Expert Brain Care, Made Virtual

We’ll need the following records to help you make a decision on treatment:

Step 1: Confirm the Diagnosis. These therapies are only for people in the early stages of Alzheimer’s disease (mild cognitive impairment or mild dementia). They are not a cure, they slow the progression of symptoms by about 30-40%.

Your care team, led by a memory specialist, will review your history, any prior testing completed elsewhere, and current symptoms, perform cognitive testing, and may recommend blood work, a brain MRI or additional testing to make a diagnosis.

Step 2: Confirm pathologic accumulation of Amyloid in the Brain. Proof of amyloid buildup is required before treatment. This can be shown through:

• An amyloid PET scan, or
• A blood test (in some cases, to help guide next steps, though expect to need a spinal fluid or PET test in most cases to confirm eligibility). or
• For patients who have had it done already, spinal fluid (lumbar puncture) test results may be sufficient to determine if there are amyloid plaques in the brain. 

Step 3: Complete a Safety Screen.  We’ll need:

• MRI: A brain MRI to understand eligibility for treatment and if eligible, to make sure the risk of amyloid-related imaging abnormalities (ARIA), a potential side effect of small bleeds or temporary swelling, is known and acceptable to you and your care team. We can help you get this test done, or use an existing recent MRI if you have one.
• Genetic testing: A genetic test for the APOE gene – different APOE genes affect risk for ARIA. We can do this from your home or in a local lab.

Your medical history, medications (especially blood thinners), and blood pressure will also be reviewed, some medications cannot be taken with these treatments. We’ll work with your current medical team to collect this on your behalf.

• Risk for ARIA largely depends on a person's APOE genes and findings on the brain MRI prior to starting treatment - it can range from less than 5% to about a 30% chance of occurring.
• ARIA generally does not cause symptoms, if it does occur, it is usually found on MRIs done to monitor treatment, symptomatic ARIA generally occurs in less than 2% of persons treated.
• The most common symptom of ARIA is headache, other symptoms include balance problems, dizziness, visual changes, and temporary worsening of confusion. 
• Swelling related to ARIA resolves on its own with time.
• ARIA, especially the small bleeds, also occur in the absence of treatment, but are more common with treatment.
• If swelling related to ARIA occurs, treatment can usually be resumed after the swelling has resolved on its own. There are however some instances when treatment must be discontinued.

Once your care team has confirmed the diagnosis, the presence of abnormal amyloid levels, and finished the safety screens including a discussion of risks and benefits of treatment,your case may then need to be presented to our panel of clinical and patient safety experts to approve treatment. Our care team will then work with you and your insurance company to find and book you into an infusion center to support ongoing care.

These medications are currently given by IV infusion, either every 2 or every 4 weeks, in an infusion center or clinic.
Follow-up MRIs are required during the first year to monitor the brain for potential side effects of swelling or small bleeds, which are the two forms of ARIA.
Your care team will also monitor your memory, daily function, and any new symptoms.
Initial treatment continues until amyloid plaque is cleared from the brain, which usually takes 6-18 months.

Treatment decisions are individualized — your neurologist and care team will discuss the potential benefits, risks, and what to expect over time.

Even while on therapy, it’s important to continue healthy lifestyle habits, control other medical conditions like high blood pressure, and attend regular follow-up visits.

Options for ongoing treatment after the initial 6–18-month period during which amyloid plaque is cleared should be discussed with your doctor.