Case Study 2

A music teacher aged 70 years was diagnosed by his neurologist with mild AD, which prompted the teacher to retire. He has otherwise been in relatively good health except for a 20-year history of paroxysmal atrial fibrillation (AF) characterized by intermittent exercise-induced episodes lasting less than 24 hours. He has been treated with metoprolol succinate 100 mg/day but never with an anticoagulant. A brain MRI at the time of AD diagnosis 1 year ago was normal. The patient and his family are eager to initiate treatment with an anti-amyloid beta monoclonal antibody (anti-Aβ mAb).

How would you best manage this patient’s mild AD?(Required)

Treatment with an anti-Aβ mAb is not indicated

Begin treatment with an anti-Aβ mAb and remain vigilant for ARIA symptoms

Begin treatment with an anti- Aβ mAb and administer tissue plasminogen activator (tPA) immediately if an ischemic stroke is suspected

Delay treatment with anti-Aβ mAb therapy until AD progression has been documented