The morning light filters through the curtains of Jean Tremblay’s modest Mississauga home as his daughter Sarah helps him button his cardigan. At 72, Jean was diagnosed with mild cognitive impairment three years ago, and recently his neurologist confirmed early-stage Alzheimer’s disease.
“There are new treatments in the U.S. that might slow this down,” Sarah tells me, her voice a mixture of hope and frustration. “But our doctor says Canada isn’t ready yet. How can that be possible?”
It’s a question echoing across thousands of Canadian households as news spreads about breakthrough therapies for early Alzheimer’s disease that received FDA approval in the United States. Yet these treatments remain unavailable to Canadians like Jean, revealing critical gaps in our healthcare system’s readiness to deliver next-generation Alzheimer’s care.
Last month, I visited three memory clinics across Ontario and spoke with neurologists, patients, and healthcare planners about Canada’s preparedness for these potentially game-changing treatments. What I found was a healthcare system caught flat-footed, despite years of warning that these therapies were coming.
Dr. Melissa Chang, a neurologist at Toronto Western Hospital who specializes in neurodegenerative disorders, didn’t mince words when we met in her office overlooking the city. “We’re simply not prepared for the infrastructure demands these treatments require,” she explained. “These aren’t pills. They’re infusion therapies requiring special monitoring, regular brain imaging, and sophisticated diagnostic capabilities that most Canadian health facilities don’t currently have.”
The treatments in question—monoclonal antibodies that target amyloid plaques in the brain—represent the first therapies that may actually modify the disease course rather than just treating symptoms. Health Canada is currently reviewing two such therapies, but approval is only the first hurdle. The greater challenge is implementation.
When I visited Sunnybrook Health Sciences Centre, clinical trials coordinator Mei Wong showed me the specialized infusion rooms where a handful of Canadian patients are receiving experimental versions of these treatments. “Each patient needs about four hours for the infusion process, plus monitoring time,” she explained. “Now multiply that by the roughly 350,000 Canadians currently living with early-stage Alzheimer’s. Where would we put them all?”
The Alzheimer Society of Canada estimates that without effective interventions, the number of Canadians living with dementia will nearly triple by 2050, reaching 1.7 million people. The economic burden, already at $12 billion annually according to Health Canada figures, would become catastrophic.
Beyond physical infrastructure, these treatments require specialized diagnostic tools that many Canadian healthcare facilities lack. PET scans to confirm the presence of amyloid plaques—a prerequisite for treatment eligibility—are scarce across Canada, with fewer than 57 scanners nationwide to serve our entire population.
“In rural communities, we’re already struggling with basic dementia care,” said Dr. James Mackenzie, who serves patients across northern Ontario through a traveling memory clinic. I joined him for a day last week as he saw patients in Thunder Bay. “If these treatments are approved without addressing the access gaps, we’ll create a two-tiered system where only urban patients near major centers can benefit.”
The situation in Indigenous communities is even more concerning. In Sioux Lookout, community health worker Elizabeth Beardy shared how diagnostic delays already complicate dementia care for First Nations elders. “Many of our people are diagnosed too late for these new treatments to help, even if they were available,” she told me as we sat in the community health center. “Our elders deserve better than that.”
Financial readiness presents another significant barrier. These treatments could cost between $20,000 and $30,000 per patient annually, according to preliminary estimates from the Canadian Agency for Drugs and Technologies in Health. Provincial drug plans and private insurers have yet to determine coverage parameters, raising concerns about equitable access.
“We’re looking at potentially billions in new healthcare spending without a national strategy to ensure fair distribution,” explained Dr. Omar Hussain, health economist at the University of British Columbia. “The provinces can’t tackle this individually—we need federal coordination.”
When I raised these concerns with Health Canada representatives, they acknowledged the challenges but pointed to ongoing work with provincial and territorial partners to develop implementation frameworks. “We recognize that approval without access doesn’t help patients,” said spokesperson Marie Duchesne. “But we need to ensure both safety and system readiness before moving forward.”
For patient advocates like Jennifer Chen of the Canadian Alzheimer’s Action Network, this cautious approach feels like unnecessary delay. “Every month these treatments aren’t available, thousands more Canadians progress beyond the point where they could benefit,” she argued during our conversation at a recent advocacy event in Ottawa. “People are considering moving to the U.S. just to access treatment.”
Some healthcare leaders are working to bridge the gaps. At Montreal Neurological Institute, Dr. Antoine Laberge is developing a pilot program to expand diagnostic capacity through shared resources. “We’re creating regional hubs where smaller hospitals can send patients for specialized testing,” he explained as he showed me their newly expanded imaging department. “It’s not enough, but it’s a start.”
The challenges extend beyond infrastructure to workforce readiness. Canada already faces a shortage of neurologists, with wait times for initial consultation stretching up to 18 months in some regions. Specialized nurses trained in administering these complex therapies and monitoring for potential side effects—which can include brain swelling and microhemorrhages—are even scarcer.
Back in Mississauga, Jean and Sarah Tremblay continue their morning routine, a ritual that grows slightly more challenging each month as Jean’s memory fades. For them, the abstractions of healthcare planning and resource allocation translate to precious time slipping away.
“I understand these treatments aren’t perfect,” Sarah said as we finished our conversation. “But shouldn’t that be our choice to make? Shouldn’t we at least have the option?”
As Canada stands at this critical juncture, the question remains whether our healthcare system can evolve quickly enough to deliver on the promise of these new therapies. The challenge isn’t just about approving new drugs—it’s about transforming how we deliver care to thousands of Canadians facing cognitive decline.
For Jean and thousands like him, the clock is ticking.
