ALZHEILMER'S TREAMENT OPTIONS

Treatments Can Improve Symptoms, Support Daily Function, and May Slow the Progression of Alzheimer’s Disease

Dr. Peters develops a treatment plan based on the stage of disease, symptoms, medical history, test results, and the patient’s goals.
For selected patients with early symptomatic Alzheimer’s disease, newer disease-modifying therapies may also be an option.

How Is Alzheimer’s Disease Treated?

Occasional forgetfulness can be a normal part of aging. More persistent changes in memory or thinking—especially changes that worsen over time or begin to affect everyday life—deserve medical evaluation. Because people may not always recognize changes in themselves; observations from a spouse, family member, or someone else who knows them well can be important.

Medications for Memory and Thinking

Several medications can help support memory, thinking, and day-to-day function in some people with Alzheimer’s disease.
Cholinesterase inhibitors, including donepezil, rivastigmine, and galantamine, are commonly used in mild to moderate Alzheimer’s dementia and may also be continued in later stages. Memantine works differently and is generally used in moderate to severe Alzheimer’s dementia, sometimes together with a cholinesterase inhibitor.
These medications may help with symptoms, but they do not stop or reverse the underlying disease.

Managing Mood, Sleep, and Behavior

Alzheimer’s disease can also affect mood, sleep, anxiety, behavior, and emotional well-being. These symptoms can have a substantial effect on both the patient and care partner.
Treatment may include changes in routine or environment, treatment of contributing medical problems, counseling or other supportive measures, and medication when appropriate.

Treating Other Conditions That Affect Brain Health

Other health problems can worsen memory, thinking, or daily function. Dr. Peters considers factors such as sleep problems, medication side effects, hearing loss, depression, and vascular risk factors such as high blood pressure, diabetes, and high cholesterol.
Addressing these issues does not treat Alzheimer’s disease itself, but it can help protect overall brain health and reduce avoidable contributors to cognitive decline.

Support for Daily Function and Safety

Treatment also includes practical measures that help patients remain as independent and safe as possible. Depending on the individual, this may include support with medications and appointments, exercise and activity, routines, home safety, driving, advance planning, and care-partner education.
These needs may change over time as the disease progresses.

Disease-Modifying Anti-Amyloid Treatment

For selected patients with early symptomatic Alzheimer’s disease, newer treatments can target amyloid, one of the biological features of the disease.
Leqembi and Kisunla are anti-amyloid therapies designed to slow disease progression. They do not cure Alzheimer’s disease or restore abilities that have already been lost, and they are not appropriate for every patient.
The decision to use one of these treatments depends on the stage of disease, confirmation of Alzheimer’s-related amyloid, medical history, MRI findings, safety considerations, and the patient’s goals and preferences.

When Is Anti-Amyloid Treatment an Option?

Anti-amyloid treatment is intended for selected patients with early symptomatic Alzheimer’s disease. Determining whether treatment is appropriate requires more than an Alzheimer’s diagnosis alone.

Stage of Alzheimer’s Disease

Current anti-amyloid treatments are used in the earliest symptomatic stages of Alzheimer’s disease. This includes some patients with mild cognitive impairment due to Alzheimer’s disease and some patients with mild Alzheimer’s dementia.
A person does not need to have dementia to be considered for treatment.

Is Treatment Right for You?

Meeting the basic criteria for anti-amyloid treatment does not mean that treatment is automatically recommended.
Dr. Peters considers the potential benefit of slowing disease progression alongside the risks, MRI monitoring requirements, infusion schedule, overall treatment burden, and the patient’s goals and preferences. The final decision is individualized and made after a careful discussion of the expected benefits, risks, and alternatives.

Anti-Amyloid Treatments: Leqembi and Kisunla

Leqembi and Kisunla are both anti-amyloid treatments for early symptomatic Alzheimer’s disease, but they differ in how they are given, how often treatment occurs, and how treatment may continue over time. The choice between them depends on the individual patient’s clinical situation, treatment goals, safety considerations, and preferences.

Patients receiving Leqembi or Kisunla need several MRI scans early in treatment to watch for treatment-related brain swelling or bleeding. With Leqembi, MRI scans are required before treatment and again after 1, 2, 3, and 6 months of treatment. With Kisunla, MRI scans are required before treatment and again before the 2nd, 3rd, 4th, and 7th infusions. Additional MRI scans may be needed if symptoms or other concerns arise.
These differences can affect convenience and treatment planning, but they do not necessarily mean one treatment is better than the other. Dr. Peters considers the available evidence, individual safety risks, treatment requirements, and patient preferences when discussing which option may be most appropriate.

What Are the Potential Benefits?

Anti-amyloid treatments can slow the progression of early Alzheimer’s disease in appropriately selected patients. In clinical studies, patients who received treatment declined more slowly in memory, thinking, and everyday function than patients who did not receive the medication.
The benefit is generally modest. These treatments do not stop Alzheimer’s disease, cure it, or restore memory or abilities that have already been lost. Instead, the goal is to preserve cognitive and functional abilities for longer by slowing the rate of decline.
Because Alzheimer’s disease progresses differently from person to person, it is not possible to predict exactly how much an individual patient will benefit. The potential benefit must therefore be considered alongside the risks, treatment requirements, and the patient’s goals.

What Are the Risks?

The most important risks of anti-amyloid treatment are brain swelling and small areas of bleeding in or around the brain, known as amyloid-related imaging abnormalities (ARIA). These changes are often found on MRI before they cause symptoms, which is why regular MRI monitoring is required during treatment.
Some patients do develop symptoms, such as headache, confusion, dizziness, vision changes, nausea, or problems with balance. More serious complications can occur, although they are less common.
The risk is not the same for everyone. It can be affected by factors such as MRI findings, other medical conditions, medications that increase bleeding risk, and APOE genetic status. Infusion-related reactions and other side effects can also occur.
Before treatment begins, Dr. Peters reviews these risks with each patient and considers whether the potential benefit of treatment outweighs the individual safety concerns.

What Testing Is Needed Before Anti-Amyloid Treatment?

Before anti-amyloid treatment can begin, Dr. Peters must confirm both that the treatment is appropriate and that it can be given safely. This usually requires more than a diagnosis of Alzheimer’s disease alone.
Some of this testing helps confirm that Alzheimer’s disease is the cause of the cognitive changes. This may include a recent cognitive assessment and biomarker testing to show that amyloid is present. Depending on the situation, amyloid confirmation may come from amyloid PET imaging, cerebrospinal fluid testing, or another appropriate biomarker approach.
Other testing helps determine whether treatment can be given safely. A brain MRI is especially important because it can show findings that may affect treatment risk or the ability to proceed. Routine laboratory testing, a review of current medications, and a review of medical history also help identify factors that may increase risk or require closer attention.
APOE genetic testing is also required before treatment. This testing does not diagnose Alzheimer’s disease, but it helps estimate the risk of treatment-related brain swelling or bleeding.
Not every patient will need the exact same combination of testing. Some studies may already have been completed during the diagnostic evaluation, while others may need to be updated or added before treatment begins. Dr. Peters reviews what has already been done and determines what else is needed before moving forward.

Deciding Whether Treatment Is Right for You

Being eligible for anti-amyloid treatment does not mean you have to receive it.
Dr. Peters reviews the expected benefits, risks, treatment requirements, and alternatives with each patient and care partner. He also considers the patient’s goals, preferences, medical history, and willingness to follow the required infusion and MRI monitoring schedule.
The decision is individualized. The goal is to determine whether the potential benefit of treatment is meaningful enough to justify the risks and demands of therapy for that particular patient.

What If Anti-Amyloid Treatment Is Not Right For You?

Anti-amyloid treatment is not appropriate for every person with Alzheimer’s disease. Some patients may be outside the stage of disease for which these treatments are used, have medical or MRI findings that increase risk, or decide that the potential benefits do not outweigh the risks and treatment requirements.
That does not mean there is nothing more to do. Treatment can still focus on medications that support memory and thinking, management of other conditions that may affect cognition, support for mood or behavior, safety and independence, and ongoing neurologic care.
Dr. Peters works with each patient and care partner to develop a plan that reflects the diagnosis, stage of disease, symptoms, medical needs, and personal goals.

What If Anti-Amyloid Treatment Is Not Right For You?

If you decide to move forward with anti-amyloid treatment, the next step is to prepare for therapy, complete the required testing, coordinate infusions and MRI monitoring, and establish the follow-up plan.

See Your Treatment Journey

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