Identification and management of Alzheimer’s Disease (AD)

Dementia is common, especially in the aging population. More than 55 million people, around the world live with dementia.

Alzheimer’s Disease (AD) is the most common form of dementia. In the united states, more than 10% of the population, above the age of 75 have AD . This is clearly a huge global healthcare issue, with a significant impact on those, who struggle with it and on our society.
Memory decline is one of the most common signs of AD.

It is also a very common complaint, in the general (and mostly healthy) population.

In the US, as an example, nearly 10% of the population, aged 45 and above experiences subjective memory complaints (SCD). While SCD could be an early sign of AD and while signs of AD pathology are very prevalent in the older population, identifying the AD patients, before full dementia is manifest, is not a simple feat.

Cognition can be assessed by a variety of tools, some could be as simple as performing 3 simple tasks (e.g., the MinCog test), others are more elaborate and are part of a neuropsychiatric assessment. Most of these tests are not very sensitive to early deterioration, are dependent on the level of education of the patient and on the rater, can be expensive and not easily accessible.

Pathology is even more challenging. Cognitive decline can be caused by overall dysfunction, due to a physical or mental decline.  When it comes to neurodegenerative causes, such as AD, the pathology is occurring within the brain, segregated by the blood-brain-barrier, and therefore, very difficult to be identified.

Imaging studies, such as MRI and PET, are available, and are expensive, reader-dependent, and not easily accessible. Cerebrospinal fluid analysis is also possible and is less reader-dependent and expensive but is more invasive and as inaccessible as imaging studies.

Now, new blood tests are emerging, which provide a prediction as to the level of amyloid in the brain – a major, albeit not the only pathological hallmark of AD.

The treatment of AD includes lifestyle changes and treatment of risk factors, such as HTN and diabetes demands. These treatments are difficult to adhere to, but are very important, as AD is a slowly progressive and chronic disease. Once dementia settles in, medications that modulate the chemistry within the brain can offer a short-term symptomatic relief.

New medications, which aim to target the pathological process of AD and slow the progression of the disease, are now becoming available. In fact, 2 of them have already received a conditional approval in the US. These treatments seem to work better, when given before dementia if fully manifest, they are expensive, require facilities such as infusion canters, and come with a significant set of adverse effects, some of which could be life-threatening.