Opinion|Videos|April 17, 2025
Diagnosis and Treatment of Alzheimer’s Disease
Author(s)Anitha Rao, MD
David Weisman, MD
David Weisman, MD
Panelists discuss how cognitive testing tools, functional assessments, and biomarker integration guide Alzheimer’s disease diagnosis and staging, while early identification enables timely access to disease-modifying therapies, care coordination, and improved long-term outcomes.
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Summary for Physicians
Cognitive Testing and Functional Correlation in Alzheimer’s Disease
Cognitive impairment is evaluated using a combination of screening tools and comprehensive assessments. Commonly used tests include:
- Mini-Mental State Examination (MMSE): Assesses orientation, memory, language, and attention. Widely used, but less sensitive to early or subtle deficits.
- Montreal Cognitive Assessment (MoCA): More sensitive for detecting mild cognitive impairment, especially executive function and visuospatial deficits.
- Clock Drawing Test & Trail Making Test (A/B): Quick assessments of executive function, attention, and visual-spatial planning.
- Neuropsychological Testing: In-depth evaluation across multiple cognitive domains, particularly useful in ambiguous or early cases.
Clinical Correlation:
- These tools can help stage the disease and track progression.
- Cognitive scores alone do not always fully reflect functional impairment; pairing assessments with instrumental activities of daily living (IADL) scales (e.g., Lawton-Brody) enhances correlation with real-world functioning.
- Disease staging integrates both cognitive performance and impact on daily living.
Role of Amyloid and Tau in MCI and Integration of Disease-Modifying Therapies
Amyloid-beta (Aβ) and tau protein accumulation are core pathological features of Alzheimer’s disease and are now accessible via:
- CSF analysis
- PET imaging (amyloid and tau tracers)
- Blood-based biomarkers (e.g., plasma Aβ42/40 ratios, p-tau), which are emerging as scalable tools for earlier, non-invasive detection.
Disease-Modifying Therapies (DMTs):
- Lecanemab and aducanumab are FDA-approved monoclonal antibodies targeting Aβ plaques, indicated for patients with early symptomatic Alzheimer’s disease (MCI or mild dementia) and confirmed amyloid pathology.
Practice Integration:
- Requires confirmation of amyloid pathology via biomarker testing.
- Patients undergo MRI screening to assess for ARIA risk (amyloid-related imaging abnormalities).
- Implementation involves interdisciplinary discussion, risk-benefit counseling, regular monitoring (e.g., MRIs during therapy), and coordination with infusion services.
- Access remains a challenge due to cost, payer criteria, and infrastructure needs.
Benefits of Early Diagnosis in Alzheimer’s Disease
- Timely Access to Therapies: Disease-modifying therapies are only indicated in early stages; delayed diagnosis may preclude eligibility.
- Patient & Family Planning: Enables informed decision-making around finances, care preferences, and safety.
- Care Coordination: Early involvement of care teams, social support, and community resources improves long-term outcomes.
- Clinical Trials: Early identification increases opportunities for trial participation and access to innovative treatments.
- Cognitive Preservation: Early lifestyle and pharmacologic interventions may help slow functional decline.
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