Lecanemab for posterior cortical atrophy: Two contrasting cases.

Area of Science:

• Neurology
• Clinical Neuroscience
• Pharmacology

Background:

• Posterior cortical atrophy (PCA) is a neurodegenerative syndrome.
• Lecanemab is an amyloid-targeting therapy approved for Alzheimer's disease.
• The efficacy and safety of lecanemab in PCA are not well-established.

Purpose of the Study:

• To evaluate the clinical implications, limitations, and risks of lecanemab treatment in PCA.
• To compare treatment outcomes in two PCA patients meeting lecanemab eligibility criteria.

Main Methods:

• Retrospective analysis of two biomarker-confirmed PCA patients.
• Review of clinical history, neuropsychological tests, imaging, and outcomes over one year.
• Assessment of lecanemab eligibility criteria application to PCA.

Main Results:

• Patient 1 (early onset, left-dominant atrophy) showed stable function despite some decline.
• Patient 2 (later onset, right-dominant atrophy) experienced parkinsonism, hallucinations, and rapid decline, leading to discontinuation.
• Treatment satisfaction varied significantly between patients.

Conclusions:

• Standard Alzheimer's disease criteria may not be suitable for PCA treatment eligibility.
• PCA requires specific visual cognition assessments and consideration of phenotypic heterogeneity.
• Coexisting pathologies can impact treatment response, necessitating a multimodal, tailored approach.