Dr Bradford Dickerson shares his clinical experience in using amyloid plaque–lowering monoclonal antibodies in Alzheimer's disease.
Professor, Department of Neurology, Harvard Medical School; Director, Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
We often augment our general clinical sense of this question of the patient's cognitive functional status with validated questionnaires that the patient themselves and, ideally, an informant who knows the person well can complete. We like to use theWe use those to try to determine the patient's overall cognitive functional status.
I should mention that if a person has active, unstable psychiatric symptoms, such as psychosis, it's really not advisable to give them this type of therapy. We have to try to work toward getting them stabilized in regard to those types of symptoms. The most important thing, though, is to evaluate for microhemorrhage or other types of hemorrhage with the susceptibility-weighted image or GRE sequence. If people have more than four microbleeds, superficial siderosis, or other evidence of hemorrhage already, that's a contraindication to this class of therapies as well. There are some nuances around that, so I would encourage you to talk with your neuroradiologist to better understand how to apply that. .
Once we have all that information, we can have a real risk-benefit ratio discussion with patients. I like to talk first about the clinical benefits that were observed in the, which include slowing of decline on changes in cognitive and functional outcomes.
Alzheimer's Disease Alzheimer Disease Vascular Dementia Multi-Infarct Dementia Cognitive Impairment Magnetic Resonance Imaging MRI - Magnetic Resonance Imaging Positron Emission Tomography PET PET Scan PET - Positron Emission Tomography Impairment Mild Cognitive Impairment MCI - Mild Cognitive Impairment Minimal Cognitive Impairment MCI
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