i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource. In this slide deck, discover new insights into early diagnosis, emerging treatment modalities, and supportive care services for Alzheimer disease. An expert faculty member will discuss biological and clinical distinctions between mild cognitive impairment, dementia, and Alzheimer disease; methods for timely diagnosis; clinical trial data on novel monoclonal antibody therapies; prevention and management of side effects associated with monoclonal antibody therapies, including ARIA, and interdisciplinary support services for improving quality of life. STATEMENT OF NEED Alzheimer disease, the most common form of dementia among older adults, is a slowly progressive neurogenerative disease that affects approximately 6 million Americans aged 65 and older (Rajan et al, 2021). Symptoms of Alzheimer disease include memory loss, confusion, impulsive behavior, difficulty with language, mood and personality changes, hallucinations, and increased anxiety or aggression, with severe symptoms such as physical decline, difficulty swallowing, and inability to communicate developing as the disease progresses into its final stages (NIA, 2023). While new therapeutic agents have recently emerged to slow the progression of Alzheimer disease by targeting its underlying causes, the disease remains incurable, and the demands of day-to-day care place significant strain on both patients and their families and caregivers. Therefore, it is critical that clinicians remain up to date on early diagnosis, emerging treatment modalities, and supportive care services in order to provide optimal care for their patients. In this live webinar chaired by Nathaniel Chin, MD, Associate Professor of Medicine in the Division of Geriatrics and Gerontology at the University of Wisconsin-Madison, speakers will explore advances in the diagnosis and treatment of Alzheimer disease. TARGET AUDIENCE Geriatricians, neurologists, primary care physicians, psychiatrists, psychogeriatricians, nurse practitioners, physician assistants, nurses, and other health care professionals (HCPs) involved in the treatment of patients with Alzheimer disease (AD). LEARNING OBJECTIVES Upon completion of this activity, participants should be able to: Utilize diagnostic methods that enable the timely identification of early Alzheimer disease (AD) Evaluate the clinical utility of novel and emerging DMTs for the treatment of individual patients with early AD Apply strategies to enhance interdisciplinary care for patients with early AD

1. Exploring Advances in the Early Diagnosis and
Treatment of Alzheimer Disease
Nathaniel Chin, MD
Associate Professor of Medicine, Division of Geriatrics and Gerontology
Medical Director, Wisconsin Registry for Alzheimer’s Prevention Study
University of Wisconsin-Madison

2. Disclosures
Advisory board/panel: NewAmsterdam Pharma
i3 Health has mitigated all relevant financial relationships

3. Learning Objectives
Utilize diagnostic methods that enable the timely identification of early
Alzheimer disease (AD)
Evaluate the clinical utility of novel and emerging disease-modifying
therapies (DMTs) for the treatment of individual patients with early AD
Apply strategies to enhance interdisciplinary care for patients with
early AD

4. Alzheimer’s Disease
Jack et al, 2018; Silbert, 2007; Neuroscience News, 2012.
Alzheimer’s disease is not the
same as dementia
Alzheimer’s disease is defined
biologically as the presence of
elevated amyloid proteins and tau
proteins in the brain
As a disease process, it is the most
common cause of
neurodegeneration leading to
dementia
Cerebral cortex
Hippocampus Entorhinal
cortex
Extreme shrinkage of
cerebral cortex Severely
enlarged
ventricles
Extreme
shrinkage of
hippocampus

5. Clinical Syndromes of Cognitive Impairment
Albert et al, 2011; Jack et al, 2018.
Mild Cognitive Impairment (MCI)
Cognitive symptom(s) that:
Raise concern to patient,
knowledgeable informant,
or health care provider
Represent a decline from
baseline
Impairment in ≥1 cognitive
domains
Preservation of independence
in functional abilities
Dementia
Cognitive symptom(s) that:
Interfere with ability to function at work or usual activities
Represent a decline from previous level
Are not explained by delirium or major psychiatric disorder
Cognitive impairment is detected and diagnosed by:
History from patient and knowledgeable informant
Objective cognitive assessment
“Bedside” mental status examination or neuropsychological
assessment
Neuropsychological assessment should be done if history
and beside exam do not lead to a confident diagnosis
Affect ≥2 thinking abilities on cognitive testing
Dementia due to AD
Gradual onset over months to years
Worsening of cognition over time
Usually, memory-complaint initially

6. Alzheimer’s Disease: Prevalence
Alzheimer’s Association, 2023; Alzheimer’s Association, 2022; Rajan et al, 2021; Peterson et al, 2018.
Approximately 5 Million Americans Have MCI Due To AD
Age
Prevalence
of MCI
60-64 6.7%
65-69 8.4%
70-74 10.1%
75-79 14.8%
80-84 25.2%
30%-50% of
people with MCI
due to AD will
progress to
Alzheimer’s
dementia over a 5-
10–year period
Number and Ages of People 65 or Older with
Alzheimer’s Dementia, 2023

7. Alzheimer’s Disease Impacts Communities Differently
ADRD = Alzheimer’s disease and related dementias.
Alzheimer’s Association, 2023; Barnes, 2022; Trojanczyk et al, 2019.
Incidence of AD is almost 2x higher in older
African American individuals
Risk of AD in Hispanic/Latino individuals is 1.5x
more
Native Americans are at higher risk for AD and
dementia than White or Asian Americans; 1 in 3
Native American elders will develop ADRD
Estimated Lifetime Risk
for AD
Age
Risk in
men
Risk in
women
45 10.3% 19.5%
65 11.6% 21.1%

8. Alzheimer’s Disease Cases Will Continue to Increase
Alzheimer’s Association, 2023; Rajan et al, 2021.
Projected Number of People 65 or Older (Total and by Age) in the US Population with Alzheimer’s
Dementia, 2020 to 2060

9. Alzheimer’s Disease: Economic Impact
Distribution of Aggregate Costs of Care by Payment
Source for Americans Age 65 or Older with Alzheimer’s
or Other Dementias, 2023
Data are in 2023 dollars
Created from data from the Lewin Model. Other payment sources
include private insurance, health maintenance organizations, and
uncompensated care.
The sum of individual dollar amounts does not equal the total
coast due to rounding.
Alzheimer’s Association, 2023.

10. Care Starts With a Diagnosis
Alzheimer’s Association, 2023.
40% of Americans would talk to their doctor right away if experiencing early
memory or cognitive loss
70% of Americans would want to know early if they have Alzheimer’s disease if it
could allow for earlier treatment
Yet…
54% of Americans who experienced cognitive symptoms did not consult with a
health care professional
41% who had cognitive symptoms interfering with daily function did not talk with a
provider
97% of primary care physicians report waiting for patients to make them aware of
symptoms or request an assessment

11. Reasons for a Delay in Diagnosis
AA = Alzheimer’s Association; PCP = primary care provider.
Alzheimer’s Association, 2022.
18% of Americans are familiar with MCI (AA survey)
98% of PCPs report it is important to diagnose MCI
35% of PCPs reported being not fully comfortable diagnosing MCI and 51% of PCPs
not fully comfortable diagnosing MCI due to AD
Top reasons for discomfort: differentiating normal aging from MCI, difficulty interpreting
daily functioning, lack of specialists for diagnostic testing
38% of PCPs reported specialists are better equipped to assess and diagnose patients
with cognitive impairment, while 43% felt specialists are better equipped to discuss
cognitive assessments
99% of PCPs refer patients to specialists when they detect cognitive impairment

12. Benefits of an Early Diagnosis: Patient/Family
Reiss et al, 2022.
Can help explain symptoms, personality changes, behavioral changes
Provides an answer to patient and family suspicions/concerns
Earlier interventions
Access to right services and support; medications
Maintain a good quality of life
Patients can participate in their care and discuss future care options
Patients can participate in their own legal and financial decisions
Helps patients and family prepare for future functional change and potential safety
issues
Allows family members and friends to develop new roles of support
Gives time for families and care partners to become more educated

13. Benefits of an Early Diagnosis: Provider
Reiss et al, 2022.
Address brain health and mental health
Address chronic diseases with a new lens
Make earlier referrals
Monitor for functional changes (ie, driving) and safety issues
Connect patient/family to community organizations
Address advanced directives and future care planning
Refer to clinical research

14. Diagnostic Workup
McCollum & Karlawish, 2020; Geerlings et al, 1999; Jessen et al, 2010; Barnes et al, 2006; Arvanitakis et al, 2018.
Assess risk factors for cognitive impairment
Age, family history of dementia, chronic medical conditions
Ask about concerns for memory or thinking changes
Examples
Do you feel like your memory is becoming worse?
How often do you have trouble remembering things? (scale 1-5)
Compared with 10 years ago, how would you rate your memory?
(scale 1-5)
If possible, talk with a knowledgeable informant
Family, friend, someone who knows person well enough to potentially
have concerns

15. Cognitive Screening
Janssen et al, 2017.
Not the same as cognitive testing or neuropsychological testing
Not diagnostic testing
Some exceptions
Explain the test and purpose of testing before administering
Set expectations and allow the patient to mentally prepare

16. Cognitive Screening (cont.)
Reiss et al, 2022.
Considerations
Well-trained staff should
administer test
Stick to the guidelines of the
instrument
Results should be discussed
with patient/family
Avoid using instrument cutoffs
for diagnosis
Talking points prior to testing
Performance testing is an
objective measurement to
potentially identify cognitive
changes beyond normal aging
May not reflect what a person
feels or others witness
Artificial process (quiet, isolated
room, specific tasks)

17. Cognitive Screening Instruments
Reiss et al, 2022.
Mini-Mental State Examination (MMSE)
Saint Louis University Mental Status Exam (SLUMS)
Montreal Cognitive Assessment (MoCA)
Mini-cog
Memory Impairment Screen (MIS)
Brief Alzheimer’s Screening Test (BAS)
General Practitioner assessment of Cognition (GPCOG)
AD8 Informant Interview (not a test)

18. How To Diagnose Cognitive Impairment?
Reiss et al, 2022.
Cognitive and functional history
Cognitive symptoms
Functional changes, if any
Cognitive screening
Separate visit, if needed
Does not provide definitive answers
Evaluate for reversible causes, including delirium and mental health
History
Labs
Brain imaging
Physical exam
Labs and head imaging

19. Cognitive History
Reiss et al, 2022.
Symptom identified
Patient, family, provider, routine screening
Patient and collateral historian
Cognition
Onset, initiating event?, course
Specific symptoms and examples
Medical changes during this time
Including head injuries, acute illnesses, surgeries
Mood, personality, behavior
Sleep, hearing
Review medical history, medications, family history, substance history

20. Functional History
BADL = basic activities of daily living.
Chudoba et al, 2020; de Ruijter et al, 2020.
Collateral historian is key
Patient perspective is important, but insight changes with disease
progression
Inquire about specific safety concerns or events/issues noticed by
family
Check list approach, reviewing IADLs and then BADLs
Semi-structured interview

21. What Are the Common Functional Abilities To Assess?
Slide courtesy of Nathaniel Chin, MD.
Making and keeping
appointments
Managing medications
Managing finances
Driving
Meal preparation and cooking
Household chores
Use of technology
Maintaining hobbies
Basic activities of daily living
Dressing
Bathing
Toileting
Transferring
Walking
Eating

22. Functional Impairment
IADL = instrumental activities of daily living; ER = emergency room.
Slide courtesy of Nathaniel Chin, MD.
Compare current abilities with baseline
Start with IADLs
Most complex are managing finances, medications, appointments
Collateral historian is key
Ideally someone who lives with the patient (spouse, child)
Patient endorsement is more confirmation than identification
Compensatory strategies are okay and expected in MCI
Rare, infrequent mistakes may not be impairments
Objective impairments are easier to identify
Missed payments, ER visits due to medication non-adherence
Impairments must be due to cognition, not due to mood/physical limitations

23. Look for Reversible Causes & Talk To Brain Health
HIV = human immunodeficiency virus; UTI = urinary tract infection; NPH = normal pressure hydrocephalus.
Slide courtesy of Nathaniel Chin, MD.
Medication reconciliation
Mood assessment
Evaluate alcohol intake or other substances
Evaluation sleep and rule out sleep apnea
Kidney, liver, or thyroid issues
Hearing or vision issues
Chronic infections
Syphilis, Lyme disease, HIV, COVID-19
Acute infections
UTI, cellulitis, pneumonia, viral colds
Brain imaging for subdural hematoma or NPH

24. Potential Tools in the Evaluation Process
GDS = Geriatric Depression Scale; PHQ = Patient Health Questionnaire; GAD = Generalized Anxiety Disorder; GAS = Geriatric Anxiety Scale;
STOP-BANG = snoring/tiredness/observed apnea/pressure/body mass index/age/neck circumference/gender;
IQCODE = Informant Questionnaire on Cognitive Decline in the Elderly; ADLs = activities of daily living; FAQ = Functional Activities Questionnaire;
QDRS = Quick Dementia Rating System; DSRS = Dementia Severity Rating Scale; FAST = Functional Assessment Rating Scale.
Slide courtesy of Nathaniel Chin, MD.
Patient
Cognition
MoCA or MMSE or SLUMS
Mental health
GDS or PHQ-9
GAD-7 or GAS
Sleep apnea
STOP-BANG
Informant
Cognitive changes
Short IQCODE or AD8
Function
Lawton IADLs/Katz ADLs
FAQ
Staging
QDRS or DSRS
FAST

25. Physical Exam
Slide courtesy of Nathaniel Chin, MD.
Neurological exam: Parkinsonism and focal neurological deficits
Brief hearing exam
Cardiovascular exam: cardiac arrhythmias, carotid stenosis
Functional assessment: transferring, ambulation

26. Blood Work and Head Imaging
BMP = basic metabolic panel; LFT = liver function tests; TSH = thyroid-stimulating hormone; CBC = complete blood count; MCV = mean corpuscular volume;
RPR = rapid plasma regain; UA = urinalysis; MRI = magnetic resonance imaging; CT = computed tomography.
Slide courtesy of Nathaniel Chin, MD.
Labs
BMP: kidney function and electrolytes
LFTs: liver function
TSH: thyroid function
CBC: acute infection, anemia, MCV (vitamin deficiency, liver disease, alcohol use)
Vitamin B12 level
If risk factors present: HIV, RPR
Other vitamins: vitamin B1, B6, D
UA only if concerned about potential urinary tract infection
Brain imaging
MRI or CT without contrast
Rule out brain mass, subdural hematoma, normal pressure hydrocephalus
Evaluate for: atrophy, hippocampal atrophy, chronic small vessel disease, prior strokes

27. Advanced Biomarker Testing
PET = positron emission tomography; FDG = fluorodeoxyglucose; DAT = dopamine transporter; CSF = cerebrospinal fluid.
Cummings, 2019.
PET scans
FDG-PET
Amyloid
Tau
DAT scan
Lumbar puncture—CSF
Amyloid and tau
Inflammation,
neurodegeneration
Blood-based biomarkers
Amyloid and tau
Inflammation,
neurodegeneration
Predictive power

28. Liquid Biopsy: Blood-Based Biomarkers for AD
Aß = amyloid; NfL = neurofilament light; pTau = phosphorylated tau; GFAP = glial fibrillary acidic protein; MMP = matrix metalloproteinase;
sAD = sporadic Alzheimer’s disease; jAD = familial Alzheimer’s disease.
Teunissen et al, 2022; Palmqvist et al, 2020; Paczynski & Day, 2022.
Currently
available blood-
based biomarkers
in the US
Aß42/Aß40
Ptau217
NfL
GFAP (for
traumatic brain
injury)

29. Genetic Testing
APOE = apolipoprotein E.
NIH NIA, 2023; Porsteinsson et al, 2021.
Late-onset Alzheimer’s disease
APOE is a risk gene, not deterministic like early-onset AD
Presence of APOE4 increases risk for developing AD
1 copy of APOE4 increases risk by 2-4x
2 copies of APOE4 increases risk by 10-15x
Not routinely ordered in clinical practice for diagnosis
Some patients may learn APOE status from direct-to-consumer testing or from
clinical trials

30. How Do MABs Work?
MAB = monoclonal antibody; Fc = fragment crystallizable region; FcR = Fc receptor.
Leisher et al, 2023; Zampar & Wirths, 2020.
Proposed mechanisms
of anti–amyloid-ß

31. Overview of 3 MABS
IgG1 = immunoglobulin 1; Aß = amyloid beta; BACE = ß-site APP cleaving enzyme; AICD = APP intracellular domain.
Leisher et al, 2023; Sims et al, 2023; Haeberlein et al, 2022; van Dyck et al, 2022; FDA, 2021; FDA, 2023.
Aducanumab
First FDA-approved therapy via accelerated
approval (6/2021)
Conflicting phase 3 trials
Human IgG1 antibody targeting aggregated
forms of Aß (oligomers, insoluble fibrils)
Lecanemab
First FDA-approved therapy via traditional
approval (7/2023)
Human IgG1 antibody targeting soluble forms
of Aß (oligomers, protofibrils)
Donanemab
Under evaluation by FDA
Human IgG1 antibody targeting insoluble Aß
(fibrils, plaques)

32. General Indications, Contraindications, Administration
IV = intravenous.
Leqembi™prescribing information, 2023; Aduhelm® prescribing information, 2022; Cummings, Apostolova, et al, 2023; Sims et al, 2023.
Patient population
MCI and mild stage dementia
Confirmed presence of amyloid
Contraindications
Hypersensitivity reactions
Many conditions noted in the Appropriate Use Guideline
Administration
IV infusions every 2 weeks (lecanemab) or 4 weeks (aducanumab,
donanemab)

33. Clinical Trial Outcomes
ADAS-cog = Alzheimer’s Disease Assessment Scale–Cognitive Subscale; NPI = Neuropsychiatric Inventory; ADCS = Alzheimer’s Disease Cooperative Study;
ADCOMS = Alzheimer’s Disease Composite Score.
Haeberlein et al, 2022; van Dyck et al, 2023 ; Sims et al, 2023.
Primary outcome (clinical)
Clinical dementia rating sum of boxes (CDR-SB): aducanumab and lecanemab
Integrated Alzheimer’s Disease Rating Scale (iADRS): donanemab
Secondary outcomes (clinical and biological)
Imaging: amyloid PET, tau PET, MRI
CSF: amyloid, tau, neurogranin, neurofilament light chain (NfL)
Blood: amyloid, tau, glial fibrillary acidic protein, NfL
Clinical: MMSE, ADAS-cog13/14, ADCS-MCI-ADL
NPI, Zarit Caregiver Burden (aducanumab)
CDR-SB, ADCS-iADL (donanemab)
ADCOMS (lecanemab)

34. Aducanumab in Early Alzheimer’s Disease
adu = aducanumab.
Haeberlein et al, 2022; Haberlein et al, 2020.
Phase 3 Studies Led to First FDA Approval
Longitudinal change
from baseline
in CDR-SB
Longitudinal change
from baseline
in amyloid PET

35. Lecanemab in Early Alzheimer’s Disease
van Dyck et al, 2023.
Phase 3 Trial Led to FDA Approval
Amyloid Burden on PET CDR-SB Score

36. Donanemab in Early Alzheimer’s Disease
Leisher et al, 2023; Sims et al, 2023.
Phase 3 Trial Stratified Patients Based on Tau PET Severity

37. What Is ARIA?
ARIA-E = amyloid-related imaging abnormalities due to vasogenic edema, sulcal effusions;
ARIA-H = amyloid-related imaging abnormalities due to microhemorrhages, superficial siderosis.
Barakos et al, 2022; Hampel et al, 2023.
Imaging finding on MRI brain scan observed in people
treated with/not treated with MAB therapy
Does not always cause symptoms
ARIA-E: edema in the brain parenchyma or effusions in
the sulci
ARIA-H: hemosiderin deposits representing
microhemorrhage in the brain parenchyma or superficial
siderosis in the subarachnoid space
Underlying mechanism still being investigated
Believed to be driven by antibody-mediated breakdown of
Aß aggregates in the blood vessels
Mobilization of brain Aß plaques impairs perivascular
clearance and/or initiates an immune response
contributing to perivascular inflammation

38. ARIA Is Seen in All MAB Treatments
ARIA = amyloid-related imaging abnormalities.
Yadollahikhales et al, 2023; Lilly, 2023.
Incidence Based on Data From Phase 3 Trials
Aducanumab Donanemab Lecanemab
Most effective
effective dose
Placebo
Most effective
dose
Placebo
Most effective
dose
Placebo
All ARIA 41.3% 10.3% 38.9% 8% 26.6% 9.4%
ARIA-E 35.2% 2.7% 26.7% 0.8% 12.6% 1.7%
ARIA-H 19.1% 6.6% 30.5% 7.2% 14.0% 7.7%
Discontinuation 6.2% 0.6% 15% 4.8% 6.9% 2.9%
Death 1% 0.9% 0.8% 1.6% 0.7% 0.8%

39. Monitoring Process
T = treatment; W = week.
Cummings, Apostolova et al, 2023.
MRI Monitoring for Lecanemab
T1 T2 T3 T4 T5 T6 T7 T8 T14 T26
W2 W4 W6 W8 W10 W12 W14 W16 W28 W52
MRI if any symptoms
suggestive of ARIA occur
MRI within 1
year prior to
initiation
MRI prior to
5th infusion
MRI prior to
7th infusion
MRI prior to
14th infusion
MRI for
selected
patients
Symptoms Observed in Patients Who Develop Symptomatic ARIA
• Headache
• Confusion
• Visual changes
• Dizziness
• Nausea
• Gait difficulty
Serious ARIA
o Seizures
o Status epilepticus
o Encephalopathy
o Stupor
o Focal neurological deficits

40. Monitoring and Management Process
Appropriate Use Guidelines for Lecanemab
Cummings, Apostolova et al, 2023.
Severe/moderate ARIA-E or
severe/moderate ARIA-H
Baseline MRI has no exclusion factors
MRI routine or conducted because of symptoms
suggestive of ARIA
ARIA-E or ARIA-H detected
Symptomatic Asymptomatic
Suspend treatment; clinical assessment;
repeat MRI monthly Mild ARIA-E or mild ARIA-H
MRI shows resolution of ARIA-E or
stabilization of ARIA-H; symptoms resolve;
patient wishes to continue
Resume treatment with lecanemab
Continue treatment with lecanemab;
monthly MRI
Continue treatment; discontinue monthly
MRI if ARIA-E resolves or ARIA-H
stabilizes
Stop lecanemab therapy for any of the following:
• Any macro-hemorrhage
• More than 1 area of superficial siderosis
• More than 10 microhemorrhages since treatment initiation
• More than 2 episodes of ARIA
• Severe symptoms of ARIA
• Patient requires treatment with an anticoagulant

41. Monitoring and Management Process (cont.)
NSAID = nonsteroidal anti-inflammatory agent.
Cummings, Apostolova et al, 2023.
Medical center resources need to manage serious or severe ARIA:
Emergency department with resources to assess suspected or known ARIA
MRI scanners readily available for unscheduled scanning of symptomatic patients
Knowledgeable MRI readers proficient in detection and interpretation of ARIA
Clinicians with experience in the management of cerebral edema or ARIA
Hospital ward for monitoring and management
Intensive care unit availability
Electroencephalography available to inpatients
Neurologist with experience in management of seizures and status epilepticus
Appropriate Use Guidelines for Lecanemab
Grading of Infusion Reactions
Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
Mild transient reaction;
reaction; infusion
interruption not
indicated; intervention
intervention not
indicated
Infusion interruption but responds
responds promptly to symptomatic
symptomatic treatment (eg,
antihistamines, acetaminophen,
NSAIDs, narcotics, IV fluids);
prophylactic medication indicated
indicated for <24 hours
Prolonged recurrence of
symptoms following initial
improvement; hospitalization
may be indicated for clinical
sequelae (eg, poorly controlled
controlled hypertension)
Life-threatening
consequences; urgent
intervention indicated (may
(may require pressor or
ventilatory support)
Death

42. What Is Needed to Provide MAB Treatments?
Cummings, Apostolova et al, 2023.
Clinician skilled in the assessment of cognition to identify individuals with mild cognitive impairment or mild dementia due to
Alzheimer’s disease
MRI available for baseline assessment of cerebrovascular pathology and for monitoring of ARIA
Radiologists, neurologists, or other clinicians expert in identification/interpretation of cerebrovascular lesions and ARIA
Amyloid PET or lumbar puncture capability to determine the amyloid status of treatment candidates
Radiologists, nuclear medicine specialists, neurologists, or other specialists skilled in the interpretation of amyloid imaging or
neurologists, radiologists, or other clinicians skilled in the conduct of lumbar puncture
Apolipoprotein E genotyping resources
Genetic expertise to counsel patients on the implications of apolipoprotein E genotyping
Expertise in communicating with patients and care partners regarding anticipated benefits, potential harm, and requirements
for administration and monitoring while on lecanemab
Infusion settings that can be made available every 2 weeks to patients receiving therapy
Knowledgeable staff at infusion sites capable of recognizing and managing infusion reactions
Communication channels between experts interpreting MRIs and clinicians treating patients with lecanemab
Communications channels established between clinicians treating patients with lecanemab and patient/care partner
Availability of hospital resources including intensive care unit
Expertise in the management of seizures and status epilepticus for patients with severe or serious ARIA
Protocol with standard operating procedures for management of serious and severe ARIA

43. Emerging Treatments (cont.)
Figures credit of Cummings J and de la Flor M.
Cummings, Zhou et al, 2023.

44. Care Is About More Than Medications
Haggerty et al, 2020; Galvin et al, 2014; Reuben et al, 2019.
8 key elements to memory care
Continuous monitoring and assessment
Ongoing care plan
Psychosocial interventions
Self-management
Caregiver support
Medication management
Treatment of related conditions
Coordination of care
Collaborative care models can lead to improved patient- and family-
centered outcomes

45. Modifiable Risk Factors of Dementia: Brain Health
Livingston et al, 2020.
• Minimize diabetes
• Treat hypertension
• Prevent head injury
• Stop smoking
• Reduce air pollution
• Reduce midlife obesity
• Maintain frequent exercise
• Reduce occurrence of depression
• Avoid excessive alcohol
• Treat hearing impairment
• Maintain frequent social contact
• Attain high level of education
Reduce neuropathological damage (amyloid or
tau-mediated, vascular, or inflammatory)
Increased and maintained cognitive reserve
Preventing dementia
Manage MCI/dementia

46. How To Support People on DMTs
Slide courtesy of Nathaniel Chin, MD.
Open communication among specialties and settings
Accurate and visible documentation of DMT use
Leveraging electronic medical records for monitoring infusions and
schedules
Nurse care managers to serve as points of contact
Education and awareness of condition, treatment, and potential side
effects
Access to clinic for adequate follow-up

47. Community Support
National Care Planning Council, 2020.
Working with community organizations
Support for patient and families
Ongoing education and providing resources
Connecting with state aging services
Area Agencies on Aging can provide resources and programs
Community centers and senior centers
Private in-home care services

48. Clinical Research
Slide courtesy of Nathaniel Chin, MD.
Clinical trials
Pharmaceutical trials
Non-pharmaceutical lifestyle trials
Studies focusing on care and care partners
Observational studies

49. Advanced Care Planning
HC-POA = health care power of attorney; POA = power of attorney.
Slide courtesy of Nathaniel Chin, MD.
Medical-legal preparation
HC-POA and financial POA
Advanced directives and living will
Understanding what is most important to a person
Medical care
Personal life
Discussion of type of care to receive during disease
Surgery
Cancer screening
Management of chronic medical conditions
Planning for future changes
Living environment

50. Key Takeaways
Treating Alzheimer’s disease starts with an accurate diagnosis of
syndrome, stage, and etiology
Clinical tools and biomarkers will improve the diagnostic process, but
nothing replaces a good history
Monoclonal therapies are adding important options to care, and they
will require infrastructure and teamwork
Memory care is best delivered in a multidisciplinary and holistic
approach, using both health care and community resources

51. References
Aduhelm® (aducanumab-avwa) prescribing information (2022). Biogen and Eisai. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/761178s005lbl.pdf
Albert MS, DeKosky ST, Dickson D, et al (2011). The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's
Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement, 7(3):270-279. DOI:10.1016/j.jalz.2011.03.008
Alzheimer’s Association (2023). 2023 Alzheimer's disease facts and figures. Alzheimers Dement, 19(4):1598-1695. DOI:10.1002/alz.13016
Alzheimer’s Association (2022). 2022 Alzheimer's disease facts and figures. Alzheimers Dement, 18(4):700-789. DOI:10.1002/alz.12638
American Psychiatric Association (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
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Barakos J, Purcell D, Suhy J, et al (2022). Detection and management of amyloid-related imaging abnormalities in patients with Alzheimer’s disease treated with anti-amyloid beta therapy. J
Prev Alzheimers Dis, 9(2):211-220. DOI:10.14283/jpad.2022.21
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