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What to Know if You’re Considering the Alzheimer’s Drug Leqembi

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What to Know if You’re Considering the Alzheimer’s Drug Leqembi

On Thursday, the Food and Drug Administration gave full approval to the drug Leqembi for patients who are in the early stages of Alzheimer’s disease, and Medicare said it would cover 80 percent of the cost of the $26,500-per-year medication. The decisions by the two federal agencies will vastly increase access to the drug but also present a dilemma for patients and their families.

There are many factors, both financial and medical, to weigh. Here are answers to some crucial questions:

Leqembi is not a cure for Alzheimer’s, and the drug doesn’t improve patients’ memories or cognitive abilities. It also does not stop the disease from getting worse. What Leqembi can do is modestly slow down cognitive decline in patients who are in the early stages of the disease. Data from a large clinical trial suggested that the drug may slow decline by about five months over a period of 18 months for those patients.

How the drug might affect a patient’s daily life is likely to vary widely. For some people, Leqembi might mean several additional months of being able to follow a recipe, balance a checkbook or accomplish other activities without help. For others, the impact might be much more subtle and barely noticeable.

Yes. The drug can cause swelling or bleeding in the brain that is often mild or moderate and resolves on its own but can be serious and in very rare cases can be fatal. The F.D.A. was so concerned about these side effects that it is requiring a “black-box warning” — the most urgent level — on the drug’s label, saying that the medication can cause “serious and life-threatening events.”

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Patients who are at higher risk include those on blood thinners, those who have had more than four microscopic bleeds in the brain and those with an Alzheimer’s-linked gene mutation called APOE4 — especially if they have two copies of the mutation. They, along with their doctors, should consider whether the increased safety risk outweighs their desire for a medication that might modestly slow cognitive decline.

A large clinical trial of the drug found that nearly 13 percent of patients receiving Leqembi experienced brain swelling, but most of those cases were mild or moderate. Less than 2 percent of patients receiving the placebo experienced such swelling. Most brain swelling did not cause any symptoms and generally resolved within a few months.

About 17 percent of the patients receiving Leqembi experienced brain bleeding, compared with 9 percent of patients receiving the placebo. The most common symptom from brain bleeds was dizziness, the study said.

Leqembi — which is administered by intravenous infusions in a doctor’s office or clinic every two weeks — will be available for people diagnosed as having early-stage Alzheimer’s and for those with a pre-Alzheimer’s condition called mild cognitive impairment. About 1.5 million people in the United States fit that description. An additional 5 million who have Alzheimer’s will not qualify for Leqembi because their disease has progressed too far.

The F.D.A.-required label on the drug instructs doctors not to treat patients without testing to confirm that they have one of the hallmarks of Alzheimer’s: a buildup in the brain of the protein amyloid, which Leqembi attacks. Amyloid levels can be assessed with PET scans, spinal taps or newly available blood tests.

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Most patients will be old enough for Medicare, which has said it will pay for 80 percent of the $26,500 annual cost of the drug. Patients would be left with about $6,600 in co-payments, which may put the drug out of financial reach for many. Some or all of that co-payment might be covered by the supplemental private insurance policies that many Medicare patients have.

There are potentially tens of thousands of dollars of additional costs, however — including medical visits for the infusions and regular brain scans. Some Alzheimer’s experts have estimated that the total cost of taking Leqembi could run to about $90,000 a year. With 80 percent coverage, treatment could potentially leave patients saddled with $18,000 per year in out-of-pocket costs.

Talk to your doctor. If your doctor is not well-versed in Alzheimer’s treatments, consider talking with a specialist. The most important thing is to discuss the decision with medical experts who will carefully explain the risks for your specific situation.

To learn those risks, ask for genetic testing to determine if you have the APOE4 gene mutation. People with two copies of that mutation — about 15 percent of Alzheimer’s patients — are at especially high risk of brain swelling and bleeding.

There are other factors to consider too. Would going to a clinic for a drug infusion every two weeks pose a burden?

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And, importantly, how do you and your family perceive your current cognitive condition and how it affects your life? Because Leqembi is for people with mild symptoms, some people might be less inclined to take safety risks, but others might consider it especially important to try a drug that might keep them at this mild stage a bit longer.

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Consumers Show Signs of Strain Amid Trump's Tariff Rollout

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Consumers Show Signs of Strain Amid Trump's Tariff Rollout

The U.S. consumer has seemed unstoppable in recent years, spending throughout soaring inflation and the highest borrowing costs in decades. That resilience helped to keep at bay a recession that many thought inevitable after the pandemic.

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Consumer spending has fueled the economy

Year-over-year percentage change in retail and food service sales

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Source: U.S. Department of Commerce

Note: Data is seasonally adjusted.

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President Trump’s tariffs and their scattershot rollout have once again raised concerns that the United States may soon face an economic downturn. While the odds of an outright recession have fallen as the highest levies have been paused, there are reasons to be worried about the ability of consumers to continue to prop up growth.

Consumer spending accounts for more than two-thirds of U.S. economic activity, meaning a sharp enough pullback could cause significant damage.

For now, consumers are still spending, although more slowly than in the past. Their attitudes about the economic outlook have soured in recent months in anticipation of elevated prices, slower growth and higher unemployment. Americans have also become choosier about how they spend their money. Leisure and business travel has declined. People are buying fewer snacks and eating out less as they look to cut costs. They are even doing fewer loads of laundry to save money.

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“The economy is really vulnerable to anything that could go wrong, and clearly there’s a lot that could go wrong,” said Mark Zandi, chief economist of Moody’s Analytics.

It is not yet clear if the slowdown simply reflects distortions related to stockpiling before Mr. Trump’s trade war starts to really bite, or if it is an early sign of a full-blown retreat.

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Part of what has enabled consumers to spend so freely up until this point is a stockpile of savings that they accrued as a result of government stimulus during the pandemic and a booming stock market. Those savings have now largely been tapped out.

“The cushion that was there during the pandemic to weather the storm of higher prices is not there now,” Diane Swonk, the chief economist at KPMG, said. The highest-earning 10 percent of Americans, who drive the bulk of consumer spending, are still in good shape, but it’s the bottom 90 percent that worry her most.

Those households are under increased financial stress.

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The share of outstanding credit card debt that is 90 days or more past due started increasing in 2023 and has continued to rise across geographies and income levels, according to data through the first quarter of this year released Tuesday by the New York Fed and research by the St. Louis Fed. The trend has become particularly pronounced for poorer households.

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Credit card delinquency is high

Percentage of credit card debt that is 90 days or more past due

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Sources: Federal Reserve Bank of New York Consumer Credit Panel/Equifax and calculations by Sánchez and Mori (2025) of the Federal Reserve Bank of St. Louis

Notes: Data is quarterly. Income categories are based on per capita aggregate gross income in 2019 from individual income tax ZIP code data.

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And real-time credit reports from Experian, one of the three major U.S. credit rating firms, suggest the pace accelerated in April.

Americans are struggling with other kinds of payments, too. The overall delinquency rate, which includes all loan types, reached its highest level since 2020 in the first quarter of this year, according to the Fed data. This was driven by student loan delinquencies, as past-due student loans once again were included in credit reports after a pandemic-era pause on federal student loan repayments.

Because they now have to pay down those balances after a five-year reprieve, consumers may increasingly have trouble servicing other kinds of loans, another strain.

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What matters most, however, is the labor market. “If American consumers have money, they’re going to spend it, and the primary place they get money is through their jobs,” said Eric Winograd, an economist at the investment firm AllianceBernstein.

Businesses are still hiring, layoffs are low and the unemployment rate has stabilized at a historically low level of around 4 percent. But the labor market is noticeably less robust than it was in the aftermath of the pandemic, a period that was marked by booming hiring, soaring wages and acute worker shortages.

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“Nothing emboldens consumers quite like a strong labor market, and we don’t have that anymore,” said Tom Porcelli, chief U.S. economist at PGIM Fixed Income.

Companies are posting far fewer job openings and positions are no longer much more plentiful than the number of people looking for work as businesses reassess their staffing needs in an environment of slowing growth.

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Jobs are no longer much more plentiful than available workers

Job openings vs. unemployment

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Source: Bureau of Labor Statistics

Note: Data is seasonally adjusted.

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Spending is now consistently increasing faster than income, once adjusted for inflation. This imbalance cannot last, said Neil Dutta, head of economic research at Renaissance Macro. Either incomes will need to accelerate or consumption must slow over time. “Given what we know about the job market and wage growth, it’s more likely that consumer spending slows than incomes rise,” he said.

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Spending is growing faster than income

Year-over-year percentage change in real consumption vs. real income

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Source: Bureau of Economic Analysis

Notes: Income excludes government transfer payments. Data is seasonally adjusted.

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Pay is no longer soaring for workers in the lowest-paid industries, such as leisure and hospitality, who saw their earnings increase the fastest in the initial recovery period when the job market was strong and demand for their services was high. Now, pay is rising faster in high-wage industries — as pay for lower- and mid-wage jobs stagnate.

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Wage growth has slowed, particularly for workers in low-wage industries

Median year-over-year percentage change in industry-level earnings for nonmanagers

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Sources: Bureau of Labor Statistics; New York Times analysis

Notes: Lines show three-month rolling averages. Medians are weighted by employment levels. “Low-wage” is the bottom 25 percent of industries, “high-wage” the top 25 percent, and “mid-wage” the middle 50 percent.

It is too early to say if the lessons of the post-pandemic period will prove applicable this time around. Consumers are clearly under heightened pressure, but it will take time to know whether they are buckling under that weight or once again muscling through.

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So far, policymakers at the Federal Reserve do not appear too worried just yet and are taking their time to assess the economic impact of Mr. Trump’s policies before restarting interest rate cuts.

“The U.S. consumer never lets us down,” John Williams, president of the Federal Reserve Bank of New York, said in a recent interview.

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Retail theft surge in Inland Empire store prompts new policy: Leave shopping bags with the cashier

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Retail theft surge in Inland Empire store prompts new policy: Leave shopping bags with the cashier

A locally owned grocery store fed up with a rise in theft in its Inland Empire community is trying to crack down on the problem by restricting the use of large personal shopping bags in the store.

On a Facebook post in April, Matthew and Allison Whitlow announced their ownership of the Grocery Outlet on East Florida Avenue in Hemet. Less than a month later, the owners noted on social media that a personal bag policy will be strictly enforced citing “an influx of theft.”

In the post, the Whitlows asked that customers leave their reusable shopping and personal bags — including anything larger than a small handbag — in the front of the grocery store with a cashier.

“While this has always been posted on our front door, we have had some take advantage and walk out of store without stopping by the register,” according to a Facebook post.

The Whitlows declined to speak with The Times about the incidents that led to their decision.

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But asking customers to leave their reusable bags at the front of the store could create confusion for shoppers who are trying to follow state law and help the environment.

Since 2014, California has worked to eliminate single-use plastic bags from grocery stores and have recently taken a step further by passing legislation that would do away with the thicker plastic bags made of high-density polyethylene, or HDPE. Grocery stores have been offering the thicker HDPE bags to shoppers instead of the banned thin plastic bags.

In response, shoppers across the state have stocked up on reusuable grocery bags, made of canvas or cloth.

The new bag policy is in response to an uptick in retail theft across the state, an issue so problematic that state officials have dispatched California Highway Patrol officers to help local police get a handle on retail crime and car theft and help bolster traffic enforcement.

Gov. Gavin Newsom has sent officers to Oakland and Bakersfield, cities that have had immense issues with smash-and-grab retail crime.

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Customers who leave their large bags at the front are allowed to take out and carry their smartphones and wallets while they shop.

The Whitlows are encouraging their customers to use store-provided hand baskets instead.

“With us being locally/independently owned, when theft occurs, it not only hurts us, but the community,” the post stated. “We know this is inconvenient for everyone, but we want to ensure that we have products for you all as well as not lose any so we can keep pricing affordable.”

Rather than resort to theft, the owners suggested in the post that shoppers who are struggling to make ends meet ask for help.

“Please ask for one of the owners, Matt or Allison, and we will see what we can do to help,” the post stated.

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Inside Elon Musk’s X Feed: Trumpism, Falsehoods and Lots of Love for Elon Musk

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Inside Elon Musk’s X Feed: Trumpism, Falsehoods and Lots of Love for Elon Musk

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This is what Elon Musk’s personal feed on X looks like.

He follows more than 1,000 people: right-wing influencers, conspiracy theorists, anti-transgender activists and dozens of his own superfans.

His feed represents a flattering alternate reality filled with boundless praise — for him, for Tesla, for X, for his politics.

And it mirrors his own deepening allegiances to the far-right.

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Note: These posts were selected by The New York Times and are shown in chronological order. Some posts were truncated for length. Source: X

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In Mr. Musk’s own telling, his political views were shaped by X.

In a recent interview with Fox News, Mr. Musk said that videos circulating on X years ago depicting crowds of migrants sparked his fascination with right-wing politics and stronger border protections.

“I’ve seen videos of people streaming across the border on Twitter, now X,” he said, citing politicized and sometimes misleading videos that have spread online about migrants. “And I was like, is this real?”

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It was a stark example of the power X has to politicize its own users — including the world’s richest man — using hyperpartisan opinions and far-right media.

To better understand how the information that Mr. Musk consumes on X could shape his worldview, The New York Times recreated a version of Mr. Musk’s personal feed by opening a new account on X and following the same 1,109 users that he follows. We then analyzed more than 175,000 posts from the accounts that he follows, using a service that collects data from X.

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Though there is no guarantee that Mr. Musk saw all of the posts captured by The New York Times, the accounts that he follows — including world leaders and business tycoons alongside conspiracy theorists and far-right influencers — reveal the voices that Mr. Musk appears to value. (This “Following” feed is different from the main “For You” feed, which includes posts from those he follows alongside others selected by X’s algorithm.)

The resulting feed, shown in this article as a selection of posts curated from the much larger set, revealed ample praise for Mr. Musk and his various priorities, mixed with a torrent of right-wing outrage over progressive politics. It highlights the ways that social networks can create information bubbles. X declined to comment.

Step, once again, into a version of Mr. Musk’s personal X feed below.

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Among the most popular topics on Mr. Musk’s feed on X? Elon Musk himself.

He follows dozens of superfans who post near-constant praise for him and his companies.

Many other users devote time to praising the executive, too — between posts about politics, memes or culture wars.

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Note: These posts were selected by The New York Times and are shown in chronological order. Source: X

Those voices are mostly right-wing: Among tens of thousands of posts during a typical week, nearly half of them came from right-wing media figures, conservative influencers, Republican politicians or government leaders.

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Those accounts included Chaya Raichik, whose X account, Libs of TikTok, has more than four million followers. Ms. Raichik’s appearances on Mr. Musk’s feed match her growing prominence offline: Her influence has exploded during the second Trump administration, and she has appeared at the White House multiple times this year, cementing her status as a top Trump advocate.

The accounts that Mr. Musk follows are also the ones he interacts with most on X, according to The Times’s analysis, giving them a valuable boost on the platform since Mr. Musk is the site’s most popular user, with more than 200 million followers.

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That seems to give his followers the power to seize Mr. Musk’s attention and could even redirect his policy goals. It is something they have noticed, with some users boasting they can catch Mr. Musk’s attention with a well-timed post or question.

“Pretty amazing when the owner of a platform personally tells you he is fixing your problem in real time,” Mario Nawfal, an influencer with more than two million followers, posted after Mr. Musk said he would fix an issue on X.

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Who does Mr. Musk follow?

Mr. Musk follows more than 1,100 users on X, including hundreds of right-wing personalities.

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Some of the ideas that circulated on Mr. Musk’s feed later emerged on the national stage.

President Trump had claimed at an address to Congress that federal funds were used for “making mice transgender” — a misleading description of various studies that tested the effect of hormone therapy on H.I.V. infections and other other side effects of the medication. The idea had gathered steam on X two months earlier, when a conservative-led animal advocacy group posted about it. The group’s account is followed by Representative Nancy Mace, Republican of South Carolina, and by Mr. Musk. Mr. Musk had personally shared one of the posts.

Later, as Tesla vehicles and dealerships were vandalized or attacked in a violent reaction to Mr. Musk, his feed was filled with calls to charge the attackers with “domestic terrorism,” giving the perpetrators 20-year prison sentences.

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Mr. Musk agreed, calling attacks on Tesla’s vehicles “extreme domestic terrorism!!” Days later, Mr. Trump repeated the idea, saying that he would enjoy seeing “the sick terrorist thugs get 20 year jail sentences.”

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The content on Mr. Musk’s feed is a mirror of his own interests: As Mr. Musk’s role in the government’s cost-cuttings grew, so did praise for those plans on X.

The accounts he follows boast frequently about his supposed cuts, claiming billions in cost-savings that have often proven false or misleading under additional scrutiny.

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Polling has shown that cutting government spending is popular, but that Mr. Musk and his Department of Government Efficiency are not. If Mr. Musk seemed oblivious to the criticism, his feed offers some reasons why: The users he follows praised his work and claimed Americans loved him for it.

Note: These posts were selected by The New York Times and are shown in chronological order. Source: X

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After a right-wing news aggregator claimed, incorrectly, that DOGE had blocked a $52 million payment for the World Economic Forum, Mr. Musk replied: “True. You’re welcome.” In reality, ending the program had saved $7.8 million.

Those inaccuracies have not stopped Mr. Musk from recommending the DOGE account to others — he frequently promotes the accounts he follows to his own 219 million followers.

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“Just follow @DOGE for details,” Mr. Musk wrote in February. “There is a firehouse of information.”

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