AAN 2026: Early Detection Changes Everything in Alzheimer Disease Care—And Pharmacists Are Uniquely Positioned to Help

In an interview with Pharmacy Times at the 2026 American Academy of Neurology (AAN) Annual Meeting, Parichita Choudhury, MD, cognitive neurologist and associate director of the memory clinic at Banner Sun Health Research Institute in Sun City, Arizona, described the current Alzheimer disease treatment landscape as the most exciting in the field's history, with 2 approved disease-modifying therapies—lecanemab (Leqembi; Eisai) and donanemab (Kisunla; Eli Lilly and Company)—now available for mild cognitive impairment and mild dementia, alongside an active clinical trial pipeline targeting amyloid, tau, glucose metabolism, inflammation, and disease prevention.

Pharmacy Times: Can you introduce yourself and explain your current role?

Parichita Choudhury, MD: I'm Parichita Choudhury. I'm a cognitive neurologist, and I work at Banner Sun Health Research Institute, where I serve as associate director of the memory clinic. I am also part of the Alzheimer Disease Research Center and coleader of its clinical core.

Pharmacy Times: Can you give us a brief overview of where Alzheimer disease treatment stands right now, particularly with the newer disease-modifying therapies that have come to market?

Choudhury: This is a very exciting time in the treatment of Alzheimer disease. We now have 2 approved disease-modifying therapies on the market, which is fantastic. In terms of the full treatment landscape, we have symptomatic therapies that have been available for a couple of decades: donepezil, rivastigmine, and galantamine, and then memantine for moderate and advanced stages of dementia. Now we also have the disease-modifying therapies—lecanemab and donanemab—available for patients with mild cognitive impairment as well as mild dementia due to Alzheimer disease. And we have much more exciting things on the horizon. Ongoing clinical trials are working to bring better treatments to market, including therapies targeting amyloid as well as tau, the other protein implicated in Alzheimer disease. We are also seeing treatments targeting metabolism, glucose metabolism, and inflammation. Finally, we are moving into the prevention space, which I think is one of the most exciting developments of all. We can now detect changes in the brain before symptoms ever appear, and that gives us a therapeutic window. Trials using both lecanemab and donanemab are attempting to remove amyloid in at-risk patients before symptom onset, and we should have readout data in a couple of years. The fact that we are now thinking about prevention in Alzheimer disease is truly remarkable.

Pharmacy Times: What are the most important things pharmacists should understand about managing patients on antiamyloid therapies, including monitoring for adverse effects like amyloid-related imaging abnormalities (ARIA)?

Choudhury: There are a few things that are particularly important for pharmacy colleagues to know. First, while these are currently infusion-based treatments, that may change quickly—subcutaneous lecanemab is already approved for maintenance dosing and could soon be dispensed directly from pharmacies. These drugs are effective at targeting amyloid, but they do carry [adverse] effects in the form of…ARIA, which—although frequently asymptomatic—can be serious and require monitoring. One area where pharmacists are especially instrumental is in identifying concomitant medications that may increase ARIA risk. While aspirin, clopidogrel, and other anticoagulants are not absolute contraindications per the FDA label, they are relative contraindications under appropriate use criteria. Pharmacists reviewing a patient's full medication list are ideally positioned to flag these combinations and ensure the treating team is aware. The second critical safety point involves patients who present with stroke-like symptoms: those on antiamyloid therapy have a very high risk of bleeding if given tPA [tissue plasminogen activator] or TNK [tenecteplase]. When pharmacists are working in inpatient or stroke settings where thrombolytics are being considered, ensuring that the team is aware of a patient's antiamyloid therapy status is something pharmacy colleagues can do that may be life-saving. Those are 2 of the most important things pharmacists need to know about these drugs.

Pharmacy Times: How is early detection changing the way we think about treatment timing, and what role can pharmacists play in that earlier identification process?

Choudhury: I'll answer in reverse, if that's helpful. Pharmacists have very good clinical judgment. They are seeing patients who are picking up medications, often patients they have known for years in their communities. It is very important that trusted health care professionals in those communities encourage patients to seek evaluation when they notice a cognitive change. I envision a community pharmacist who has known a patient for a decade beginning to notice subtle changes and encouraging that person to get evaluated—much the same way pharmacists play a role in preventing infectious disease through vaccines. That is a key role pharmacists can and should play. As for how early detection is changing treatment timing, having the ability to detect disease early gives us that window of opportunity I mentioned. Our disease-modifying therapies are most effective in the early stages of disease, and the earlier we intervene, the better the opportunity to slow progression. But even beyond pharmacological treatment, early detection matters enormously. It helps people plan. It helps us educate patients and their families. It helps patients get the community support they need to function well with the disease. It helps caregivers understand what is happening. Early detection is important not just for pharmacological management but for everything that comes with a diagnosis of Alzheimer disease. I will also add that vascular copathology is one of the most common co-occurring conditions in our older adults with Alzheimer disease, and pharmacists dispensing antihypertensives and statins have an incredibly important opportunity to reinforce why adherence to those medications matters for brain health. And finally—a plug I always make—donepezil, which is frequently dispensed for nighttime administration, is not well suited for nighttime use. Please encourage your patients to take it during the day.

Pharmacy Times: Looking ahead, what experimental therapies or pipeline developments are you most excited about for Alzheimer disease treatment?

Choudhury: There are several exciting pipeline developments. The first is trontinemab, also known as the "brain shuttle" drug. It uses a vehicle that attaches to the monoclonal antibody and shuttles it across the blood-brain barrier, increasing drug concentrations in the brain and allowing for faster amyloid removal. I find that very exciting and hope it yields a positive trial. The second area is antitau therapies. Several antitau drugs are currently in trials, and I am particularly excited about a combination trial that pairs amyloid- and tau-targeting therapies—building on the successes we have already achieved with amyloid-directed treatment to see whether we can more meaningfully slow or even halt disease progression. The third area is prevention trials. The fact that we now have Alzheimer disease prevention trials at all is one of the most exciting developments in our field's history. If those trials come out positive, we have the potential to make a meaningful difference at a truly societal level for patients and families.