What is Lormalzi? Expert explains how it works and who it’s meant for

For decades, Alzheimer’s treatment mostly focused on managing symptoms. Medicines helped patients sleep better, feel calmer, or cope with memory problems for some time, but the disease itself continued to progress quietly in the background. Now, a newer therapy called Lormalzi, also known as Donanemab, is changing that conversation.

Doctors and researchers across the world are closely watching this treatment because it does something earlier Alzheimer’s drugs could not fully achieve: it targets one of the biological changes linked to the disease itself.

In simple words, Lormalzi is not designed to “reverse” Alzheimer’s or cure dementia. Instead, it aims to slow down the worsening of memory and thinking problems in people diagnosed at an early stage. That difference matters deeply for families trying to hold on to everyday moments for a little longer. Treatments that can delay that loss, even modestly, are now being seen as an important step in Alzheimer’s care.

According to Dr M V Padma Srivastava, Chairperson of Neurology at Paras Health, “Lormalzi (Donanemab) is a next-generation Alzheimer’s therapy designed to slow the progression of the disease in its early stages, particularly in patients with mild cognitive impairment (MCI) and early dementia. Unlike conventional medicines that mainly manage symptoms, this treatment targets one of the key biological changes associated with Alzheimer’s disease.”

The therapy belongs to a newer class of drugs called monoclonal antibodies. These medicines are specially designed in laboratories to recognise and attach to harmful substances in the body.

In Alzheimer’s disease, one of those harmful substances is amyloid-beta plaque, a sticky protein buildup found in the brain. Scientists believe these plaques interfere with nerve cell communication and contribute to memory decline over time.

The US Food and Drug Administration approved Donanemab for adults with early symptomatic Alzheimer’s disease in 2024. The approval specifically covered patients with mild cognitive impairment and mild dementia linked to Alzheimer’s disease.

One reason this therapy has drawn global attention is because it directly targets amyloid plaques instead of only addressing symptoms.

Dr Srivastava explains, “Donanemab is an antibody-based therapy that targets amyloid-beta plaques in the brain, which are considered one of the hallmark abnormalities in Alzheimer’s disease. By helping clear these plaques, the treatment aims to reduce further nerve cell damage.”

The medicine is given through an intravenous infusion once every month. Unlike some long-term therapies that continue indefinitely, Donanemab follows what doctors describe as a “treat-to-target” approach.

“It is administered as a monthly infusion, generally for around 18 months or until scans show plaque reduction to the desired level,” says Dr Srivastava.

This approach is important because doctors use brain imaging scans to track whether amyloid plaque levels are reducing over time. Once the target level is achieved, treatment may be stopped in certain patients.

This is not a treatment for every person with dementia.

Experts say the medicine works best in people diagnosed very early, before significant brain damage has already occurred. That means early testing becomes extremely important.

The therapy is mainly meant for:
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People with mild cognitive impairment linked to Alzheimer’s disease
Patients in the early dementia stage
Individuals with confirmed amyloid plaque buildup through specialised tests

Dr Srivastava notes, “Its effectiveness depends greatly on early and accurate diagnosis through PET scans or cerebrospinal fluid testing.”

That detail is crucial because many older adults experience forgetfulness for reasons unrelated to Alzheimer’s disease. A proper neurological evaluation is necessary before considering therapies like Donanemab.

The FDA also states that treatment should begin in patients with mild cognitive impairment or mild dementia stages, which were the groups studied during clinical trials.

This is where the discussion becomes both hopeful and careful.

Clinical trials have shown encouraging results, but doctors are also clear that Donanemab is not a cure.

Dr Srivastava says, “The therapy may help slow memory loss, cognitive decline, and deterioration in daily functioning, allowing patients to maintain independence and quality of life for a longer duration. It represents a major shift from symptom management toward disease-modifying treatment in Alzheimer’s care.”

​Studies found that patients receiving Donanemab showed slower decline in memory, thinking ability, and daily functioning compared to those receiving placebo treatment.

Still, neurologists caution against viewing the treatment as a miracle drug.

Some researchers have raised concerns about whether reducing amyloid plaques always translates into meaningful long-term cognitive improvement for every patient.

That scientific debate continues, but many specialists believe the therapy still marks an important turning point in Alzheimer’s research because it offers something that was unavailable until recently: a chance to slow disease progression rather than only manage symptoms.

Like many advanced therapies, Donanemab comes with possible side effects and requires close medical supervision.

One major concern is a condition called ARIA, short for Amyloid-Related Imaging Abnormalities. This can involve swelling or tiny bleeding spots in the brain.

Dr Srivastava explains, “Patients also require close monitoring for Amyloid-Related Imaging Abnormalities (ARIA), including brain swelling or microbleeds.”

The FDA has also issued warnings regarding these risks. In some cases, ARIA may not cause symptoms, but serious complications can occur.

Doctors usually recommend regular MRI scans during treatment to monitor brain changes safely.

Other side effects may include headaches, infusion reactions, nausea, dizziness, or temporary confusion.

Because of these risks, experts stress that treatment decisions should always involve detailed conversations between neurologists, patients, and caregivers.

Alzheimer’s disease affects millions of families worldwide and remains one of the most emotionally difficult neurological disorders.

For years, families often heard the same painful message after diagnosis: progression could be managed, but not slowed meaningfully.

Donanemab may not change everything overnight, but it signals a major scientific shift. It reflects a future where earlier diagnosis, targeted therapies, and personalised brain care may become increasingly important.

For caregivers watching loved ones slowly lose memories, names, and familiar routines, even a modest slowing of decline can carry enormous emotional value.

And perhaps that is why conversations around Alzheimer’s treatment are beginning to sound different now. Less helpless. More cautious hope.

This article includes expert inputs shared with TOI Health by:

Padma Shri Dr M V Padma Srivastava, Chairperson of Neurology at Paras Health Gurugram.

Inputs were used to explain what Lormalzi is, how this new Alzheimer’s therapy works inside the brain, and which patients may benefit from it according to experts.