Front Line Assessment, Diagnosis, and Referral for Alzheimer Disease - Episode 8
Treatment Options and Disease-Modifying Therapies in Alzheimer Disease
Panelists discuss how current Alzheimer treatments combine pharmacologic options like cholinesterase inhibitors, NMDA antagonists, and recently approved monoclonal antibodies with nonpharmacologic strategies such as lifestyle modifications, cognitive engagement, and managing comorbidities, all aiming to preserve quality of life, delay progression, and harness new therapies that are transforming the outlook for early diagnosis and proactive management.
Current treatment options for Alzheimer disease encompass both pharmacologic and nonpharmacologic strategies. Medications include cholinesterase inhibitors, such as donepezil and rivastigmine, which boost brain acetylcholine levels to enhance nerve communication. Another class involves NMDA receptor antagonists like memantine, which modulate glutamate activity to protect neurons. Recently approved monoclonal antibodies, such as donanemab and lecanemab, target amyloid plaques directly, offering disease-modifying potential with intravenous infusions every 2 weeks or monthly. Besides these, emerging therapies like metformin, antivirals, and blood pressure control medications are being explored for their neuroprotective effects, aiming to modulate disease progression.
In addition to medications, a holistic approach emphasizes lifestyle modifications and supportive therapies. Physical activity, cognitive exercises, and social engagement help maintain neural networks and functional independence. Optimizing sleep—using new classes like orexin inhibitors—can reduce plaque accumulation and improve memory consolidation. Managing comorbidities, including hearing loss and depression, also plays a vital role in delaying cognitive decline. These nondrug interventions, combined with medical treatments, aim to preserve quality of life, delay institutionalization, and enhance overall brain health.
The advent of disease-modifying therapies, especially monoclonal antibodies, has reinvigorated the outlook on Alzheimer management. While their approval has not drastically changed diagnostic thresholds, it provides clinicians with new tools to offer hope and early intervention opportunities. Physicians now feel more empowered to detect the disease sooner and initiate treatments that can slow or potentially prevent progression. Ongoing research, supported by advances like artificial intelligence–driven drug discovery, promises even more effective and less invasive options in the future, such as subcutaneous injections administered at home. These developments mark a transformative era in the fight against Alzheimer, making early detection and proactive management more critical than ever.
