How Does the ReCODE Protocol Compare With Anti-Amyloid Therapy Like Lecanemab?
Last Updated: November 2025
In this FAQ, Dr. Jessica Knape of HealthSpan Internal Medicine in Boulder, CO, explains the key differences between FDA-approved anti-amyloid drugs like Lecanemab and the ReCODE Protocol. She outlines how ReCODE targets the root metabolic, inflammatory, hormonal, vascular, toxic, and genomic drivers of cognitive decline, while medications focus on amyloid removal. As a ReCODE 2.0 Certified Practitioner, she also discusses emerging options like TB006 to help patients choose the safest, most effective path.
As new Alzheimer’s drugs like Lecanemab receive FDA approval, many patients and families are asking how these medications compare with the ReCODE Protocol, a precision-medicine approach designed to identify and treat the root causes of cognitive decline. While both approaches aim to help people with early Alzheimer’s disease, what they do — and what results they offer — are fundamentally different.
The ReCODE Protocol addresses the underlying metabolic, inflammatory, hormonal, vascular, toxic, and genomic drivers of cognitive decline. Anti-amyloid medications like Lecanemab focus on a single target: removing amyloid plaques from the brain. Understanding these distinctions is essential for choosing the safest, most effective path for you or your loved one.
At HealthSpan Internal Medicine in Boulder, Colorado, Dr. Jessica Knape, MD MA is a ReCODE 2.0 Certified Practitioner with more than a decade of experience caring for adults with Alzheimer’s, dementia, and cognitive decline, and over 20 years in the practice of internal medicine. Our clinic offers emerging therapeutics such as TB-006, a promising anti-galectin therapy with a different mechanism of action and a safer, more inclusive clinical profile. This FAQ will help you understand the differences, risks, benefits, costs, and suitability of each option.
Brainspan Takeaway
Lecanemab removes amyloid protein but does not treat the metabolic and inflammatory drivers of Alzheimer’s.
ReCODE identifies and treats root causes, offering stabilization or improvement in many early-stage patients.
Lecanemab may slow decline modestly; it does not reverse cognitive impairment.
Lecanemab carries risks, including ARIA (brain swelling/bleeds) — especially high in APOE4 carriers.
Many patients are excluded from Lecanemab due to MRI findings, anticoagulant use, or safety concerns.
ReCODE is generally safer for patients with metabolic, hormonal, or toxin-related contributors to decline.
TB006 is compassionate use medication, an emerging therapy with fewer exclusion criteria, and early evidence of better tolerability.
Costs differ substantially: infusion therapy vs. precision-medicine evaluation.
Early intervention is essential regardless of approach.
Key Points
ReCODE treats multi-factor drivers; Lecanemab targets only amyloid.
APOE4 carriers have higher rates of Lecanemab-related ARIA events.
TB006 offers a safer monthly infusion strategy which targets Galectin-3
ReCODE + genomics (IntellxxDNA) improves personalization and safety.
ReCODE is appropriate for a broader group of patients than Lecanemab.
Lecanemab has strict eligibility requirements and high monitoring needs.
What Lecanemab Does — and What It Doesn’t Do
Lecanemab’s Mechanism of Action
Lecanemab is a monoclonal antibody that binds to soluble amyloid protofibrils, helping remove them from the brain. Amyloid is believed to contribute to Alzheimer’s, but research increasingly shows it is a downstream effect, not the root cause.
Benefits
Clinical trials show:
A 27% slowing of cognitive decline over 18 months.
Reduced amyloid levels on PET scans.
Some stabilization of daily functioning.
Important:
Slowing decline ≠ improvement.
Patients continue to decline — just more slowly.
Limitations
Does not reverse cognitive impairment
Does not treat metabolic or inflammatory drivers
Works only for early Alzheimer’s with confirmed amyloid
Requires bi-weekly IV infusions and frequent MRIs
High cost and insurance variability
Modest clinical benefit for most patients
Risks of Lecanemab — Including ARIA
The most significant risk is ARIA: Amyloid-Related Imaging Abnormalities, which includes:
ARIA-E: Brain swelling (edema)
ARIA-H: Microhemorrhages (small brain bleeds)
Who is most at risk?
APOE4 carriers — especially homozygous (two copies of APOE4) — have the highest rate of ARIA, sometimes exceeding 30–40% in trials.
Other risks
Headaches
Confusion
Seizures (rare)
Infusion reactions
Worsening symptoms after an ARIA episode
Because of these risks, Lecanemab requires:
Multiple MRIs in the first months
Strict monitoring
Careful exclusion of high-risk individuals
Who Is Excluded From Taking Lecanemab?
Lecanemab has several exclusion criteria, including:
Use of anticoagulants (blood thinners)
History of brain bleeds
More than 4 microhemorrhages on MRI
Significant cardiovascular disease
Uncontrolled hypertension
Severe kidney disease
Autoimmune or inflammatory conditions requiring immunosuppression
Moderate to severe Alzheimer’s disease
Inability to undergo regular MRI monitoring
In other words, a substantial portion of cognitively impaired patients — including many who need help the most — do not qualify.
How the ReCODE Protocol Differs
ReCODE identifies and treats the root causes of cognitive decline
Unlike Lecanemab, which targets one protein, ReCODE addresses the full spectrum of contributors that impair the brain:
Insulin resistance
Chronic inflammation
Hormonal depletion
Nutrient deficiencies
Mitochondrial dysfunction
Gut dysbiosis
Sleep apnea
Vascular problems
Environmental toxins
Chronic infections
Genomic vulnerabilities (APOE, detox genes, inflammatory genes)
Because Alzheimer’s is rarely caused by a single problem, the ReCODE Protocol uses comprehensive diagnostics to create an individualized plan.
Benefits of ReCODE
Many patients see cognitive improvement
Works for all Alzheimer’s subtypes
Addresses metabolic roots, not just symptoms
Can be used preventively
No exclusions for APOE4 carriers
Typically safer than monoclonal therapy
Supported by published studies showing improvement in 84% of early-stage participants
Limitations
Requires lifestyle engagement
Improvements take time
Not designed for late-stage Alzheimer’s
How TB006 Fits Into the Landscape
TB006 is a newer Alzheimer’s therapeutic targeting galectin-3, a molecule involved in inflammation, amyloid aggregation, and neurodegeneration. Unlike Lecanemab, TB006:
Does not rely on amyloid-targeted pathways alone
Has a safer profile in early studies
Shows potential benefit across multiple dementia types
Has fewer exclusion criteria
Does not have the same level of ARIA risk
Appears more suitable for patients with vascular, mixed, toxic, or inflammatory contributors
Once monthly infusion x 3-6 months
Because TB006 targets neuroinflammation and pathological protein interactions more broadly, it may help:
Alzheimer’s
Vascular dementia
Mixed dementia
Toxin-related cognitive impairment
Post-inflammatory cognitive conditions
Dr. Knape is a certified provider of TB006, providing this safe option for compassionate use.
Cost Comparison: ReCODE vs. Lecanemab vs. TB006
Lecanemab
Approx. $26,500/year for the drug
Infusion center fees
Frequent MRI monitoring
Neurology visits
Potential ER costs for ARIA
Requires amyloid confirmation via PET or CSF
Insurance coverage varies widely.
ReCODE Program
Costs typically include:
Advanced labs
Genomic testing (e.g., IntellxxDNA)
Medical visits
Personalized supplements
Lifestyle support
Costs vary by patient needs but are generally far lower than infusion-based therapy over a year.
TB006
Pricing varies by clinical program but is generally:
Less expensive than Lecanemab
Less monitoring-intensive
contact our office to see if you or your loved one may be a candidate
Which Option Is Right for You?
If you want to address root causes: ReCODE
If you qualify and want modest slowing of decline: Lecanemab
If you want a safer, more inclusive emerging treatment: TB006
If you are APOE4-positive: ReCODE or TB006 are typically safer
If your decline is metabolic, inflammatory, or toxic: ReCODE
If you have MRI exclusions or are on blood thinners: ReCODE or TB006
Most importantly, early diagnosis and intervention produce the best outcomes — regardless of treatment path.
When to Seek Urgent Care
Seek immediate medical attention for:
Sudden confusion
Severe headache
Slurred speech
Weakness on one side
Vision changes
Seizures
These symptoms may indicate ARIA, stroke, or another emergency.
Sources
Reversal of Cognitive Decline: A Novel Therapeutic Program, Bredesen DE, 2014
Precision Medicine Approach to Alzheimer’s Disease, Toups K, Bredesen DE et al., 2022
Reversal of Cognitive Decline: 100 Patients, Bredesen DE et al., 2018
TrueBinding, Inc. — Phase 1b/2 Trial + Proof-of-Concept Results
Ready to improve your cognitive health?
Schedule a Discovery Call with Dr. Knape to explore your personalized options — including TB006 access, BrainSpan PreCODE (prevention), BrainSpan ReCODE (reversal), and clinical genomics for deep root-cause clarity.
Medically reviewed by
Dr. Jessica Knape, MD, MA Board Certified in Internal Medicine and Integrative and Holistic Medicine
Healthspan Internal Medicine — serving patients in Boulder, CO
Book a Discovery Call | About Dr. Knape
This content is for educational purposes and does not replace personalized medical advice.
