_______________________________ Alzheimer Disease and Dementias: Early Detection and Care Planning
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]. FUTURE DIRECTION OF TREATMENT AND CARE Emerging treatments and ongoing research offer hope for future dementia care. Current investigations include anti- amyloid and anti-tau therapies, neuroprotective agents, and personalized medicine approaches. Gene therapy and stem cell research are also being explored. Recent advancements, such as lecanemab, show promise in reducing amyloid plaques and potentially slowing cognitive decline [21]. Advancements in early detection and prevention strategies, like blood-based biomarkers and lifestyle interventions, are shaping the future of dementia care. While many treatments are still in development, they represent promising directions for more effective management and potential prevention of dementia [30]. Future dementia care emphasizes a holistic and personalized approach, integrating pharmacological and nonpharmacologi- cal interventions, leveraging technology for remote monitoring, and enhancing caregiver education and support. Advances in precision medicine and biomarker research are expected to enable earlier and more accurate diagnoses, allowing for timely intervention and better disease management. Ongoing research into genetic and environmental factors will likely lead to pre- ventive strategies and more effective treatments, improving outcomes for individuals with dementia and their families [2].
TREATMENT OPTIONS Pharmacological treatments for dementia focus on managing symptoms and slowing disease progression. The main medi- cations include cholinesterase inhibitors (donepezil, rivastig- mine, galantamine) and an N -methyl-D-aspartate (NMDA) receptor antagonist, memantine. Cholinesterase inhibitors increase acetylcholine levels, improving cognitive function and behavioral symptoms in mild-to-moderate Alzheimer dis- ease [2]. Memantine regulates glutamate activity and is used for moderate to severe Alzheimer disease. These medications can improve cognition, mood, and daily functioning but may have side effects. Cholinesterase inhibitors can cause nausea, vomiting, diarrhea, dizziness, and sleep disturbances, while memantine may cause dizziness, headaches, and constipation [10]. Although they do not cure dementia, they can temporarily improve symptoms or slow their worsening [26]. The European Academy of Neurology suggests that the use of a combination of cholinesterase inhibitor (ChEI) plus memantine rather than ChEI alone may provide useful benefits in patients with moderate-to-severe Alzheimer disease. (https://onlinelibrary.wiley.com/doi/full/10.1111/
ene.12707. Last accessed August 21, 2024.) Level of Evidence : Expert Opinion/Consensus Statement
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
CASE STUDY: MANAGING EARLY-STAGE ALZHEIMER DISEASE
INITIAL ASSESSMENT AND DIAGNOSIS Background
Patient A, a 68-year-old retired teacher, has been experienc- ing memory lapses and difficulty with daily tasks over the past year. Her family has noticed that she often forgets recent conversations, misplaces items, and struggles with planning activities. Concerned about her cognitive decline, the patient’s daughter, Ms. S, schedules an appointment with a neurologist specializing in dementia. Initial Assessment During the initial consultation, the physician conducts a thorough medical history review and physical examination. Patient A undergoes cognitive testing using the MMSE and the MoCA. Her MMSE score is 24/30, and her MoCA score is 22/30, indicating mild cognitive impairment. The physi- cian also orders an MRI to rule out other potential causes of cognitive decline.
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MDRI2026
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