ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -24 مورد

Contraindications to the use of amyloid-targeted therapies for Alzheimer disease

Contraindications to the use of amyloid-targeted therapies for Alzheimer disease
Contraindications – These conditions increase the risk of adverse effects of anti-amyloid therapy
  • APOE ε4 homozygotes*
  • Moderate to severe dementia (CDR score >1)
  • Non-Alzheimer disease pathologies as the cause of cognitive impairment or dementia
  • Bleeding disorders (eg, platelets <50,000 or INR >1.5)
  • Anticoagulant therapy (warfarin, heparin, DOAC) or dual antiplatelet therapy*
  • History or MRI finding suggestive of:
    • CAA-related inflammation/amyloid beta-related angiitis
    • Prior cerebral hemorrhage (ICH >10 mm)
    • High-risk vascular malformation
    • Any stroke or TIA within the last year
    • Cerebral infarction due to large artery occlusion (cardiogenic embolism or atherothromboembolism)
    • Multiple lacunar strokes (>2)
    • Multiple microhemorrhages (>4)
    • Superficial siderosis
    • Vasogenic edema
    • Brain tumor other than meningioma or arachnoid cyst
    • Active/unresolved CNS infection
    • Severe subcortical hyperintensities (Fazekas score of 3)
  • Systemic treatment with immunosuppressants, immunoglobulins, or monoclonal antibodies that suppress the immune system or their derivatives
  • Active autoimmune or immunologic disease
  • Pregnancy
  • BMI >35 or <17
  • Inability to comply with MRI monitoring
Relative contraindications – Having one or more of these conditions can increase the risk and/or decrease the benefits of anti-amyloid therapy
  • Unstable medical or psychiatric condition
  • Major depression, uncontrolled (GDS-15 score >8)
  • Seizures within the previous 12 months
  • Cerebral contusion
  • Encephalomalacia
  • Brain aneurysm
  • Breastfeeding
Some of the contraindications listed here are being reevaluated as more patients are treated with these therapies. At present, we adhere fairly closely to these in order to minimize risk to our patients.

APOE ε4: apolipoprotein E epsilon 4; BMI: body mass index; CAA: cerebral amyloid angiopathy; CDR: clinical dementia rating; CNS: central nervous system; DOAC: direct oral anticoagulant; ICH: intracerebral hemorrhage; GDS: Geriatric Depression Scale; INR: International Normalized Ratio; MRI: magnetic resonance imaging; TIA: transient ischemic attack.

* Some clinicians consider these as relative contraindications and treat these patients after risk/benefit discussions with the patient and care partners.
Graphic 147094 Version 1.0