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Peer-reviewedCC BY 4.0The Journal of Prevention of Alzheimer's Disease

Baseline MRI markers and clinical outcomes during anti-amyloid β therapy: A real-world study in a Japanese dementia center

  • Yuki Kujuro1
  • Marina Saito1
  • Manami Maruko1
  • Kazuko Kamiyama2
  • Aya Nakano3
  • Emi Qian4
  • Teppei Okamura5
  • Daisuke Ito4,6
  • Toshimi Kageyama7
  • Ichiro Sugiyama8
  • Eriko Ishihara8
  • Tatsuro Kuwahara9
3 more authors
  • Kazunori Moritani7
  • Hitoshi Katai10
  • Hidenori Hattori1
10 affiliations
  1. 1Department of Neurology, Tachikawa Hospital, Tachikawa-shi, Tokyo, Japan
  2. 2Care Coordination Office, Tachikawa Hospital, Tachikawa-shi, Tokyo, Japan
  3. 3Neuropsychology Unit, Tachikawa Hospital, Tachikawa-shi, Tokyo, Japan
  4. 4Department of Neurology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
  5. 5Department of Radiology, Tachikawa Hospital, Tachikawa-shi, Tokyo, Japan
  6. 6Memory Center, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
  7. 7Department of Cardiology, Tachikawa Hospital, Tachikawa-shi, Tokyo, Japan
  8. 8Department of Neurosurgery, Tachikawa Hospital, Tachikawa-shi, Tokyo, Japan
  9. 9Department of Psychiatry, Tachikawa Hospital, Tachikawa-shi, Tokyo, Japan
  10. 10Department of Gastroenterological Surgery, Tachikawa Hospital, Tachikawa-shi, Tokyo, Japan
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Abstract

IMPORTANCE: Predictors of decline and of amyloid-related imaging abnormalities (ARIA) during anti-amyloid β therapy in routine care are undefined.

OBJECTIVE: To identify baseline predictors of cognitive, functional, and safety outcomes.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort of 161 consecutive patients initiating anti-amyloid β therapy at a Tokyo dementia center, 2024 to 2026 (lecanemab, 89; donanemab, 72).

EXPOSURES: Lecanemab or donanemab.

MAIN OUTCOMES AND MEASURES: Change in MMSE and CDR-Sum of Boxes (CDR-SB); baseline medial temporal atrophy (VSRAD Z score), amyloid PET burden, and microbleeds; ARIA.

RESULTS: With lecanemab, MMSE and CDR-SB declined significantly at every assessment (CDR-SB +0.79, +1.10, +1.60 at 6, 12, 18 months); memory and orientation declined while language was preserved. Greater baseline medial temporal atrophy was associated with greater 12-month CDR-SB worsening (r = 0.39; P = .01; n = 40); patients in the most severe standard category (Z ≥ 3) worsened by 2.62 versus 0.64 points (adjusted β = +2.18; P < .001). Atrophy was associated with older age (r = 0.19; P = .03) and with baseline memory-related measures — ADAS-Cog score (r = 0.32; P < .001) and the MMSE subdomains of delayed recall (β = −0.25; P = .006) and time orientation (β = −0.30; P = .04) — but not MMSE total score. Amyloid PET burden showed no significant association at most time points. All ARIA events were asymptomatic; ARIA-H occurred in 6 of 25 with microbleeds versus 3 of 136 without (odds ratio, 14.0; P < .001). Donanemab follow-up was 6 months.

CONCLUSIONS AND RELEVANCE: Baseline medial temporal atrophy was associated with functional decline and microbleeds with ARIA-H. Pretreatment MRI may provide prognostic and safety information during anti-amyloid β therapy.

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Cite

BibTeXRIS
BibTeX
@article{kujuro2026baseline,
  title = {{Baseline MRI markers and clinical outcomes during anti-amyloid β therapy: A real-world study in a Japanese dementia center}},
  author = {Yuki Kujuro and Marina Saito and Manami Maruko and Kazuko Kamiyama and Aya Nakano and Emi Qian and Teppei Okamura and Daisuke Ito and Toshimi Kageyama and Ichiro Sugiyama and Eriko Ishihara and Tatsuro Kuwahara and Kazunori Moritani and Hitoshi Katai and Hidenori Hattori},
  journal = {The Journal of Prevention of Alzheimer's Disease},
  year = {2026},
  month = oct,
  doi = {10.1016/j.tjpad.2026.100686},
  url = {https://doi.org/10.1016/j.tjpad.2026.100686},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Baseline MRI markers and clinical outcomes during anti-amyloid β therapy: A real-world study in a Japanese dementia center
AU  - Yuki Kujuro
AU  - Marina Saito
AU  - Manami Maruko
AU  - Kazuko Kamiyama
AU  - Aya Nakano
AU  - Emi Qian
AU  - Teppei Okamura
AU  - Daisuke Ito
AU  - Toshimi Kageyama
AU  - Ichiro Sugiyama
AU  - Eriko Ishihara
AU  - Tatsuro Kuwahara
AU  - Kazunori Moritani
AU  - Hitoshi Katai
AU  - Hidenori Hattori
PY  - 2026
DA  - 2026/10/17
JO  - The Journal of Prevention of Alzheimer's Disease
DO  - 10.1016/j.tjpad.2026.100686
UR  - https://doi.org/10.1016/j.tjpad.2026.100686
AB  - IMPORTANCE: Predictors of decline and of amyloid-related imaging abnormalities (ARIA) during anti-amyloid β therapy in routine care are undefined.  OBJECTIVE: To identify baseline predictors of cognitive, functional, and safety outcomes.  DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort of 161 consecutive patients initiating anti-amyloid β therapy at a Tokyo dementia center, 2024 to 2026 (lecanemab, 89; donanemab, 72).  EXPOSURES: Lecanemab or donanemab.  MAIN OUTCOMES AND MEASURES: Change in MMSE and CDR-Sum of Boxes (CDR-SB); baseline medial temporal atrophy (VSRAD Z score), amyloid PET burden, and microbleeds; ARIA.  RESULTS: With lecanemab, MMSE and CDR-SB declined significantly at every assessment (CDR-SB +0.79, +1.10, +1.60 at 6, 12, 18 months); memory and orientation declined while language was preserved. Greater baseline medial temporal atrophy was associated with greater 12-month CDR-SB worsening (r = 0.39; P = .01; n = 40); patients in the most severe standard category (Z ≥ 3) worsened by 2.62 versus 0.64 points (adjusted β = +2.18; P < .001). Atrophy was associated with older age (r = 0.19; P = .03) and with baseline memory-related measures — ADAS-Cog score (r = 0.32; P < .001) and the MMSE subdomains of delayed recall (β = −0.25; P = .006) and time orientation (β = −0.30; P = .04) — but not MMSE total score. Amyloid PET burden showed no significant association at most time points. All ARIA events were asymptomatic; ARIA-H occurred in 6 of 25 with microbleeds versus 3 of 136 without (odds ratio, 14.0; P < .001). Donanemab follow-up was 6 months.  CONCLUSIONS AND RELEVANCE: Baseline medial temporal atrophy was associated with functional decline and microbleeds with ARIA-H. Pretreatment MRI may provide prognostic and safety information during anti-amyloid β therapy.
SN  - 2274-5807
SN  - 2426-0266
ER  -