Antiamyloid treatment for dementia: concerns outweigh hopes

PURPOSE OF REVIEW: To review the association between Alzheimer pathology and dementia and the role of mAbs targeting amyloid in the treatment of people with dementia and mild cognitive impairment. RECENT FINDINGS: There is an association, but Alzheimer pathology explains less than 40% of the attributable risk of dementia when other pathologies such as vascular, Lewy Body and TDP-43 are accounted. Recent trials of passive immunization with MABs, including Aducanumab Lecanemab and Donanemab, have demonstrated some benefits but the effects are small in size and may be due to bias. The side effect of amyloid-related imaging abnormalities (ARIA) is common and potentially serious. The costs of assessments for treatment and actual treatment costs are large compared with potentially modest benefits. SUMMARY: It is still uncertain about the place of MABs in the treatment of Alzheimer's dementia. Further research is required regarding the long-term benefits and risks.