Clinical Management in Alzheimer's Disease in the Era of Disease-Modifying Therapies

Purpose of reviewDiscuss emerging anti-amyloid disease-modifying therapies for Alzheimer's disease (AD) and outline how these therapies will change our clinical management of patients with AD.Recent findingsBuilding on decades of preclinical work supporting an initiating role of amyloid-beta (A beta) in driving downstream neurodegeneration in AD, monoclonal antibody therapies have been developed against pathologic forms of A beta to treat AD. Recent phase III clinical trials have demonstrated clinical benefit for several of these anti-amyloid agents, with additional agents currently under investigation. However, these agents are associated with significant side effects, most notably amyloid-related imaging abnormalities (ARIA).Given the potential benefit of these anti-amyloid disease-modifying therapies, obtaining an accurate AD diagnosis will become more paramount than ever. Clinicians will also need to carefully screen patients based on potential for side effects of these therapies and closely monitor and manage side effects that arise. Together, the advent of anti-amyloid therapies represents a significant and exciting shift in how we manage patients with AD.