____________________ Alzheimer’s Disease and Dementias: Insights for Early Detection and Care Planning
ALZHEIMER DISEASE STAGE AND FAMILY ISSUES
Disease Stage Issues/Concerns of Family
Steps to Address
Early (Stages 1–3)
Accept and address an uncertain future. Identify potential areas of internal family conflict. Recognize that Alzheimer disease can often unveil past conflict.
Form a cohesive family alliance. Seek professional guidance (elder law attorneys, financial planners, social workers). Identify long-term care needs and desires for the person with Alzheimer disease. Establish an honest, open, and supportive communication method. Acknowledge collective grief and loss as the loved one declines. Family members/caregivers may feel trapped, leading to new or worsened conflicts. There may be a sense of lost freedom due to disease-related limitations. It can be hard to separate the person from the illness, necessitating additional support (e.g., respite care). Managing disease symptoms (wandering, mood swings, sleep changes) can be challenging. Balancing work, caregiving, and personal life may seem impossible as needs increase. Without prior planning, families face tough decisions about living arrangements, finances, and external support. Family members may experience grief, health issues, anger, denial, and exhaustion. Family cohesion may suffer due to concerns about providing safe, proper care (e.g., transferring, feeding, supervision). Long-term planning can ensure the person receives hospice care or allows the family to decide. The person is vulnerable to normal age-related health issues. Family may experience exhaustion and worry about their own well-being and the impact on their children and spouse. Long-term stress and grief can affect family relationships and cohesion, especially without planning. Family members may face physical and mental health challenges requiring additional support and lifestyle changes.
Middle (Stages 4–5)
Caregiving needs become more intense to include financial, home safety, and some life management.
Late (Stages 6–7)
Patient will need full-time support for all activities of daily living. Family members may find themselves dealing with effects of long-term caregiving (e.g., financial and health challenges, inability to work, poor self- care).
Source: [23]
Table 6
In 2021, the FDA granted accelerated approval to aducanumab for the treatment of Alzheimer disease [27]. It is the first new treatment approved for Alzheimer disease since 2003 and is the first therapy that targets the fundamental pathophysiology of the disease. Approval of aducanumab was based on evidence showing a significant reduction of beta amyloid plaque in those receiving the drug (compared with placebo) [27]. Preliminary studies have been conflicting, and the FDA’s decision to grant accelerated approval to aducanumab was controversial. The manufacturer discontinued aducanumab in 2024 [29]. In 2023, the FDA granted accelerated approval to lecanemab for the treatment of Alzheimer disease [21]. Like aducanumab, lecanemab is an anti-amyloid monoclonal antibody, and the presence of amyloid beta pathology should be confirmed prior to treatment initiation. Lecanemab is an intravenous infusion
given every two weeks at an infusion center, but subcutaneous delivery is being studied in trials. Nonpharmacological treatments are essential for managing dementia and improving the quality of life for patients and caregivers. Cognitive therapies, such as cognitive stimulation, reminiscence therapy, and cognitive rehabilitation, enhance cognitive function, communication skills, and overall well- being [12]. These therapies engage patients in activities that stimulate thinking, memory, and social interaction. Lifestyle interventions, including regular physical exercise, social engage- ment, and a healthy diet, show promise in reducing dementia risk and slowing cognitive decline. These interventions are often combined with pharmacological treatments for a com- prehensive care approach [2; 28].
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Book Code: ANCCTX2027
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