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Reduced diffusion associated with amyloid-related imaging abnormalities in three patients treated with donanemab
Schwartz NU, Dietz CD, Lin Z, Tammewar G, Bui N, La Joie R, Wang Y, Sreekrishnan A et al.. Neurocase, 2026-07-02
Topic: Amyloid, tau and blood-test diagnosis
Amyloid-related imaging abnormalities (ARIA) with edema (ARIA-E) and with hemorrhage (ARIA-H) are common adverse effects of amyloid-targeting therapies (ATT), characterized on MRI by T2/fluid-attenuated inversion recovery (FLAIR) hyperintensities and susceptibility-sensitive hypointensities, respectively. ARIA resulting from ATT is not commonly associated with reduced diffusion or acute infarcts. In this case series, we describe three patients with mild cognitive impairment due to Alzheimer's disease (AD) - a 75-year-old woman, a 74-year-old woman, and an 80-year-old man ( APOE ε3/ε3, ε4/ε4, and ε3/ε4, respectively) - who developed ARIA accompanied by transient foci of reduced diffusion within the first six months of donanemab treatment, without permanent T2/FLAIR correlates. The diffusion-restricting lesions may represent ischemic infarcts, although the lack of permanent T2/FLAIR correlate is atypical. Clinicians should be aware that reduced diffusion may accompany ARIA. The course can be highly dynamic, and both the clinical presentation and management implications may vary.
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APA 7th
Schwartz, N. U., Dietz, C. D., Lin, Z., Tammewar, G., Bui, N., La Joie, R., et al. (2026). Reduced diffusion associated with amyloid-related imaging abnormalities in three patients treated with donanemab. Neurocase. https://doi.org/10.1080/13554794.2026.2695021
Vancouver
Schwartz NU, Dietz CD, Lin Z, Tammewar G, Bui N, La Joie R, et al. Reduced diffusion associated with amyloid-related imaging abnormalities in three patients treated with donanemab. Neurocase. 2026. doi:10.1080/13554794.2026.2695021. PMID: 42388121.
BibTeX
@article{schwartz2026-42388121,
author = {Schwartz, N. U. and Dietz, C. D. and Lin, Z. and Tammewar, G. and Bui, N. and La Joie, R. and Wang, Y. and Sreekrishnan, A. and others},
title = {{Reduced diffusion associated with amyloid-related imaging abnormalities in three patients treated with donanemab}},
journal = {Neurocase},
year = {2026},
doi = {10.1080/13554794.2026.2695021},
pmid = {42388121},
url = {https://doi.org/10.1080/13554794.2026.2695021}
}
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Key findings
- ARIA resulting from ATT is not commonly associated with reduced diffusion or acute infarcts.
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Study details
- Evidence strengthLow
How this study scored 48/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported and randomised / 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 multi-centre collaboration, so those were left out: it earned 28 of the 58 points we could judge it on, which is 48 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Neurocase) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” 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 | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| 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 (pubmed indexes it as a clinical or observational study) |
| Randomised / blinded | 0 / 2 | No randomisation 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 |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 42388121) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 28 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 28 of the 58 points we could judge it on is 48 out of 100. |
| Total | 48 / 100 | — |
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