{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T10:49:15Z","timestamp":1792234155899,"version":"4.4.0"},"reference-count":94,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Background: Anti-amyloid therapies (AAT) are reshaping the therapeutic landscape of Alzheimer\u2019s disease (AD), yet their implementation remains constrained by the risk of amyloid-related imaging abnormalities (ARIA). Although the ARIA phenomenon is well recognized, most available evidence stems from clinical trial safety reports framed predominantly from a dementia-oriented perspective, with relatively limited integration of vascular neurology principles. Methods: In this narrative review, we examine drug-induced ARIA through a neurovascular lens, highlighting how cerebrovascular comorbidity, particularly cerebral amyloid angiopathy (CAA), influences the risk and severity of ARIA. Results: We critically evaluated how CAA comorbidity has been assessed in randomized controlled trials, focusing on exclusion criteria, imaging thresholds, and the resulting implications for external validity. Finally, we evaluated current approaches to ARIA risk stratification and proposed a more integrative framework that combines vascular imaging markers, APOE \u03b54 genotype, and key clinical comorbidities. Conclusions: A more tailored patient selection and monitoring strategies may ultimately improve real-world outcomes and optimize resources in the era of AAT.<\/jats:p>","DOI":"10.3390\/ph19040579","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T04:10:27Z","timestamp":1775448627000},"page":"579","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Drug-Induced Amyloid-Related Imaging Abnormalities: A Neurovascular Perspective on Risk Assessment"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7530-818X","authenticated-orcid":false,"given":"Marialuisa","family":"Zedde","sequence":"first","affiliation":[{"name":"Stroke Unit, Neurology Unit, Azienda Unit\u00e0 Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy"},{"name":"\u201cThe Inflammatory Cerebral Amyloid Angiopathy and Alzheimer\u2019s Disease Biomarkers\u201d Study Group of the SINDem (Italian Neurological Society for Dementia), 20145 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2942-1307","authenticated-orcid":false,"given":"Mattia","family":"Losa","sequence":"additional","affiliation":[{"name":"\u201cThe Inflammatory Cerebral Amyloid Angiopathy and Alzheimer\u2019s Disease Biomarkers\u201d Study Group of the SINDem (Italian Neurological Society for Dementia), 20145 Milan, Italy"},{"name":"Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9353-8314","authenticated-orcid":false,"given":"Andrea","family":"Donniaquio","sequence":"additional","affiliation":[{"name":"E.O. Ospedali Galliera, 16128 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4429-914X","authenticated-orcid":false,"given":"Ilaria","family":"Gandoglia","sequence":"additional","affiliation":[{"name":"Neurology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo Del","family":"Sette","sequence":"additional","affiliation":[{"name":"Neurology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Roccatagliata","sequence":"additional","affiliation":[{"name":"Neurology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy"},{"name":"Neuroradiology Unit, Department of Health Sciences, University of Genoa, 16126 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3385-3224","authenticated-orcid":false,"given":"Fabrizio","family":"Piazza","sequence":"additional","affiliation":[{"name":"\u201cThe Inflammatory Cerebral Amyloid Angiopathy and Alzheimer\u2019s Disease Biomarkers\u201d Study Group of the SINDem (Italian Neurological Society for Dementia), 20145 Milan, Italy"},{"name":"CAA and AD Translational Research and Biomarkers Laboratory, School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Pardini","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy"},{"name":"Neurology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0512-9298","authenticated-orcid":false,"given":"Rosario","family":"Pascarella","sequence":"additional","affiliation":[{"name":"\u201cThe Inflammatory Cerebral Amyloid Angiopathy and Alzheimer\u2019s Disease Biomarkers\u201d Study Group of the SINDem (Italian Neurological Society for Dementia), 20145 Milan, Italy"},{"name":"Neuroradiology Unit, Ospedale Santa Maria della Misericordia, AULSS5 Polesana, 45100 Rovigo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1408","DOI":"10.1016\/S0140-6736(25)01329-7","article-title":"Treatment for Alzheimer\u2019s disease","volume":"406","author":"Fox","year":"2025","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1056\/NEJMoa2212948","article-title":"Lecanemab in Early Alzheimer\u2019s Disease","volume":"388","author":"Swanson","year":"2023","journal-title":"N. 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