Start with a memory-clinic diagnosis, not with a drug request
Charité, Freiburg and Heidelberg all provide specialist memory or neurocognitive clinics. A useful assessment begins with the time course of cognitive symptoms, daily-function change, medication review, neurological examination and structured neuropsychological testing. Depression, sleep disorders, medication effects, vascular disease, metabolic disorders and other neurological causes may mimic or contribute to cognitive decline.
- Detailed history from the patient and, when possible, a close relative or caregiver
- Neuropsychological testing of memory and other cognitive domains
- Medication and comorbidity review
- Neurological examination
- Brain MRI or CT review
- Laboratory testing for potentially reversible contributors when clinically appropriate
Alzheimer’s disease is only one cause of dementia
Charité’s memory services explicitly evaluate Alzheimer’s disease alongside frontotemporal dementia, Lewy-body dementia, vascular dementia and other causes. Rapidly progressive cognitive decline can also require a different work-up, including inflammatory, infectious or other neurological causes. A second opinion is especially valuable when the diagnosis was made from symptoms alone or when progression is unusually fast.
Biomarkers matter when disease-modifying therapy is being considered
Freiburg documents CSF testing, amyloid imaging and other advanced diagnostic tools in its memory-clinic pathway. The EMA indication for lecanemab requires confirmed amyloid pathology, so a clinical label of 'possible Alzheimer’s' is not enough for treatment selection. The exact biomarker pathway can use CSF and/or appropriate amyloid imaging depending on the center and clinical situation.
Lecanemab is a selected early-Alzheimer’s treatment, not a general dementia therapy
Leqembi (lecanemab) received EU marketing authorisation on 15 April 2025 for adults with mild cognitive impairment or mild dementia due to Alzheimer’s disease who have confirmed amyloid pathology and are ApoE4 non-carriers or heterozygotes. Freiburg reports providing lecanemab outpatient therapy for early Alzheimer’s disease. The medicine reduces amyloid and has been shown to slow cognitive decline, but it does not reverse established dementia or cure Alzheimer’s disease.
- Clinical diagnosis of early Alzheimer’s disease
- Confirmed amyloid pathology
- ApoE4 genotype compatible with the authorised indication
- Assessment of MRI findings and other safety factors
- Ability to attend repeated infusions and safety monitoring
- A realistic discussion of expected benefit, risk and long-term logistics
ARIA risk makes MRI access part of the treatment pathway
The EMA highlights amyloid-related imaging abnormalities (ARIA), including brain swelling and bleeding, as a major safety issue with lecanemab. Treatment must be supervised by clinicians experienced in Alzheimer’s disease with timely MRI access. The MRI schedule and other safety requirements should be confirmed with the treating center because product information can be updated after authorisation.
Standard Alzheimer’s care remains important even when anti-amyloid therapy is not suitable
Freiburg notes that newer anti-amyloid therapy complements rather than replaces established care. Memory-clinic management can include symptom-directed medication, cognitive and physical activity, management of vascular and psychiatric comorbidity, social support, caregiver education and planning for changing daily-function needs. These measures remain relevant across stages of Alzheimer’s disease.
International travel requires a realistic infusion and follow-up plan
Lecanemab is administered repeatedly rather than as a one-time hospital procedure. Freiburg describes outpatient infusions every two weeks with ongoing monitoring. International patients should therefore clarify whether eligibility assessment, infusions and MRI surveillance can all be provided in Germany, whether part of follow-up can be transferred home and whether the center currently has treatment capacity. Charité explicitly notes that eligibility assessment does not guarantee an infusion place.
What to send for a German Alzheimer’s second opinion
A complete record package helps the memory clinic determine whether the question is diagnostic clarification, standard treatment optimisation or eligibility for an anti-amyloid pathway.
- Neurology, psychiatry, geriatrics or memory-clinic reports
- Neuropsychological or cognitive testing results
- Brain MRI or CT reports and original images
- CSF Alzheimer biomarkers if already tested
- Amyloid PET or other biomarker imaging if already performed
- ApoE genotype if already available
- Current medication list including anticoagulants and antiplatelet therapy
- Relevant vascular, bleeding, seizure and neurological history
- A specific question: confirm diagnosis, optimise care or assess early-Alzheimer’s disease-modifying treatment eligibility
Official sources
Sources last checked 2026-09-01. Clinical pathways, eligibility and hospital procedures can change; confirm current requirements directly with the treating center.
- Memory clinic / dementia and cognitive disorders — Charité – Universitätsmedizin Berlin ↗
- Lecanemab indication clinic — Charité – Universitätsmedizin Berlin ↗
- Memory Clinic and Dementia — University Medical Center Freiburg ↗
- New treatment option for Alzheimer’s patients — University Medical Center Freiburg ↗
- Outpatient department for neurocognitive disorders — Heidelberg University Hospital ↗
- Leqembi (lecanemab) – EU product information — European Medicines Agency ↗