Understanding Alzheimer’s Disease and Diagnosis
What is the difference between Alzheimer’s disease, mild cognitive impairment, and dementia?
Alzheimer’s disease is a progressive brain disease that can cause changes in memory, thinking, and daily function. Mild cognitive impairment describes cognitive changes that are greater than expected with normal aging but do not substantially interfere with independence. Dementia describes cognitive decline that has become severe enough to interfere with independent daily life. Alzheimer’s disease can cause either mild cognitive impairment or dementia.
Can I have Alzheimer’s disease without having dementia?
Yes. Alzheimer’s disease can begin before dementia develops. Some people have mild cognitive impairment due to Alzheimer’s disease, which means they have measurable cognitive changes but can still manage most everyday activities independently.
Does mild cognitive impairment mean that I have Alzheimer’s disease?
No. Mild cognitive impairment can have several causes, and some people remain stable or even improve over time. In others, it represents an early symptomatic stage of Alzheimer’s disease. An evaluation can help determine the most likely cause.
How does Dr. Peters determine whether Alzheimer’s disease is causing my memory or thinking changes?
Dr. Peters considers the full clinical picture rather than relying on any single test. This includes the changes you and those close to you have noticed, cognitive testing, your medical and family history, medications, neurologic examination, brain imaging, laboratory results, and, when appropriate, Alzheimer’s biomarker testing.
What tests are needed to diagnose Alzheimer’s disease, and why might I need an MRI, blood tests, a PET scan, or other testing?
The tests depend on your individual situation. Cognitive testing helps Dr. Peters assess memory and other areas of thinking and establish the degree and pattern of cognitive change. Routine blood tests can identify other medical conditions that may contribute to cognitive symptoms, while a brain MRI can look for structural changes or other conditions that may affect memory and thinking. When appropriate, Alzheimer’s biomarker tests, such as blood-based biomarkers, amyloid PET imaging, or cerebrospinal fluid testing, can provide evidence of Alzheimer’s-related changes in the brain. More detailed neuropsychological testing may sometimes be useful. Dr. Peters considers all of these findings together rather than relying on any single test.
What are Alzheimer’s biomarkers, and what do my biomarker results mean?
Alzheimer’s biomarkers are tests that look for biological changes associated with the disease, such as amyloid or tau. Testing may include blood-based biomarkers, amyloid PET imaging, or cerebrospinal fluid testing. Biomarker results can help determine whether Alzheimer’s disease is likely to be causing your cognitive changes, but they do not stand alone. Dr. Peters interprets them together with your symptoms, cognitive testing, medical history, and brain imaging.
Is Anti-Amyloid Treatment Right for Me?
Who may be eligible for Leqembi or Kisunla?
Leqembi and Kisunla are intended for selected patients with early symptomatic Alzheimer’s disease. This includes some people with mild cognitive impairment due to Alzheimer’s disease and some with mild Alzheimer’s dementia. Treatment also requires confirmation that amyloid is present in the brain and that treatment can be given safely.
If I have been diagnosed with Alzheimer’s disease, why might I not qualify for anti-amyloid treatment?
An Alzheimer’s diagnosis alone does not make someone eligible for treatment. Dr. Peters also considers the stage of disease, evidence of amyloid, MRI findings, medical history, current medications, and factors that may increase the risk of brain swelling or bleeding. Even when basic eligibility criteria are met, the potential benefits, risks, treatment requirements, and your goals must be considered together.
What can Leqembi or Kisunla realistically do for me—and what can’t they do?
Leqembi and Kisunla can slow the progression of early Alzheimer’s disease in appropriately selected patients. They do not cure Alzheimer’s disease, stop it from progressing, or restore memory or abilities that have already been lost. The goal is to preserve memory, thinking, and everyday function for longer by slowing the rate of decline.
How much can anti-amyloid treatment slow Alzheimer’s disease, and will I notice a difference?
In clinical studies, anti-amyloid treatment slowed cognitive and functional decline by roughly 25 to 30 percent overall in carefully selected patients, although results vary by treatment and study. The benefit is generally modest and represents slower decline rather than improvement, so you may not notice an obvious change. It is not possible to predict exactly how much any individual patient will benefit.
What is the difference between Leqembi and Kisunla, and how will Dr. Peters decide which is more appropriate for me?
Both Leqembi and Kisunla target amyloid and are used for selected patients with early symptomatic Alzheimer’s disease, but they differ in how often they are given and how treatment may continue over time. Leqembi begins with treatment every two weeks and may later transition to a maintenance schedule. Kisunla is given every four weeks and may be stopped when amyloid PET imaging shows that amyloid plaques have been reduced to minimal levels. Dr. Peters considers the available evidence, your safety risks, treatment requirements, clinical situation, and preferences when discussing which option may be more appropriate.
How often will I receive treatment, and how long will treatment continue?
Leqembi may be given by intravenous infusion every two weeks or by an under-the-skin injection once weekly. After 18 months, treatment may continue on the same schedule or transition to maintenance treatment with intravenous infusions every four weeks or weekly injections at a maintenance dose. Kisunla is given by intravenous infusion every four weeks and may be stopped when amyloid PET imaging shows that amyloid plaques have been reduced to minimal levels. Your treatment course may also change based on your health, safety results, and Dr. Peters’ clinical judgment.
Treatment Safety and Monitoring
What is amyloid-related imaging abnormality, and how serious is the risk of brain swelling or bleeding?
Amyloid-related imaging abnormalities, often called ARIA, are changes seen on MRI that can include brain swelling or small areas of bleeding. They are often detected before they cause symptoms, but some patients may develop headache, confusion, dizziness, vision changes, nausea, or balance problems. More serious complications can occur, although they are less common. Your individual risk depends on factors such as MRI findings, medical conditions, medications that increase bleeding risk, and APOE genetic status.
Why do I need MRI scans during treatment, and how often will they be required?
Patients receiving Leqembi or Kisunla need several MRI scans early in treatment to watch for treatment-related brain swelling or bleeding. With Leqembi, MRI scans are required before treatment and again after 1, 2, 3, and 6 months of treatment. With Kisunla, MRI scans are required before treatment and again before the 2nd, 3rd, 4th, and 7th infusions. Additional MRI scans may be needed if symptoms or other concerns arise.
What happens if an MRI or other required safety test is missed or delayed?
Required safety testing must be completed and reviewed before treatment can continue when indicated. If an MRI or other required test is missed or delayed, an infusion may need to be postponed until the necessary testing has been completed and Dr. Peters has reviewed the results.
What symptoms should I report during treatment, and when should I seek emergency care instead of contacting the Cognitive Care Program?
Report new or worsening neurologic symptoms promptly, including headache, confusion, dizziness, vision changes, nausea, balance problems, or other significant changes in your health. Also contact the program after a hospitalization, emergency department visit, or important medication change.
The Cognitive Care Program is not an emergency service. If symptoms are sudden, severe, or may require urgent medical attention, seek emergency care rather than waiting for a response from the program.
Why is APOE genetic testing recommended, and what do the results mean for my treatment risk?
APOE is a gene that can affect the risk of certain complications from anti-amyloid treatment. Testing can help estimate your risk of amyloid-related imaging abnormalities, including brain swelling or bleeding. Some APOE variants are associated with higher risk. Dr. Peters uses this information as one part of the discussion about whether treatment is appropriate and how carefully it should be monitored.
Can I receive Leqembi or Kisunla if I take a blood thinner or have other medical conditions?
Possibly, but these factors may affect whether treatment can be given safely. Dr. Peters reviews your medical history, medications, and MRI findings before treatment. Medications that affect blood clotting and conditions that increase the risk of brain bleeding may make treatment less appropriate or require additional consideration. Tell the care team before starting a blood thinner or making other important medication changes.
The Cognitive Care Program
What exactly is the Cognitive Care Program, and when do I enroll?
The Cognitive Care Program is a self-pay program that provides neurologist oversight, care coordination, safety monitoring, follow-up, and patient and care-partner support during anti-amyloid treatment. You enroll only after your evaluation is complete, Dr. Peters has determined that treatment is medically appropriate, and you have decided to proceed. Enrollment occurs when you sign the program agreement, pay the program fee, and identify a care partner.
What does the Cognitive Care Program fee cover—and what costs are not included?
The fee covers Dr. Peters’ Alzheimer’s-related professional care during the treatment cycle, including neurologist oversight, scheduled follow-up, safety review, treatment decisions, review of relevant test results, care coordination, and routine communication with you and your care partner. It does not include the cost of Leqembi or Kisunla, infusion services, MRI or PET imaging, laboratory testing, outside physicians or facilities, hospital or emergency care, or other services provided outside the program. Some of those costs may be covered separately by Medicare or other insurance.
Will Medicare or my insurance cover the medication, infusions, MRI scans, PET scans, and other testing?
Some of these services may be covered by Medicare, commercial insurance, or another payer, depending on your individual coverage. The Cognitive Care Program fee does not include the medication, infusion services, MRI or PET imaging, laboratory testing, or other outside services. Because coverage varies, the program does not guarantee that any particular service will be covered.
Who obtains insurance authorization for Leqembi or Kisunla, and what happens if my insurance does not approve treatment?
The infusion provider is responsible for obtaining insurance authorization for the medication and infusion services. Under the program’s current proposed policy, if coverage is denied and treatment cannot proceed, $4,500 of the $5,000 program fee will be refunded.
Why do I need a care partner, whom can I choose, and what will that person be expected to do?
A care partner can be a spouse, family member, or another trusted person you choose. Your care partner can help keep track of appointments, infusions, MRI scans, and other testing; notice changes in your memory, function, or health; and help you understand information and treatment decisions. The amount of involvement can change over time based on your needs and preferences, and you may change your designated care partner with reasonable notice to the practice.
Will Dr. Peters also treat my other neurologic conditions while I am enrolled in the Cognitive Care Program?
The Cognitive Care Program covers your Alzheimer’s disease and other dementia-related care. Neurologic conditions unrelated to dementia remain outside the program and may be treated through Dr. Peters’ traditional neurology practice and billed to insurance as appropriate.
What to Expect During Treatment
Who should I contact for different questions or problems—the Cognitive Care Program, Dr. Peters, the infusion center, or another provider?
Use the Cognitive Care Program’s dedicated contact information for routine treatment questions, scheduling concerns, nonurgent symptoms, or changes that could affect your treatment. Problems that occur during an infusion should be addressed first by the infusion provider. For sudden or severe symptoms that may require urgent medical attention, seek emergency care rather than waiting for a response from the program.
Can I join the Cognitive Care Program if I am already receiving Leqembi or Kisunla from another physician?
Yes. Patients already receiving Leqembi or Kisunla elsewhere may transfer their treatment and dementia care to Dr. Peters. Before accepting the transfer, Dr. Peters will need sufficient records to review your diagnosis, treatment history, prior imaging, any treatment complications, and your current monitoring status so that he can safely assume responsibility for your care.
How soon after I enroll can treatment begin?
There is no single timeline for every patient. Before the first treatment, Dr. Peters must confirm that all required clinical and safety information is complete, which may include MRI, laboratory testing, biomarker confirmation, APOE testing, or other studies. The infusion provider must also complete the necessary medication and infusion authorization. Treatment can begin once these requirements are in place.
What happens if I miss or need to reschedule an infusion?
Contact the infusion provider and the Cognitive Care Program as soon as possible so your treatment schedule can be adjusted and any required safety monitoring remains properly coordinated. Because certain MRI scans must occur before specific treatments, a delay in required safety testing may require an infusion to be postponed until the testing is completed and reviewed.
Can I travel while receiving Leqembi or Kisunla, and how should I plan around infusions and MRI scans?
Travel may be possible, but it is generally discouraged. Treatment requires regular infusions, scheduled MRI scans, and follow-up care that must occur at the appropriate times. Discuss travel plans with the Cognitive Care Program in advance so that required treatment and safety monitoring can remain on schedule.
Can some of my follow-up visits with Dr. Peters be done by telemedicine?
Yes. Follow-up may be provided by telemedicine when you prefer it and Dr. Peters determines that an in-person visit is not necessary. Some evaluations or circumstances may still require an in-person visit.
How will Dr. Peters track changes in my memory, thinking, and daily function over time?
Dr. Peters will follow your cognitive and functional status at regular visits and repeat standardized cognitive assessments over time. He will also consider changes in everyday function, symptoms, treatment tolerance, test results, and observations from your care partner. This longitudinal approach helps show how your condition is changing rather than relying on any single test or visit.
What should I do if I am hospitalized, develop a new medical condition, or another doctor changes my medications during treatment?
Contact the Cognitive Care Program promptly. Changes in your health, hospitalization or an emergency department visit, and important medication changes can affect treatment or safety. Be especially sure to tell the program before starting a medication that affects blood clotting, such as a blood thinner.
Does the Cognitive Care Program schedule my outside tests and appointments, or does it coordinate and track them while I schedule them myself?
The program helps coordinate required MRI scans, laboratory studies, PET imaging, infusions, and other parts of your treatment plan, and it tracks results so that Dr. Peters has the information needed for clinical decisions.
Long-Term Care and What Comes Next
What happens when my first treatment cycle ends or if treatment has to be paused or stopped early?
Treatment may pause or stop because of safety findings, changes in your health, your preference, or other clinical considerations. At the end of your treatment cycle, Dr. Peters reviews your treatment course, cognitive and functional status, safety findings, and future care needs with you and your care partner. Depending on your situation, treatment may continue in a different form, conclude, or stop, and you may transition to the ongoing Cognitive Care Program for continued Alzheimer’s care and support.
What happens if my memory or daily function continues to worsen even though treatment is proceeding as planned?
Anti-amyloid treatment slows Alzheimer’s disease in some patients but does not stop it, so decline can continue even when treatment is working as intended. Dr. Peters will follow your cognitive and functional changes over time and reassess your treatment, safety, symptoms, and overall care needs. Your Alzheimer’s care continues even if treatment changes or eventually ends.
