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

Article · Kujuro Y, Saito M, Maruko M, Kamiyama K, Nakano A, Qian E, Okamura T, Ito D, Kageyama T, Sugiyama I, Ishihara E, Kuwahara T, Moritani K, Katai H, Hattori H

- Archive id: doi:10.1016/j.tjpad.2026.100686
- Published: 2026-10-17
- Venue: The journal of prevention of Alzheimer's disease
- DOI: https://doi.org/10.1016/j.tjpad.2026.100686
- PMID: 42892274
- PMCID: PMC13696334
- Citations: 0
- Source URL: https://doi.org/10.1016/j.tjpad.2026.100686
- PDF: https://europepmc.org/articles/PMC13696334/pdf
- Provenance: europepmc

## 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.

_Abstract reproduced under CC-BY (article license as recorded by Europe PMC; abstract reproduced unmodified apart from markup removal)._

Topics: [Alzheimer's, Parkinson's & Neurodegeneration](https://space-kitty.com/topics/neurodegeneration)

---
Space Kitty Archive · https://space-kitty.com · API: https://space-kitty.com/api/v1 · MCP: https://space-kitty.com/mcp · Premium: $0.20/request via x402 (Base Sepolia (testnet)). Metadata: arXiv (CC0), OpenAlex (CC0), Europe PMC (CC BY/CC0 works), ClinicalTrials.gov.