Recordings from the 2025 Neuro-APP Symposium-Untangling The Web Monoclonal Antibodies.

Video Transcription

Video Summary

The presentation reviews Alzheimer’s disease pathology, diagnosis, epidemiology, and emerging treatments. Symptoms may appear decades after brain changes begin. The amyloid-cascade hypothesis links beta-amyloid plaques and abnormal tau tangles to neuronal damage, but Alzheimer’s is likely multifactorial: inflammation, vascular risks, genetics, infections, mitochondrial dysfunction, and other processes may also contribute. Tau may correlate more closely with cognitive impairment than amyloid burden.<br /><br />Alzheimer’s is the most common cause of dementia, and its prevalence and public-health costs are expected to rise as the population ages. Early diagnosis is difficult, so evaluation may include cognitive and functional testing, blood biomarkers such as phosphorylated tau, APOE testing, MRI, and amyloid PET or cerebrospinal-fluid testing. Early identification matters, but treatment decisions should account for disease stage, health, support, and patient goals.<br /><br />Cholinesterase inhibitors and memantine can provide symptomatic benefit but do not cure the disease. Newer anti-amyloid antibodies—lecanemab and donanemab—can reduce amyloid and modestly slow progression in some patients with early Alzheimer’s; meaningful functional improvement remains limited and long-term benefits are uncertain. Aducanumab, the first such drug, was discontinued after concerns about its evidence, safety, and uptake.<br /><br />Anti-amyloid therapies require substantial monitoring, including MRI scans, and can cause amyloid-related imaging abnormalities (ARIA), such as brain swelling or bleeding. APOE ε4 status can increase ARIA risk, and anticoagulant use may make treatment less suitable. The speaker emphasizes careful patient selection, clear expectations, and continued research into Alzheimer’s biology and combination therapies.

Keywords

Alzheimer's disease

dementia

amyloid-beta

tau tangles

early diagnosis

biomarkers

phosphorylated tau

APOE ε4

lecanemab

ARIA