Rads have expanded role in Alzheimer’s monitoring

OTTAWA – Health Canada recently approved a new disease-modifying therapy (DMT) for the treatment of patients with early Alzheimer’s Disease (AD). This marks an exciting turning point in AD care, with Canada joining other countries in adopting this innovative treatment to fight AD.

As the first DMTs enter Canadian clinical practice, radiologists will play a critical role in ensuring safe, accurate, and effective treatment delivery, by monitoring its effects on the brain.

Lecanemab (commercially known as LEQEMBI), an anti-amyloid therapy, is indicated for use in individuals living in the early stages of disease (defined as mild cognitive impairment or mild dementia). AD specialists will require the support of radiology to select appropriate patients to receive therapy by using specific cognitive dementia protocols for screening.

Beyond diagnosis, neuroimaging plays a crucial role in patient monitoring once treatment has been initiated. Anti-amyloid therapies, like lecanemab, are associated with amyloid related imaging abnormalities (ARIA), which may present in one of two forms: ARIA with edema/effusion (ARIA-E) or ARIA with hemosiderin/hemorrhage (ARIA-H).

While ARIA are often asymptomatic, early detection is essential to inform treatment decisions and minimize overall patient risk. The rate of ARIA events is specific to each anti-amyloid drug and may differ across treatments.

Dr. Sharon Cohen (pictured), a behavioural neurologist and medical director of The Toronto Memory Program, told Global News that, “Here we have an antibody that can clear amyloid from the brain.”

She explained, “Amyloid is a sticky protein that damages the brain and is the earliest brain change in Alzheimer’s.”

Optimistically, she said: “Most people, at four years of treatment, are staying mild and are staying in their own homes, independently.”

However, Dr. Samir Sinha, a geriatrician at Sinai Health and the University Health Network, added a few cautions. “It’s not covered and it’s quite expensive. If one commits to being on this medication, one needs to go through routine MRIs. And there are some serious side effects that can come with this.”

Current monitoring protocols call for a baseline MRI to be performed prior to treatment initiation and frequent early-treatment scans at defined intervals throughout the course of treatment. For all details on MRI monitoring protocols, refer to the LEQEMBI Canadian Product Monograph and the educational programs available at www.understandingARIA.ca.

Radiologist’s responsibilities to detect subtle imaging changes, distinguish ARIA from other pathologies, and effectively communicate with the treating physician, places them at the forefront of patient care. Radiology expertise will be pivotal in supporting multidisciplinary decision-making.

The approval of lecanemab marks far more than the arrival of a new therapeutic option in AD. It signals a shift towards biomarker-driven, imaging-intensive AD care where a multidisciplinary approach becomes even more important. This advancement also signals new hope for patients living with AD and caregivers alike.

In this new era where imaging will guide diagnosis, safeguard and inform treatment decisions, the radiology community becomes a pivotal force in shaping patient outcomes. Their expertise ensures that as innovation accelerates, patient safety remains at the forefront of AD care.