The Barbara and Maurice Deane Healthy Brain Initiative

Alzheimer’s Disease Treatment

While there are many types of dementia, Alzheimer’s disease is by far the most common. According to the Alzheimer’s Association, approximately 6.7 million Americans have Alzheimer’s disease, as of 2023. In Alzheimer’s disease, plaques form in the brain and tend to affect people at any age. Symptoms usually get worse over time.

The U.S. Food and Drug Administration has approved new medications to treat mild or early dementia due to Alzheimer’s disease. These medications are called monoclonal antibodies (one example is Lecanemab though others are being considered for approval as well) and are infused directly into the blood. Injectable forms are being developed.

At present, Mount Sinai is offering the monocloncal antibody Lecanemab to eligible patients.

How It Works

Monoclonal antibodies work by clearing the plaques from your brain. These plaques are usually made up of a protein called amyloid. We’re not sure whether the plaques cause dementia, but we know they play a significant role.

Recent studies showed that monoclonal antibodies can slow the decline of symptoms such as forgetfulness and problems with day-to-day function. Patients who received the monoclonal antibody Lecanemab experienced an average of six-month slower decline in their symptoms than those who didn’t. The Lecanemab study followed patients for 18 months, and we do not know yet what happens after that point.

Side Effects

Monocloncal antibodies can cause side effects in some patients. The most serious is swelling or bleeding in the brain, which affects about 20 percent of patients receiving Lecanemab (one in five). Most patients with these symptoms don’t feel anything and we can find it only with a magnetic resonance imaging (MRI) scan. At some point in treatment, some patients may experience: 

  • Confusion
  • Difficulty walking
  • Dizziness
  • Headaches
  • Nausea
  • Vision changes
  • Seizures
  • Inability to speak
  • Loss of movement in an arm or leg

About 25 percent of patients (1 in 4) develop infusion-related reactions when receiving Lecanemab. Most of these reactions presented as mild flu-like symptoms, such as chills, body aches, joint pain and/or feeling shaky, nausea, vomiting, or dizziness or lightheadedness. In a smaller number of patients, infusion-related reactions are more severe, such as changes in heart rate, blood pressure or difficulty breathing. Rarely, patients with an infusion-related reaction had to be hospitalized because of severe allergic reactions.  

Who It Can Help

To receive Lecanemab, you must be:

  • 50 to 90 years of age
  • Diagnosed with mild cognitive impairment or mild dementia due to Alzheimer’s
  • Have minimal or no functional impairment
  • Have a body mass index between 17 and 35
  • Able to receive magnetic resonance imaging scans

There are also other requirements that your clinician can discuss with you. To be sure you meet these requirements, we will do the following tests:

  • An Alzheimer’s disease biomarker test by amyloid positron emissions testing (PET) or by spinal tap study. The biomarker must be positive for Alzheimer’s disease.
  • A brain magnetic resonance imaging (MRI) scan no more than 12 months before starting treatment
  • Possible genetic testing for genes that may increase the risk of side effects from monoclonal antibodies (such as the APOE4 gene)

Per Mount Sinai’s best practice guidelines, you cannot receive Lecanemab if you:

  • Are taking medications to thin your blood (except for standard doses of aspirin and other antiplatelets)
  • Have a bleeding disorder
  • Have had a stroke or transient ischemic attack in the previous year
  • Have a history of seizures

Treatment Process

You will receive an intravenous infusion every 2 weeks, in a certified facility, for at least 18 months. We will also perform MRI scans regularly to monitor for complications. The infusion itself takes one hour, plus the time for check-in and post-infusion monitoring. After your first infusion, we will monitor you for at least three hours after the infusion. In addition, we will perform MRI scans before your 5th, 7th, and 14th infusion, to check for swelling or bleeding in the brain.

Medicare Coverage

If you meet certain criteria, Medicare will pay for the treatment. Depending on your insurance plan, you may have a copay.