Disease-modifying anti-amyloid antibodies are appropriate only in confirmed amyloid-positive early Alzheimer's disease, so establish the biology before treating — amyloid PET or CSF, or a plasma marker confirmed where it is unreliable — rather than acting on a clinical syndrome alone.
Genotype APOE before the first dose. ε4 homozygotes carry the highest risk of amyloid-related imaging abnormalities, and that belongs in the consent conversation and the MRI monitoring schedule. The aim is to select and counsel properly, not to withhold: both the diagnosis and the risk are confirmable before treatment starts.
- Confirm amyloid positivity by PET or CSF before starting an anti-amyloid antibody, not on clinical features alone.
- Genotype APOE first; ε4 homozygotes have the highest ARIA risk and need it in consent.
- Record the baseline MRI and the monitoring schedule before the first dose.
- Where a plasma biomarker is used, confirm it in the groups where it is least reliable.
Why it matters
These drugs suit only confirmed amyloid-positive disease, and APOE4 status changes both the risk and the conversation.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for neurology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free