Memory & Dementia
How Do We Treat Dementia?
Amarish Dave, DO explains why dementia treatment depends on the cause, stage, symptoms, health risks, safety needs, and goals of each patient and family.
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What Is the New Alzheimer's Disease Treatment?
Alzheimer's treatment has entered a new era. Leqembi and Kisunla are different from older Alzheimer's medications because they target beta-amyloid, one of the abnormal proteins associated with the disease.
Written and medically reviewed by Amarish Dave, DO, board-certified neurologist. This page is educational and does not replace an individual medical evaluation.
Leqembi (lecanemab) and Kisunla (donanemab) are disease-modifying treatments. Clinical trials showed that they can slow cognitive and functional decline in appropriately selected patients with early Alzheimer's disease. They do not cure Alzheimer's disease and do not restore memory that has already been lost.
These medications are not intended for everyone with memory loss or every person with dementia. Determining eligibility requires a comprehensive evaluation of the diagnosis, disease stage, brain imaging, biomarkers, medical history, medications, and treatment risks.
Who may qualify for these new Alzheimer's treatments?
These treatments are intended to be started during early Alzheimer's disease. Potential candidates are people with:
- Mild cognitive impairment due to Alzheimer's disease
- Mild Alzheimer's dementia
The presence of amyloid-beta pathology must be confirmed before treatment. A diagnosis or memory complaint alone is not enough. Read more about who qualifies for Leqembi, or begin with a comprehensive memory loss and dementia evaluation.
How do you know if someone has Alzheimer's amyloid?
Alzheimer's amyloid pathology can be confirmed with appropriate biomarker testing, such as amyloid PET imaging or cerebrospinal fluid testing, depending on the clinical situation and available testing. The diagnostic process must also determine whether Alzheimer's disease actually explains the person's cognitive symptoms. Learn what tests are ordered for dementia and what happens during a dementia evaluation.
Why is a brain MRI important?
MRI is an important part of evaluating and monitoring patients being considered for anti-amyloid treatment. These medications can cause amyloid-related imaging abnormalities, known as ARIA. Patients therefore require MRI monitoring during treatment.
- Brain swelling (ARIA-E)
- Small areas of bleeding or hemosiderin deposition (ARIA-H)
ARIA needs careful monitoring
Many cases are asymptomatic, but serious and rarely life-threatening complications can occur. New headache, confusion, dizziness, visual change, weakness, numbness, seizure, or other concerning neurological symptoms during treatment require prompt medical guidance; sudden stroke-like symptoms require emergency care.
What does APOE genetic testing have to do with treatment?
APOE ε4 status can affect the risk of ARIA. People with two copies of APOE ε4 have a higher incidence of ARIA than people with one copy or no copies. Current prescribing information recommends APOE ε4 testing before treatment to help inform the discussion about ARIA risk. Genetic testing can also have personal and family implications, so those implications should be discussed with the patient before testing.
Leqembi vs. Kisunla
Leqembi and Kisunla are both FDA-approved amyloid-targeting monoclonal antibodies for Alzheimer's disease, but they are different medications with different dosing and treatment protocols. Both should be initiated in patients with mild cognitive impairment or mild dementia stage of disease—the populations studied in their clinical trials. One is not universally better than the other; the decision depends on the individual patient's diagnosis, risks, preferences, logistics, and monitoring needs.
Why early diagnosis matters more now
Families have historically questioned whether an early Alzheimer's diagnosis would change anything. Disease-modifying treatments make early evaluation increasingly important because these medications are intended for early Alzheimer's disease—not advanced dementia. Someone with progressive memory or thinking changes should consider evaluation before significant functional decline has occurred.
Continue learning about diagnosis and treatment
Review how dementia is treated, how lifestyle can impact dementia, and the Neurology Video Library.
A complete evaluation also distinguishes Alzheimer's disease from other causes of cognitive change, including Lewy body dementia, frontotemporal dementia, and normal pressure hydrocephalus.
Frequently asked questions
- What are the newest treatments for Alzheimer's disease?
- Leqembi (lecanemab) and Kisunla (donanemab) are newer FDA-approved disease-modifying treatments that target beta-amyloid. They may slow cognitive and functional decline in appropriately selected people with early Alzheimer's disease, but they do not cure the disease or restore memory already lost.
- What is Leqembi?
- Leqembi is the brand name for lecanemab, an amyloid-targeting monoclonal antibody given by intravenous infusion. It is intended to be started in patients with mild cognitive impairment or mild dementia due to Alzheimer's disease after amyloid pathology is confirmed and treatment risks are reviewed.
- What is Kisunla?
- Kisunla is the brand name for donanemab, an amyloid-targeting monoclonal antibody given by intravenous infusion. Like Leqembi, it is intended for the early symptomatic stages of Alzheimer's disease and requires confirmation of amyloid pathology and ongoing safety monitoring.
- Who qualifies for Leqembi or Kisunla?
- Potential candidates are people with mild cognitive impairment due to Alzheimer's disease or mild Alzheimer's dementia, with confirmed amyloid-beta pathology. Eligibility also depends on MRI findings, medical history, medications, genetic risk discussion, and the ability to complete treatment and monitoring.
- Do these medications cure Alzheimer's disease?
- No. They do not cure Alzheimer's disease and do not restore memory that has already been lost. Clinical trials showed that they can slow cognitive and functional decline in appropriately selected patients with early Alzheimer's disease.
- How is amyloid confirmed before treatment?
- Amyloid pathology may be confirmed with amyloid PET imaging or cerebrospinal fluid testing, depending on the clinical situation and available testing. The broader evaluation also determines whether Alzheimer's disease is the likely cause of the person's symptoms.
- Why do patients need MRI scans?
- MRI is used before and during treatment to look for findings that affect eligibility and to monitor for amyloid-related imaging abnormalities, or ARIA. The timing and number of scans depend on the medication and treatment protocol.
- What is ARIA?
- ARIA means amyloid-related imaging abnormalities. ARIA-E refers to brain swelling, while ARIA-H refers to small areas of bleeding or hemosiderin deposition. Many cases cause no symptoms, but serious and rarely life-threatening complications can occur.
- Why is APOE testing performed?
- APOE ε4 status helps inform ARIA risk. People with two copies have a higher incidence of ARIA than people with one or no copies. Current prescribing information recommends testing before treatment, with discussion of the medical and personal implications of genetic information.
- Can someone with advanced Alzheimer's disease receive these treatments?
- These medications were studied and are intended to be initiated in mild cognitive impairment or mild dementia due to Alzheimer's disease, not advanced dementia. A specialist must determine whether a person fits the studied population and can safely complete treatment monitoring.
Related Alzheimer's and dementia videos
Continue with medically reviewed videos about dementia diagnosis, testing, treatment, and brain health.
Memory & Dementia
What Is Lewy Body Dementia?
Amarish Dave, DO explains Lewy body dementia, including changes in thinking and alertness, visual hallucinations, movement symptoms, and acting out dreams.
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How to Manage Urinary Incontinence in Dementia
Amarish Dave, DO shares practical, dignity-centered strategies for scheduled toileting, safer bathroom access, simpler clothing, and recognizing changes that need medical evaluation.
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Why Do People With Dementia Have Hallucinations?
Amarish Dave, DO explains why hallucinations can occur in dementia, why they are especially associated with Lewy body dementia, and when a sudden change needs medical evaluation.
Watch VideoSubscribe to the NeurologistCare YouTube channel for additional short videos answering common questions about Alzheimer's disease, dementia, and neurological health.
Concerned about memory loss or treatment eligibility?
Learn more about comprehensive memory and dementia evaluation at NeurologistCare.com. In-person neurological and memory evaluations are available in Crystal Lake and Woodstock, Illinois, and Lake Geneva, Wisconsin, with telehealth available when appropriate for patients physically located anywhere in Illinois or Wisconsin at appointment time.
Medical disclaimer
This information is for general educational purposes and is not individualized medical advice. Eligibility for Alzheimer's disease-modifying treatment requires individualized evaluation of diagnosis, disease stage, imaging, biomarkers, medical history, and treatment risks.
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