Japan's Two New Alzheimer's Drugs Require Amyloid Confirmation Before Use

A woman in her 70s visited a clinic with her husband after experiencing memory decline and repetitive questioning over the past two to three years. She scored low on a cognitive function test during a driver's licence renewal and needed a medical certificate. Although she had previously excelled at cooking, she had recently struggled with seasoning. An MRI showed mild brain atrophy and she scored 23 on a cognitive function test, leading to a diagnosis of early Alzheimer's-type dementia. Initially concerned about side effects, she decided to proceed after her son researched the treatment. She subsequently received intravenous infusions twice weekly for 18 months, and her cognitive function score rose to 27 with no further decline, allowing her to maintain her daily routine and continue enjoying gateball with her husband.

Over the past two years, two new drugs have become available in Japan for mild cognitive impairment and mild dementia caused by Alzheimer's disease. Patients seeking these treatments must first confirm amyloid beta accumulation through a PET scan or cerebrospinal fluid test. Once accumulation is confirmed, the drugs can be prescribed. Both are administered by intravenous infusion, with dosing frequencies of once every two weeks and once every four weeks, and infusion durations of one hour and 30 to 45 minutes respectively. Annual costs are similar, and although the drugs are expensive, they are covered by insurance, and high-cost medical assistance programmes can cap monthly out-of-pocket payments.

Managing side effects requires regular check-ups and frequent MRI scans. Patients are often initially worried about side effects, but after reviewing materials and online information and learning that adverse events are uncommon, they can proceed with treatment with confidence. The new drugs help patients maintain their existing lifestyle and continue pursuing their hobbies.