Both nonpharmacologic and pharmacologic interventions are needed to optimally treat the cognitive, behavioral and psychological symptoms of Alzheimer's disease.
Telementoring for health care teams
The Alzheimer’s Association is committed to improving dementia diagnosis and access to care. Project ECHO is a free telementoring program that promotes that goal by connecting dementia experts with health care teams for training.
Key elements of a strategy to maximize dementia outcomes include regular monitoring of patient's health and cognition, education and support to patients and their families, initiation of pharmacologic and nonpharmacologic treatments as appropriate, and evaluation of patient/family motivation to volunteer for a clinical trial.
Although current medications cannot cure Alzheimer's disease, one treatment addresses its underlying biology, which the FDA has determined is reasonably likely to predict important benefits to patients.
Others may help lessen symptoms, with the following treatment goals:
- maintain quality of life
- maximize function in daily activities
- enhance cognition, mood and behavior
- foster a safe environment
- promote social engagement, as appropriate
Treating cognitive symptoms
While aducanumab is the first approved treatment to address the underlying biology of Alzheimer's disease, not all patients will be candidates for the treatment.
There are five additional FDA-approved Alzheimer's drugs that treat the symptoms of Alzheimer's disease and can temporarily slow the worsening of symptoms and improve quality of life for those with Alzheimer's and their caregivers.
Proven models for management
The Association strives to connect clinicians to effective evidence-based models of care that can be easily replicated. Explore the case studies that are paving the way for improved dementia care.
Managing behavioral symptoms
Behavioral and psychological symptoms of dementia (BPSD), especially agitation, aggression, depression and psychosis, are the leading causes for assisted living or nursing facility placement.1 Early recognition and treatment can reduce the costs of caring for these patients and improve the quality of life of the patient and caregiver.
Monitoring Alzheimer's disease
After a diagnosis of Alzheimer's disease is made and a treatment plan implemented, patients should return for evaluation on a regular basis. Both cognitive and behavioral symptoms of dementia tend to change as the disease progresses, so regular visits allows adaptation of treatment strategies to current needs. Patients with dementia may not be a reliable resource for history-taking, so encourage a family member, friend or caregiver to accompany the patient to all visits.
Nonmedical issues patients need to address
Your patients and their families may be using or have questions about alternative treatments, “prevention” food and vitamins, or “memory/brain booster” supplements.
There are legitimate concerns about using these drugs as an alternative or in addition to physician-prescribed therapy. Effectiveness and safety are unknown, purity is unknown, adverse reactions are not routinely monitored, and dietary supplements can have serious interactions with prescribed medications.
Learn more: Alternative Treatments
Over the past 25 years, researchers have learned a lot about the pathology of Alzheimer's. Aducanumab, granted accelerated FDA-approval in June 2021, is a new type of treatment that addresses the disease in a way that has never been done before, compared with other currently approved drugs.
The FDA has also granted “Breakthrough Therapy” designation to two anti-amyloid drugs for Alzheimer’s: donanemab (Lilly) and lecanemab (Biogen/Eisai). This action is meant to speed the development and review of drugs that are intended to treat a serious condition. It acknowledges that preliminary evidence indicates the drug “may demonstrate substantial improvement over available therapy.” Though these additional drugs are not yet approved by the FDA, this designation underscores the scientific validity of pursuing this treatment pathway.
At the same time, the Alzheimer’s Association supports the advancement of research that addresses the disease through multiple different pathways with an eye toward effective combination therapies that work at different stages of the disease.
There is no definitive evidence, but risk factors identified in epidemiologic studies and randomized clinical trials show that cardiovascular risk factors, such as hypertension, hypercholesterolemia and smoking, increase the risk for cognitive decline. Other studies have found that remaining physically active and socially and intellectually engaged can have a positive impact on cognition.
Learn more: Prevention
Importance of the caregiver – your care partner
Most patients with Alzheimer's disease have a primary caregiver — often a family member — who is crucial to ensuring appropriate care for your patient with dementia. Caregivers often strive to meet all of the health and personal needs of the person with dementia, but they often neglect their own. Many caregivers report high levels of stress, which can contribute to illness. Nearly 40 percent suffer from depression. Physicians and other health care professionals can help by looking for signs of caregiver burnout, treating medical problems and referring them to support services, such as the Alzheimer's Association's 24/7 Helpline (800.272.3900). Our Alzheimer's caregiving information offers guidance on how to maintain physical and mental health in the midst of caregiving, as well as advice on how to manage their loved one's daily care, enhance their daily life, and respond to behaviors.
Help and support for your patients
- 24/7 Helpline 800.272.3900: We can help your patients and their caregivers with questions and local support resources.
- Find a support group: Patients with Alzheimer's or another dementia and caregivers can find support and get advice at a local Alzheimer's Association support group. Our message boards are also a good place to find advice and support..
- Alzheimer's Navigator: Free online tool designed specifically for individuals with Alzheimer's disease and their caregivers, helping them create customized action plans and providing access to information, support and local resources.
1. Yaffe K, Fox P, Newcomer R, et al. "Patient and Caregiver Characteristics and Nursing Home Placement in Patients with Dementia." JAMA. 2002;287(16):2090–2097.