yet, but that would be awesome. And the prevention therapies, I think, are super exciting. If we find out in the next 3 to 5 years that we can prevent Alzheimer disease or slow it down much more robustly by treating people before [they develop] symptoms, that’s going to be huge.

PHEO: How could your team’s research potentially be applied to other neurological diseases?

SNIDER: In a lot of different ways. One of the things we do well here at Washington University is to collaborate among researchers. There is an organization called the Hope Center [for Neurological Disorders] at the basic science level whose premise is that there are common pathways among all these disorders, and the basic science researchers work together on those common pathways. Specifically, for what I do in the clinical trials and clinical research side, for many neurologic neurodegenerative diseases, we all struggle with the same problems: how to measure disease progression more accurately, and how to develop treatments that slow disease progression and do it in a cost-effective way. The lessons we’ve learned on how to roll this out in the community potentially could be helpful. I think what we see a lot of other programs doing is moving into the fluid biomarker field. Alzheimer disease has really come a long way; now we need better markers for Parkinson disease and TDP-43 and a lot of other degenerative things.

On the practical side, what we’ve been able to do with our advanced practice providers to increase access is big, and I hope some of our colleagues have already followed suit. I think it’s something that’s rolling out to a lot of different areas now, just because there are not enough neurologists. If we can train advanced practice providers to be specialists in these areas, that really helps.

REFERENCES

1. van Dyck CH, Swanson CJ, Aisen P, et al. Lecanemab in early Alzheimer’s disease. N Engl J Med. 2023;388(1):9-21. doi:10.1056/NEJMoa2212948
2. Mintun MA, Lo AC, Duggan Evans C, et al. Donanemab in early Alzheimer’s disease. N Engl J Med. 2021;384(18):1691-1704. doi:10.1056/NEJMoa2100708