Understanding treatment pathways for Alzheimer’s Disease

In the realm of neurological disorders, Alzheimer’s Disease (AD) stands as one of the most challenging and devastating conditions of our time. With its progressive nature and profound impact on memory, cognition, and daily functioning, AD poses significant hurdles for both patients and their loved ones. As the global population ages, the prevalence of this disease continues to rise, further emphasizing the pressing need for effective treatment pathways.

This blog looks at all the factors that must be considered when determining a treatment pathway for patients, as well as the drugs used to treat those with AD.

Alzheimer’s Disease (AD) is diagnosed as a set of clinical features, such as cognitive dysfunction, behavioral alterations, and functional decline. But it is also viewed as a continuum of states, spanning from normal cognition to advanced and severe dementia.

Treating individuals with AD is a multi-disciplinary endeavor as it should consider the disease state of the patient which is governed by multiple factors:


  • Where the patient is on the AD continuum
  • What issues are driving most of the burden
  • Goals of the treatment
  • Co-morbidities
  • Concomitant medications
  • Lifestyle
  • Environment

So when making decisions about AD treatment, there are several important factors to be considered – is there sufficient support for the patient and caregiver, are there any adjustments for the environment needed including where they live, and who can support them during the treatment , are there any changes needed to the patient’s lifestyle, as well as addressing risk-factors of the treatment and providing AD-specific medications.


Current drugs used to treat AD

AD-specific medications include drugs which target brain neurotransmitter imbalance – these include choline esterase inhibitors (ChEi) and NMDA-receptor antagonists used both individually and in combination and are approved for the treatment of patients with established dementia.

In the past two years, the FDA has granted an approval, under an accelerated process, for two medications, which are based on antibodies to beta-amyloid, which is a toxic substance that accumulates in the brain of patients with AD. These treatments have received approval under an accelerated process.
These drugs were tested in large studies and initial analysis showed that patients that were on treatment deteriorated less than those on placebo. But these treatments are associated with amyloid-related imaging abnormalities (ARIA) in the form of brain edema and hemorrhage, and in rare cases, an increased risk of mortality.

On July 6, one of these medications, lecanemab (Lequembi) has received final approval from the FDA for the treatment of patients with mild cognitive impairment (MCI) and mild dementia. But before administration, patients should be tested for their ApoE status as the subtype ApoE4 is linked to a higher risk of ARIA. In addition, administration of lecanemab to patients who are receiving anticoagulation is also associated with an increased risk for ARIA in the form of brain hemorrhage
. Data from a large clinical trial with another medication of the same class, is very promising, with the expectation that it will also be approved soon.

Navigating the treatment plans for AD

Despite ongoing research efforts, a definitive cure for AD remains elusive. However, there is a growing body of knowledge surrounding various treatment modalities and strategies that can help manage symptoms, slow down disease progression, and enhance the quality of life for individuals living with AD. Understanding these treatment pathways is crucial for patients, caregivers, and healthcare professionals alike, enabling them to make informed decisions and provide the best possible care.


[1] Aisen PS, Cummings J, Jack CR Jr, Morris JC, Sperling R, Frölich L, Jones RW, Dowsett SA, Matthews BR, Raskin J, Scheltens P, Dubois B. On the path to 2025: understanding the Alzheimer’s disease continuum. Alzheimers Res Ther. 2017 Aug 9;9(1):60. doi: 10.1186/s13195-017-0283-5. PMID: 28793924; PMCID: PMC5549378.

[1] Jack CR Jr, Bennett DA, Blennow K, Carrillo MC, Dunn B, Haeberlein SB, Holtzman DM, Jagust W, Jessen F, Karlawish J, Liu E, Molinuevo JL, Montine T, Phelps C, Rankin KP, Rowe CC, Scheltens P, Siemers E, Snyder HM, Sperling R; Contributors. NIA-AA Research Framework: Toward a biological definition of Alzheimer’s disease. Alzheimers Dement. 2018 Apr;14(4):535-562. doi: 10.1016/j.jalz.2018.02.018. PMID: 29653606; PMCID: PMC5958625

[1] Atri A. The Alzheimer’s Disease Clinical Spectrum: Diagnosis and Management. Med Clin North Am. 2019 Mar;103(2):263-293. doi: 10.1016/j.mcna.2018.10.009. PMID: 30704681.

[1] https://www.fda.gov/news-events/press-announcements/fda-converts-novel-alzheimers-disease-treatment-traditional-approval