Neurologist Andrew P. Thaliath, M.D., of Norton Neuroscience Institute, reviews who qualifies for anti-amyloid therapy, how lecanemab and donanemab differ, and key safety parameters.

Author: Sara O. Thompson

Medically reviewed by:
Andrew P Thaliath, MD

Published: October 27, 2026

The Norton Healthcare Center for Continuing Medical Education has made available speaker sessions from the 2026 Neuroscience Symposium, including the presentation “Primary Care Provider’s Guide to Anti-amyloid Therapies in Treatment of Alzheimer’s” by Andrew P. Thaliath, M.D., of Norton Neuroscience Institute.

Anti-amyloid therapy can slow progression of mild cognitive impairment or mild dementia due  Alzheimer’s disease, but it works only for the right patient and requires careful monitoring. Topics in Dr. Thaliath’s presentation covered patient selection, treatment protocols and safety monitoring.

The continuing education opportunity is available online here.

Here are the key points for referring physicians.

Who is an appropriate candidate

Anti-amyloid therapy is indicated for patients with mild cognitive impairment (MCI) or mild dementia due to Alzheimer’s disease. Patients in the moderate or severe stages are not candidates. The same is true for patients with non-Alzheimer’s dementia.

Appropriate use recommendations for both approved drugs call for:

• A clinical diagnosis of Alzheimer’s disease
• A Mini-Mental State Examination (MMSE) score of at least 20
• Biomarker confirmation of amyloid pathology through amyloid PET, cerebrospinal fluid (CSF) testing or in some instances a Food and Drug Administration-approved blood-based biomarker per provider discretion
• A recent brain MRI at least within the past year (Certain imaging parameters may make a patient ineligible for treatment.)
• Genetic testing, specifically APOE genotyping to stratify risk of amyloid-related imaging abnormalities (ARIA)
• A care partner who can help with monitoring requirements

Dr. Thaliath cautioned against ordering biomarker tests for family history or subjective memory complaints alone.

Lecanemab and donanemab at a glance

Possible benefits

It is key to set realistic expectations. These drugs are not a cure and do not stop disease progression. Roughly they slow down the progression of the disease by about 30%. Clinical benefit varies, and patients in the earlier stages may benefit more than patients in later stages. The burden of infusions and frequent MRI monitoring is also an important consideration for patients who elect to go on these therapies.

Safety considerations

Infusion reactions

Infusion reactions typically can present with symptoms of fever, chills, headache, rash, nausea, vomiting, abdominal discomfort and blood pressure changes.

The majority are self-limited within the first 24 hours of an infusion and can be managed at home with symptomatic treatment.

In some instances, hospitalization for more serious adverse events is needed.

Monitoring for ARIA

ARIA can appear as swelling (ARIA-E) or hemorrhage (ARIA-H). Most cases are asymptomatic, but symptoms can include headache, confusion, visual changes, dizziness and gait difficulty. Serious cases may involve seizures, encephalopathy and focal neurological deficits. In rare instances, fatalities have occurred in the setting of ARIA.

APOE4 status drives risk of ARIA. Noncarriers are at a lower risk of ARIA. Heterozygotes are at a moderate risk and homozygotes are at a higher risk of ARIA. Surveillance MRIs are needed even when patients have no symptoms, and the treating physician must review each scan before the next infusion.

Anticoagulation

Current recommendations advise against anti-amyloid therapy in patients who need anticoagulation.

Thrombolytics  

Current guidelines advise against intravenous thrombolytic therapy in the event of a stroke for individuals on anti-amyloid therapy.