A plain-language guide to Alzheimer's disease, the two infusion medications approved to treat it, and what starting one really requires. Written for the families in Maryland who are managing this on someone else's behalf.
Alzheimer's disease is the most common cause of dementia, and 7.4 million Americans age 65 and older are living with it. Two infused medications, lecanemab (Leqembi) and donanemab (Kisunla), are approved for people in the earliest stages. They slow the rate of decline. They do not reverse it, they do not bring memory back, and they do not stop the disease. Both carry a boxed warning for brain swelling and bleeding, and both require amyloid testing, genetic testing, and MRI scans on a set schedule. Springside administers these infusions in Columbia, Bowie, and Frederick, Maryland. Your neurologist keeps managing care. We handle the infusion, the insurance authorization, and the paperwork.
Dementia is not a disease. It is a general term for a loss of memory, reasoning, and other thinking skills serious enough to interfere with daily life. Many different diseases cause it.
Alzheimer's disease is one of them, and the most common. It is a specific, progressive disease of the brain, marked by two abnormal protein deposits: amyloid beta plaques that build up between nerve cells, and tau tangles that form inside them. Nerve cells lose connections with one another and eventually die. The damage typically begins in the parts of the brain that form new memories, then spreads.
The distinction matters more than it might seem. Other diseases cause dementia too, including vascular dementia from damaged blood flow in the brain, Lewy body dementia, and frontotemporal dementia. Some people have more than one at once. The infusion medications on this page are approved for Alzheimer's disease specifically, in its early stages, and are not treatments for dementia in general. A diagnosis of dementia is not by itself a ticket to these drugs.
Alzheimer's is usually described as a continuum rather than a set of hard borders. People move through it at very different speeds.
The anti-amyloid infusions are labeled for the first two of those stages that produce symptoms, mild cognitive impairment and mild dementia. That is the narrow window most families are trying to figure out whether they are still inside.
Most people search this question before they search anything else. Forgetting a name and remembering it an hour later is ordinary. So is losing the car keys, or walking into a room and forgetting the errand.
What tends to concern a clinician is a pattern that is getting worse over months and is starting to cost something: the same question asked four times in an afternoon, bills going unpaid, a familiar route that stops being familiar, a recipe cooked for thirty years that no longer comes out. Only a clinical evaluation can sort this out, and there are treatable conditions, including thyroid problems, vitamin deficiency, depression, sleep apnea, and medication side effects, that can look like early dementia and are worth ruling out first.
Symptoms build gradually and vary from person to person. Common ones include:
The early symptom that brings most families in is rarely memory. It is a change in the person: less initiative, less interest, a shorter fuse, an unwillingness to go to things they used to enjoy. People are also very good at covering for a long time, and a spouse may have been quietly filling gaps for a year or more before anyone says it out loud. If you are the one noticing, you are probably not wrong, and you are probably later in this than you think.
This page is educational and is not medical advice. Nothing here can diagnose Alzheimer's disease or tell you whether a treatment is right for your family member. That takes a clinical evaluation by a physician, cognitive testing, imaging, and confirmation of amyloid pathology. Be skeptical of anything sold to you as a cure, a reversal, or a way to restore memory, including supplements, infusions marketed for "brain health," and clinics that promise results no approved medication delivers. No treatment available today reverses Alzheimer's disease or stops it. If your family member has a sudden change in alertness, a fall with a head injury, a new severe headache, new weakness or trouble speaking, or a seizure, seek emergency care.
Treatment runs on two separate tracks, and they are often confused with one another.
The first is symptom treatment. Oral medications, including cholinesterase inhibitors such as donepezil and rivastigmine and the drug memantine, can help with memory and thinking for a period of time in some people. They do nothing to the underlying disease process. Alongside them sits everything that is not a prescription: routines, sleep, safety at home, structured activity, driving decisions, and support for the caregiver.
The second is disease-directed treatment, which is where the infusions come in. These are the first medications that act on Alzheimer's disease itself rather than on its symptoms.
Lecanemab and donanemab are monoclonal antibodies. They are engineered to attach to amyloid beta in the brain and prompt the immune system to clear it. On a PET scan, the plaques measurably go down.
Here is the part that gets overclaimed everywhere else. Clearing plaque slows how fast a person declines. It does not move them backward. Someone on one of these drugs is still expected to get worse over time. The hoped-for result is that they get worse more slowly than they otherwise would have, which may mean holding onto independence and recognition somewhat longer. Memory does not return. Lost function does not come back. The disease continues.
Whether that trade is worth the monitoring, the time, and the risk is a real decision, not an obvious one. It belongs to your family and the prescribing neurologist, with everyone working from the same honest description of the benefit.
Both labels say treatment should be started in people at the mild cognitive impairment or mild dementia stage of Alzheimer's disease, because that is the population studied in the trials. Two things must be established before a first dose:
These drugs are not approved for moderate or advanced Alzheimer's, and they are not approved for vascular, Lewy body, or frontotemporal dementia.
Lecanemab (Leqembi). Given intravenously at 10 mg/kg once every two weeks, infused over approximately one hour. After 18 months, the label moves to maintenance dosing of 10 mg/kg once every four weeks. Lecanemab is also available as a weekly under-the-skin autoinjector, which is a different route with its own dosing and its own monitoring schedule.
Donanemab (Kisunla). Given intravenously once every four weeks, infused over approximately 30 minutes. The dose steps up over the first three infusions, 350 mg, then 700 mg, then 1,050 mg, reaching 1,400 mg from the fourth infusion onward. The label says to consider stopping treatment once amyloid PET imaging shows plaques reduced to minimal levels, so this is not necessarily a therapy taken forever.
This is the section to read twice before agreeing to anything. The commitment is larger than showing up for infusions.
Both Leqembi and Kisunla carry a boxed warning, the FDA's most serious form of warning, for amyloid related imaging abnormalities, known as ARIA. Clearing amyloid from blood vessel walls in the brain can cause swelling, called ARIA-E, and small areas of bleeding, called ARIA-H.
The labels state that ARIA usually occurs early in treatment and is usually without symptoms, showing up only on a scan. They also state plainly that serious and life-threatening events can occur, that ARIA can be fatal, and that serious brain hemorrhages larger than one centimeter, some of them fatal, have been seen with this class of drug.
Risk is not the same for everyone. People who carry two copies of the ApoE ε4 gene, roughly 15 percent of people with Alzheimer's disease according to the labels, have a higher rate of ARIA, including symptomatic, serious, and severe cases, than people with one copy or none. That is why the genetic test comes before the first dose rather than after.
Blood thinners deserve a specific conversation. The Kisunla label directs additional caution when antithrombotic or clot-dissolving drugs are being considered for someone on treatment, partly because ARIA can produce neurologic symptoms that mimic a stroke. If your family member takes a blood thinner, raise it with the neurologist early.
Because ARIA is usually silent, it is caught by imaging rather than by how someone feels. Both labels require a recent baseline brain MRI before the first dose, then MRIs on a fixed schedule during treatment.
Practically, that means arranging MRI appointments and getting them read on time, because a scheduled dose can be held or stopped based on what the scan shows. Additional MRIs may be ordered at any point if symptoms appear. Plan for the imaging the way you plan for the infusions, and expect the first several months to be the busiest.
Call the prescribing neurologist right away for headache, confusion, visual changes, dizziness, nausea, or difficulty walking, and seek emergency care for anything sudden or severe. These are the symptoms the labels associate with ARIA, and someone with memory impairment may not report them on their own. That falls to whoever is watching.
If you have never brought someone for an infusion, here is the shape of a typical visit.
You can stay for the whole visit. Caregivers are welcome in the infusion suite, and for someone with memory impairment a familiar person in the chair alongside them usually makes the appointment go better. Bring what helps: headphones, a blanket, a photo album, a snack if eating is allowed that day. Tell us in advance if your family member becomes anxious in clinical settings, is sensitive to noise, needs help to the restroom, or does better at a particular time of day. We can often place them in a quieter spot and schedule around their better hours.
Plan for more than the infusion time. The times above come from each drug's FDA label and cover the infusion itself. Check-in, IV placement, any premedication, and observation are on top of that. When we confirm your appointment, we will tell you the full window so you can arrange the rest of the day around it.
You can change where infusions are given without changing neurologists. The neurologist continues to manage the Alzheimer's care, orders the MRIs, and writes the infusion order. We administer the medication and report back to them.
Many Maryland insurance plans now prefer, and some require, that non-urgent infusions be given at an ambulatory infusion center rather than a hospital outpatient department. That is often at meaningfully lower out-of-pocket cost. Coverage rules and prior-authorization requirements for anti-amyloid therapy vary by plan and tend to be strict, so we verify benefits and handle the authorization before the first visit.
