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Baseline MRI markers and clinical outcomes during anti-amyloid β therapy: A real-world study in a Japanese dementia center
Kujuro Y, Saito M, Maruko M, Kamiyama K, Nakano A, Qian E, Okamura T, Ito D et al.. The journal of prevention of Alzheimer's disease, 2026-10-17
Topic: Amyloid, tau and blood-test diagnosis
Plain-language summary
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.
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APA 7th
Kujuro, Y., Saito, M., Maruko, M., Kamiyama, K., Nakano, A., Qian, E., et al. (2026). Baseline MRI markers and clinical outcomes during anti-amyloid β therapy: A real-world study in a Japanese dementia center. The journal of prevention of Alzheimer's disease. https://doi.org/10.1016/j.tjpad.2026.100686
Vancouver
Kujuro Y, Saito M, Maruko M, Kamiyama K, Nakano A, Qian E, et al. Baseline MRI markers and clinical outcomes during anti-amyloid β therapy: A real-world study in a Japanese dementia center. The journal of prevention of Alzheimer's disease. 2026. doi:10.1016/j.tjpad.2026.100686. PMID: 42892274.
BibTeX
@article{kujuro2026-42892274,
author = {Kujuro, Y. and Saito, M. and Maruko, M. and Kamiyama, K. and Nakano, A. and Qian, E. and Okamura, T. and Ito, D. and others},
title = {{Baseline MRI markers and clinical outcomes during anti-amyloid β therapy: A real-world study in a Japanese dementia center}},
journal = {The journal of prevention of Alzheimer's disease},
year = {2026},
doi = {10.1016/j.tjpad.2026.100686},
pmid = {42892274},
url = {https://doi.org/10.1016/j.tjpad.2026.100686}
}
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Key findings
- 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).
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Study details
- Study designretrospective cohort
- Participants40
- Evidence strengthModerate
How this study scored 69/100
Published in a peer-reviewed journal, and it is a retrospective cohort study, reconstructed from past records. Scored zero for effect reported and randomized / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multicenter collaboration, so those were left out: it earned 40 of the 58 points we could judge it on, which is 69 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (The journal of prevention of Alzheimer's disease) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 7 / 12 | A retrospective cohort study, reconstructed from past records |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 1 / 4 | 40 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multicenter collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 42892274) |
| Free to read | 2 / 2 | Free to read |
| Points | 40 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 40 of the 58 points we could judge it on is 69 out of 100. |
| Total | 69 / 100 | — |
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