Progressive cerebral volume loss on MRI is a hallmark of Alzheimer's disease and has been widely used as an outcome measure in clinical trials, with the prediction that disease-modifying treatments would slow loss. However, in trials of anti-amyloid immunotherapy, the participants who received treatment had excess volume loss. Explanations for this observation range from reduction of amyloid β plaque burden and related inflammatory changes through to treatment-induced toxicity. The excess volume changes are characteristic of only those immunotherapies that achieve amyloid β lowering; are compatible with plaque removal; and evidence to date does not suggest an association with harmful effects. Based on the current evidence, we suggest that these changes can be described as amyloid-removal-related pseudo-atrophy. Better understanding of the causes and consequences of these changes is important to enable informed decisions about treatments. Patient-level analyses of data from the trials are urgently needed, along with longitudinal follow-up and neuroimaging data, to determine the long-term trajectory of these volume changes and their clinical correlates. Post-mortem examination of cerebral tissue from treated patients and evaluation of potential correlation with antemortem neuroimaging findings are key priorities.

中文翻译：

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阿尔茨海默病抗淀粉样蛋白β免疫治疗后的脑容量变化：淀粉样蛋白去除相关的假性萎缩


MRI 显示进行性脑容量丢失是阿尔茨海默病的标志，已被广泛用作临床试验中的结果测量，预测疾病缓解治疗将减缓丢失。然而，在抗淀粉样蛋白免疫治疗的试验中，接受治疗的受试者容量损失过多。对这一观察结果的解释范围从淀粉样蛋白β斑块负荷和相关炎症变化的减少到治疗诱导的毒性。多余的容量变化仅是那些实现淀粉样蛋白β降低的免疫疗法的特征;与去除牙菌斑相容;迄今为止的证据表明与有害影响无关。根据目前的证据，我们建议这些变化可以描述为淀粉样蛋白去除相关的假性萎缩。更好地了解这些变化的原因和后果对于做出明智的治疗决策非常重要。迫切需要对试验数据进行患者层面的分析，以及纵向随访和神经影像学数据，以确定这些体积变化的长期轨迹及其临床相关性。对接受治疗的患者的脑组织进行尸检并评估与生前神经影像学检查结果的潜在相关性是关键优先事项。