Should You Use Lecanemab for Alzheimer’s? Understanding the Risks, Benefits, and Real-Life Decisions
- Apr 29
- 4 min read
When someone you love is diagnosed with early Alzheimer’s disease, one of the first questions you may face is:
Should you use lecanemab for Alzheimer's?
It is a difficult question—and an important one.
Because for the first time, families are being offered a treatment designed to target the underlying biology of Alzheimer’s disease. But along with that opportunity comes uncertainty, risk, and deeply personal decisions.
What Is Lecanemab?
Lecanemab is an anti-amyloid therapy used in early Alzheimer’s disease. It works by targeting amyloid plaques in the brain—one of the hallmark features of Alzheimer’s pathology.
It is given as an infusion and requires ongoing monitoring, including regular MRI scans.
For some families, it represents hope.
For others, it raises important questions.
Understanding the Risks: What Is ARIA?
One of the most important risks associated with lecanemab is something called ARIA, or amyloid-related imaging abnormalities.
There are two primary types:
ARIA-E: swelling in the brain
ARIA-H: bleeding in the brain
These risks are not theoretical. They are measurable and real.
In some individuals, especially those with underlying microvascular changes, the risk can be significant.
Absolute risk refers to the actual likelihood of an event occurring. For example, a 10–20% absolute risk means that 10 to 20 out of every 100 people in that risk group may experience ARIA.
Understanding this risk is essential when deciding whether to move forward with treatment.
Should You Use Lecanemab for Alzheimer’s? A Real Family Decision
When my mother was diagnosed with Alzheimer’s disease in 2024, she qualified for lecanemab based on how early her condition had been recognized.
But her brain imaging placed her in a higher-risk category.
She had enough microvascular changes to suggest a 15–17% absolute risk of developing ARIA-E or ARIA-H.
As a family, we were not comfortable with those odds.
And so, we made the decision not to proceed.
That decision was not easy.
But it was right for her.
What Happened Next May Surprise You
Because I have taught my family how to understand the dementia journey, because we have managed her psychiatric symptoms thoughtfully, and because we actively work to preserve her dignity, she is doing extremely well.
In fact, several weeks before writing this, she read my first book.
A week later, she gave me a five-star review—smiling with pride as she told me it was uplifting, easy to read, and that she especially loved the personal stories.
That is a picture of a person with dementia who is thriving.
And it is a reminder that treatment decisions are not the only factor that determines quality of life.
Understanding the Complexity of Alzheimer’s Treatment Decisions
There is a tendency to think that medical decisions are purely scientific.
That if we just look at the data, the answer becomes clear.
But that is not how real decisions are made.
Treatment decisions are always personal.
They depend on:
Risk tolerance
Values
Lifestyle
Logistics (such as the ability to travel for infusions and MRIs)
My parents have always had a low risk tolerance. Choosing not to proceed aligned with who they are.
How to Decide What Is Right for Your Family
If you are asking yourself whether you should use lecanemab for Alzheimer’s, here are the questions that matter most:
Do you fully understand the potential benefits of treatment?
Do you understand the risks, including ARIA?
What is your loved one’s risk tolerance?
What are your family’s values?
What are the logistical realities of treatment?
There is no algorithm that can answer these questions for you.
But there is clarity that comes from asking them honestly.
There Is No Right Answer
When I talk with families, I often reassure them:
There is no right answer—only the answer that is right for you.
There is no shame in saying yes.
And there is no shame in saying no.
There is only the responsibility—and the privilege—of making a decision that aligns with your loved one, your family, and your values.
And that is what good dementia caregiving looks like.
If You Want Help Navigating the Dementia Journey
If you are caring for someone with dementia, you have likely realized how quickly this journey becomes overwhelming.
Most caregivers are trying to figure it out as they go—without a clear understanding of what is happening, or what comes next.
This is the work I do.
I help caregivers understand the what, when, and why of dementia so they can navigate the how with clarity and confidence.
If you want personalized guidance and support as you move through this journey, you can learn more about working with me here:
If you want personalized guidance:
If you prefer a self-paced approach:
Amy Shaw, PA-C, is a dementia care clinician, educator, author, and founder of Better Dementia™, a national education platform for caregivers. She is the author of The Arc of Conversation: A How-to Guide for Goals of Care Conversations (Springer, 2025) and provides self-paced dementia education and one-to-one family support. She helps families understand the what, when, and why of dementia so they can master the how of caregiving.
