Alzheimer Disease: Selection and Delivery of Amyloid-Targeting Treatments

The arrival of amyloid-targeting treatments (ATTs) marks a turning point in the treatment of Alzheimer disease which has produced a shift from symptomatic management to disease modification. With this promise comes a host of new challenges for clinicians, health systems, patients, and caregivers. As we stand at the forefront of this evolving therapeutic landscape, the need for guidance is urgent. The articles in this issue of Practical Neurology are aimed at helping neurologists deliver ATTs safely, equitably, and effectively in everyday clinical settings.

From infusion center capacity to staffing and imaging protocols, there are many considerations that go into building a system that supports timely and safe treatment with ATTs. Drs. Weisman and Cabral provide a detailed assessment of the logistical requirements and infrastructure needed to implement ATTs in clinical practice.

Next, Dr. Abi Chakra and colleagues tackle the pivotal question of how to select appropriate patients for ATTs. They walk clinicians through considerations to help identify patients likely to benefit from therapy while minimizing harm.

A key factor in determining patient eligibility for ATTs is proof of brain amyloid positivity. Drs. Tanner and Schindler outline the central role of amyloid-β and tau biomarkers in confirming Alzheimer pathology. They offer strategies for choosing testing modalities (eg, blood-based, cerebrospinal fluid, imaging biomarkers) and interpreting test results.

Once ATTs have been initiated, patients must be followed closely to track clinical progression and monitor for side effects. Drs. Brown and Vaishnavi discuss clinical and biomarker-based methods to assess patient response to ATTs and provide recommendations for the use of these assessments to monitor the efficacy of ATTs. Then, Drs. Bouchachi and Scharre describe the most common complication of ATTs, amyloid-related imaging abnormalities, and how to monitor for this side effect.

Finally, Drs. Cavedoni and O’Brien highlight how new and existing disparities in Alzheimer disease care limit access to ATTs and offer recommendations to help clinicians, researchers, and health systems promote equitable access to ATTs.

Together, these contributions provide a practical and nuanced roadmap for implementing ATTs in neurology practices. It has been a pleasure working with the authors and editorial team, and we hope you will take away valuable insights from this issue of Practical Neurology.