Sep 21, 2026 · 1h 16m
Alzheimer’s care weighs earlier diagnosis against treatment risk
REBOOT #511 Alzheimer's Disease: Updates in Diagnosis and Treatment
Blood-based biomarkers and anti-amyloid drugs are changing dementia care, but diagnosis, eligibility, monitoring, and long-term benefit remain unsettled.
- 1A sound Alzheimer’s evaluation combines collateral history, cognitive and functional assessment, vascular context, imaging, and careful interpretation of test scores.
- 2Plasma p-tau can support diagnosis, but clinicians must explain uncertain performance, appropriate use, and the limits of risk prediction.
- 3Lecanemab and donanemab offer modest potential benefits alongside ARIA, bleeding risk, MRI surveillance, and unresolved questions about treatment duration.
Don't miss
The follow-up case of Mr. E, stable after 18 months of lecanemab without ARIA, crystallizes the unresolved question of maintenance treatment.
The brief
Halima Amjad joins the Curbsiders hosts to explain a practical Alzheimer’s workup, beginning with collateral history, cognitive domains, function, vascular risks, and imaging.
The episode treats plasma p-tau as a promising but still evolving tool: useful in selected evaluations, yet difficult to interpret for asymptomatic people and future risk.
APOE testing becomes clinically consequential when anti-amyloid therapy is considered, because genotype helps shape bleeding-risk counseling, eligibility discussions, and monitoring plans.
The central tension is modest treatment benefit versus ARIA and other harms; lecanemab and donanemab require careful selection, serial MRI, and urgent evaluation of warning symptoms.
Mr. E remains functionally stable after 18 months of lecanemab without ARIA, but the case leaves maintenance dosing and long-term treatment strategy unresolved.
Amjad’s closing framework is individualized rather than algorithmic: advances in biomarkers and therapy matter, but prevention, diagnosis, and risk-benefit counseling must move together.
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