Dementia and Alzheimer Disease Medical Slides

Reference CLARITY-AD (lecanemab): 27% slowing of cognitive decline on CDR-SB over 18 months in early AD, with ARIA (amyloid-related imaging abnormalities) in 21% (edema) and 17% (microhemorrhages). Present TRAILBLAZER-ALZ 2 (donanemab): 35% slowing in low/medium tau subgroup. Emphasize the risk-benefit discussion: modest clinical effect, significant ARIA monitoring requirements (serial MRI), and restriction to early symptomatic AD with confirmed amyloid positivity.

Present the "reversible dementia" workup as a high-yield teaching topic: B12 deficiency, hypothyroidism (TSH), neurosyphilis (RPR), HIV, normal pressure hydrocephalus (triad of gait apraxia, urinary incontinence, dementia), subdural hematoma, medication effects (anticholinergics, benzodiazepines), and depression (pseudodementia). While these account for <5% of dementia cases, they are treatable and should be excluded systematically in every evaluation.

Present the 2024 NIA-AA biological definition: A (amyloid — PET or CSF/plasma Aβ42), T (tau — phospho-tau PET or CSF/plasma p-tau), N (neurodegeneration — FDG PET, MRI atrophy, NfL). Alzheimer is biologically defined by A+T+ regardless of symptoms. This framework enables clinical staging (preclinical, MCI, dementia) and is essential for trial enrollment and anti-amyloid therapy eligibility, making it a foundational concept for modern neurology education.