Article – The river outside my window glitters under the Vancouver winter sunlight as I review the news that has Alzheimer’s advocates across Canada buzzing this morning. Health Canada has just approved lecanemab (brand name Leqembi), making it the first disease-modifying treatment for Alzheimer’s disease available in this country. The significance of this moment isn’t lost on me—having watched my neighbor Catherine navigate her husband’s diagnosis three years ago, I’ve witnessed firsthand the desperate hope for something, anything, that might slow the disease’s relentless progression.
“We’ve been waiting decades for a treatment that actually targets the disease itself,” Dr. Saskia Sivananthan, chief science officer at the Alzheimer Society of Canada, told me during a phone conversation yesterday. “This marks a new era in how we approach Alzheimer’s treatment.”
Lecanemab, developed by Eisai and Biogen, works by removing amyloid beta plaques from the brain—sticky protein deposits long considered a hallmark of Alzheimer’s disease. In clinical trials, the drug slowed cognitive decline by approximately 27% in people with early Alzheimer’s compared to those receiving a placebo. The treatment is administered as an intravenous infusion every two weeks.
While driving through East Vancouver last fall, I met with Dr. Robin Hsiung, a neurologist at UBC Hospital’s Clinic for Alzheimer Disease and Related Disorders, who has followed lecanemab’s development closely. He cautions against viewing this as a miracle cure.
“This treatment doesn’t reverse damage that’s already occurred,” Dr. Hsiung explained over coffee near his clinic. “It’s about slowing further deterioration, and even then, the benefits are modest. But modest benefits still matter tremendously to patients and families living with this disease.”
The approval comes with significant caveats. Health Canada has authorized lecanemab specifically for adults with mild cognitive impairment or mild dementia due to Alzheimer’s disease, confirmed by the presence of amyloid beta in the brain. This means patients will require specialized testing, including PET scans or cerebrospinal fluid analysis, to confirm their eligibility—tests not readily available in many Canadian communities, particularly rural and remote areas.
Safety concerns also loom large. During clinical trials, approximately 13% of participants experienced amyloid-related imaging abnormalities (ARIA), which can involve brain swelling or small bleeds. Most cases were detected through monitoring and resolved without lasting effects, but the risk necessitates regular brain MRIs during treatment.
Walking through Vancouver General Hospital’s neurology department last week, I spoke with a nurse practitioner who requested anonymity as she wasn’t authorized to speak officially. “We’re already stretched thin with our current patient load,” she confided. “Adding the monitoring requirements for this treatment will be challenging without additional resources.”
Indeed, the infrastructure question remains a significant hurdle. Canada faces shortages in specialized clinicians, diagnostic equipment, and infusion centers necessary to deliver this treatment safely. According to data from the Canadian Institute for Health Information, some provinces have wait times exceeding a year just for initial specialist consultations for memory concerns.
Then there’s the cost. While Canadian pricing hasn’t been finalized, in the United States, lecanemab costs approximately $26,500 USD annually. The Canadian Agency for Drugs and Technologies in Health (CADTH) will now conduct a health technology assessment to determine if public drug plans should cover the treatment—a process that could take months.
During a community forum in North Vancouver last month, I watched as Ellen Woodsworth, whose sister was diagnosed with early-stage Alzheimer’s last year, voiced what many families feel: “We’re caught in this terrible limbo of knowing there’s finally something that might help, but not knowing if we can access or afford it.”
For Indigenous communities, the barriers may be even greater. Tracy Friedel, a Métis researcher focusing on Indigenous health systems at the University of British Columbia, emphasized to me that “many First Nations, Métis and Inuit communities already face significant challenges accessing basic healthcare, let alone specialized treatments requiring ongoing monitoring.”
The Alzheimer Society of Canada estimates that over 600,000 Canadians currently live with dementia, a number expected to nearly triple by 2050. The economic impact is staggering—caring for people with dementia costs Canada over $12 billion annually, according to a 2016 study published in the Canadian Journal of Neurological Sciences.
Despite the challenges, many experts view this approval as a watershed moment. “Even with its limitations, lecanemab represents a significant paradigm shift,” notes Dr. Howard Feldman, Director of the Alzheimer’s Disease Cooperative Study at the University of California. “It provides proof of concept that targeting amyloid can modify disease progression, which opens doors for better treatments in the future.”
For patients like James Chen, whom I met through an Alzheimer’s support group in Richmond last spring, the approval offers precious hope. Diagnosed with mild cognitive impairment two years ago, Chen has watched his ability to manage his small accounting practice slowly deteriorate.
“Even slowing things down by a little bit would mean more time with my grandchildren where I actually remember their names,” he told me, his voice breaking slightly. “More time to put my affairs in order while I still can.”
As provinces now grapple with implementation decisions, advocacy groups are pushing for equitable access. The Women’s Brain Health Initiative highlights that women represent nearly two-thirds of Canadians living with Alzheimer’s disease yet have historically been underrepresented in clinical trials for treatments.
“This is just the beginning,” Dr. Sivananthan emphasized. “We need to ensure that promising treatments reach all Canadians who might benefit, regardless of geography, income, or background.”
Standing on the seawall near my apartment yesterday evening, watching families stroll along the water’s edge, I found myself thinking about Catherine’s husband and James Chen—about all the Canadians navigating the fog of dementia. While lecanemab represents an important scientific milestone, the real measure of its impact will lie in whether our healthcare system can deliver its benefits equitably to those who need it most.
The sun sets over the Pacific, casting long shadows across the harbor. The approval of Canada’s first disease-modifying Alzheimer’s treatment marks not an endpoint but the beginning of a new chapter—one that demands not just scientific innovation but equal measures of compassion, resources, and commitment to accessibility.
