Management

We utilize both pharmacological and nonpharmacologic interventions to optimally treat and manage the cognitive, behavioral and psychological symptoms of Alzheimer's disease and other types of dementia.

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.

Current medications cannot cure Alzheimer's disease. One FDA-approved treatment addresses its underlying biology; however, Medicare coverage and access to the drug are limited.

Other treatments 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 (Aduhelm™) is the first approved treatment to address the underlying biology of Alzheimer's disease, Medicare coverage of the drug is limited.

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.

• Learn how Alzheimer's drugs work

Managing behavioral symptoms

Behavioral and psychological symptoms of dementia (BPSD), for example, agitation, aggression, depression and psychosis, are associated with 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.

• Physician Topic Sheet: Managing Behavioral and Psychological Symptoms of Dementia (BPSD) (PDF)
• Alzheimer's Association Position Statement on Treatment of BPSD (PDF)

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 allow 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.

Alternative treatments

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 products 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, Dietary Supplements, Cannabis Products  

Future 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 three anti-amyloid drugs for Alzheimer’s: donanemab (Lilly), gantenerumab (Genentech/Roche) 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.

Risk reduction

Epidemiologic studies and some randomized clinical trials show that certain cardiovascular risk factors — such as midlife hypertension, diabetes, midlife obesity, being physically inactive and smoking — as well as poor quality sleep increase the risk for cognitive decline and may increase risk of dementia. Traumatic brain injury can also increase the risk for dementia. Additional studies have found that balanced nutrition and cognitive stimulation may have a positive effect on reducing risk for cognitive decline.

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.

^1. Toot S, Swinson T, et al. "Causes of nursing home placement for older people with dementia: a systematic review and meta-analysis." International Psychogeriatrics. 2017; pp. 195 - 208.