Donanemab-associated clinical improvement in Alzheimer's disease presenting predominantly with neuropsychiatric symptoms: A case report

Late-life depression may mask Alzheimer's disease (AD). We report a 78-year-old man with treatment-refractory depressive and anxiety symptoms accompanied by paroxysmal somatic attacks, unresponsive to psychotropic treatment and modified electroconvulsive therapy. Ultimately, biomarker evaluation confirmed AD pathology, and donanemab was initiated. Follow-up amyloid positron emission tomography demonstrated marked amyloid clearance, particularly in the frontal lobe, accompanied by concurrent improvement in depressive symptoms, cognition, and reduced somatic attacks. This case suggests that anti-amyloid therapy may benefit AD patients presenting with refractory neuropsychiatric symptoms, potentially related to frontal amyloid clearance, underscoring the importance of AD screening in resistant late-life depression.