Alzheimer's disease therapy monitoring with MRI
50 Million people suffer from Alzheimer’s disease (AD) worldwide. 1.6 Million people die from AD every year, making AD the second leading cause for death in Neurology worldwide.1
Until now it has no cure, but recently, drugs that can slow the progress of Mild Cognitive Impairment (MCI) – the early stage of Alzheimer’s Disease (AD) – have become available. Possible side effects of these drugs are called Amyloid Related Imaging Abnormalities (ARIA), and MRI is the method of choice to monitor these for the occurrence of ARIA.
In July 2023, the US Food and Drug Administration (FDA) for the first time gave traditional approval to amyloid beta directed antibody for the treatment of AD. With such Disease Modifying Therapies (DMTs) entering the clinic, the potential to improve patient care and possibly slow disease progression is enormous.
How a Disease Modifying Therapy works
This family of treatments target the pathology of Alzheimer's disease by reducing the amyloid beta plaques that typically accumulate in the brains of AD patients. Clinical studies have demonstrated that removing amyloid beta from brain reduces cognitive and functional decline in patients living with early AD2,3
MRI is the diagnostic tool of choice for detecting ARIA and regular MR scans are recommended for patients undergoing monoclonal antibody-based therapy. ASNR recommends using T2 FLAIR for monitoring of ARIA-E and T2* gradient-echo imaging for detection of ARIA-H.4 Additionally, in case of stroke like symptoms, DWI helps to determine if the root cause is ischemia or ARIA. FDA recommends MRI monitoring scans for Leqembi according to the following schedule.5
Requirements for therapy monitoring by FDA for Leqembi
ASNR kindly prepared together with our collaborators from Washington University, St. Louis/MO, USA, the required protocols for MAGNETOM scanners. All Siemens Healthineers MAGNETOM MRI scanners are capable of providing the required T2 FLAIR, T2*, and DWI contrasts.