Abstract:

Amyloid-related imaging abnormalities (ARIA) represent a significant safety concern that requires attention during the treatment of Alzheimer's disease (AD) with lecanemab, and their occurrence is associated with multiple factors. This paper reports the case of a 77-year-old male patient with AD who developed manifestations of both ARIA with edema and effusion (ARIA-E) and ARIA with haemorrhage (ARIA-H) after six months of lecanemab treatment. The patient carried ARIA risk factors, including the ApoE ε3/ε4 heterozygous genotype, impaired glymphatic system function, and long-term use of antithrombotic medication. Although imaging abnormalities emerged during treatment, the patient's cognitive function remained stable, and his serum glial fibrillary acidic protein (GFAP) concentration decreased. Following assessment and glucocorticoid intervention, the patient continued lecanemab treatment, and the treatment course remained stable. A review of the CNKI, Wanfang, and PubMed databases identifies a total of 8 reported ARIA cases, comprising 4 males and 4 females with a median age of 72 years. Among these, at least 6 cases are heterozygous for ApoE ε3/ε4 (3 cases) or ApoE ε2/ε3 (3 cases). The predominant manifestations are mild to moderate ARIA-E (3 cases) and/or ARIA-H (3 cases). The literature indicates that the ARIA risk factors included the ApoE ε3/ε4 heterozygous genotype, long-term use of antithrombotic medication, and the presence of microbleeds and white matter lesions at baseline. Furthermore, this case suggests that glymphatic system impairment may also be a potential risk factor. This case suggests that for patients with multiple ARIA risk factors, standardized imaging monitoring, timely identification and intervention, and comprehensive benefit-risk assessment can achieve safe and continuous disease-modifying therapy, providing a practical basis for individualized clinical management.

Key words: Lecanemab, Amyloid-related imaging abnormalities, Alzheimer's disease