Advancing Precision Therapeutics in Dementia – How Does Imaging Fit In
July 09, 2024 | 12:00 pm ET
Organized as part of the SNMMI/ACNM "Hot Topics" Webinar Series

Organizer:
Katherine Zukotynski, BASc, MD, PhD, P.Eng; Gary Ulaner, MD, PhD, FACNM; Twyla Bartel, DO, MBA, FACNM

Moderator:

Speaker:
Sandra E. Black, O.C., O.Ont., Hon.DSc., MD, FRCP(C), FRSC, FANA, FAHA, FAAN

Course Summary:
Cerebral Vasculopathy and Protein Misfolding are comorbid and interact. Genetics, sex and environment factors make the relationships even more complex, challenging and urgent.  • The arrival of precision therapies brings new hope, but will require frequent neuroimaging both MRI and Molecular PET for screening, diagnosis, and monitoring following appropriate use guidelines for the use of the anti-amyloid antibodies, with Eisai’s Lecanemab approved by the FDA in the US and Lilly’s Donanemab currently undergoing review.  • Annual cost for the first year of Lecanemab is $28K US for biweekly infusions, but once amyloid PET falls below 1.5 centiloids, the plan would be to pause infusions, follow clinically and repeat PET at intervals to see if amyloid deposits are re-accumulating, which may guide booster re-administrations.  • Adverse effects include Amyloid Related Imaging Abnormalities (ARIA-E) i.e. vasogenic edema, which can be silent or symptomatic (headache, seizure and confusion), and microbleeds, siderosis and macro bleeds (ARIA H) related to amyloid fibrils injuring the vessel walls while exiting. Macrobleeds can cause neurological signs and occasionally can be fatal. More data on long- term PET follow-up are needed to guide timing and frequency of ongoing infusions, and periodic MRI scans will be needed to monitor for ARIA-E and H, especially in the initial period.  • Rapid advances in multiple-modality imaging both PET and MRI, enhanced by Machine Learning methods, will be needed, further informed by genetics, csf or plasma proteomics (Phosphotau 217, Neurofilament light and Glial Fibrillary Acid Protein), which will further facilitate Precision Diagnosis and Therapeutics for early-stage Alzheimer’s, and a secondary prevention trial in cognitively unimpaired at risk individuals is already underway with Lecanemab 

Course Objectives:

• Update the role of brain imaging in anti-amyloid therapies.
• Discuss the role of PET and MRI for these entities.
• Discuss the new hope of precision therapies as well as their costs and adverse effects .

CE Information:
CE Credit applications for physicians, pharmacists, physicists and technologists are pending. Check back for updates regarding CE Credit status.