Opinion
Video
Diagnosis and Treatment of Alzheimer’s Disease
Author(s):
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.
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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