{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T07:16:36Z","timestamp":1792826196093,"version":"4.5.0"},"reference-count":80,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2023,6,6]],"date-time":"2023-06-06T00:00:00Z","timestamp":1686009600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Excess accumulation and aggregation of toxic soluble and insoluble amyloid-\u03b2 species in the brain are a major hallmark of Alzheimer\u2019s disease. Randomized clinical trials show reduced brain amyloid-\u03b2 deposits using monoclonal antibodies that target amyloid-\u03b2 and have identified MRI signal abnormalities called amyloid-related imaging abnormalities (ARIA) as possible spontaneous or treatment-related adverse events. This review provides a comprehensive state-of-the-art conceptual review of radiological features, clinical detection and classification challenges, pathophysiology, underlying biological mechanism(s) and risk factors\/predictors associated with ARIA. We summarize the existing literature and current lines of evidence with ARIA-oedema\/effusion (ARIA-E) and ARIA-haemosiderosis\/microhaemorrhages (ARIA-H) seen across anti-amyloid clinical trials and therapeutic development. Both forms of ARIA may occur, often early, during anti-amyloid-\u03b2 monoclonal antibody treatment. Across randomized controlled trials, most ARIA cases were asymptomatic. Symptomatic ARIA-E cases often occurred at higher doses and resolved within 3\u20134 months or upon treatment cessation. Apolipoprotein E haplotype and treatment dosage are major risk factors for ARIA-E and ARIA-H. Presence of any microhaemorrhage on baseline MRI increases the risk of ARIA. ARIA shares many clinical, biological and pathophysiological features with Alzheimer\u2019s disease and cerebral amyloid angiopathy. There is a great need to conceptually link the evident synergistic interplay associated with such underlying conditions to allow clinicians and researchers to further understand, deliberate and investigate on the combined effects of these multiple pathophysiological processes. Moreover, this review article aims to better assist clinicians in detection (either observed via symptoms or visually on MRI), management based on appropriate use recommendations, and general preparedness and awareness when ARIA are observed as well as researchers in the fundamental understanding of the various antibodies in development and their associated risks of ARIA. To facilitate ARIA detection in clinical trials and clinical practice, we recommend the implementation of standardized MRI protocols and rigorous reporting standards. With the availability of approved amyloid-\u03b2 therapies in the clinic, standardized and rigorous clinical and radiological monitoring and management protocols are required to effectively detect, monitor, and manage ARIA in real-world clinical settings.<\/jats:p>","DOI":"10.1093\/brain\/awad188","type":"journal-article","created":{"date-parts":[[2023,6,7]],"date-time":"2023-06-07T12:26:55Z","timestamp":1686140815000},"page":"4414-4424","source":"Crossref","is-referenced-by-count":425,"title":["Amyloid-related imaging abnormalities (ARIA): radiological, biological and clinical characteristics"],"prefix":"10.1093","volume":"146","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0894-8982","authenticated-orcid":false,"given":"Harald","family":"Hampel","sequence":"first","affiliation":[{"name":"Eisai Inc., Alzheimer\u2019s Disease and Brain Health , Nutley, NJ 07110 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aya","family":"Elhage","sequence":"additional","affiliation":[{"name":"Eisai Inc., Alzheimer\u2019s Disease and Brain Health , Nutley, NJ 07110 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Cho","sequence":"additional","affiliation":[{"name":"Eisai Inc., Alzheimer\u2019s Disease and Brain Health , Nutley, NJ 07110 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liana G","family":"Apostolova","sequence":"additional","affiliation":[{"name":"Department of Neurology, Indiana University School of Medicine , Indianapolis, IN 46202 , USA"},{"name":"Department of Radiology, Indiana University School of Medicine , Indianapolis, IN 46202 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A R","family":"Nicoll","sequence":"additional","affiliation":[{"name":"Division of Clinical Neurosciences, Clinical and Experimental Sciences, University of Southampton , Southampton SO16 6YD , UK"},{"name":"Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust , Southampton SO16 6YD , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alireza","family":"Atri","sequence":"additional","affiliation":[{"name":"Banner Sun Health Research Institute, Banner Health , Sun City, AZ 85351 , USA"},{"name":"Center for Brain\/Mind Medicine, Department of Neurology, Brigham and Women\u2019s Hospital and Harvard Medical School , Boston, MA 02115 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,6,6]]},"reference":[{"key":"2023110723370908600_awad188-B1","doi-asserted-by":"crossref","first-page":"e105","DOI":"10.1016\/S2468-2667(21)00249-8","article-title":"Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: An analysis for the global burden of disease study 2019","volume":"7","author":"GBD 2019 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