Distinguishing and Managing Early-Stage Alzheimer’s Disease (AD): Leveraging Interdisciplinary Collaboration for Prompt Identification and Optimal Patient Management
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A 67-year-old woman presents with up to 7 years of memory complaints. She asks repetitive questions about plans, is nervous while driving, and is very worried and anxious about her memory as her mother developed dementia in her late 60’s. She has struggled with worsening depression and sleep difficulty over the past 3 years. MMSE = 26/30 (missed two orientation and two memory recall questions); she can encode and recall 4/5 elements of an address; and has good knowledge of current and personal events, with a few inaccuracies and forgetfulness with details and timing. All else, including activities of daily living, is unremarkable. How would you diagnose this patient?
Severe dementia
Moderate dementia
Mild dementia
Mild cognitive impairment
Choosing initial treatment for mild cognitive impairment or Alzheimer’s disease, and continuing or altering subsequent treatment should always include which of the following?
Outlining that Alzheimer’s disease is ultimately a curable disease
Focusing on memory alone as the primary target of treatment
Continuing the same treatment regimen when there’s major breakthrough activity
Making shared decisions together with the patient to help maximize patient engagement and adherence
Which of the following is true regarding multidisciplinary care for patients with Alzheimer’s disease?
Comprehensive treatment of Alzheimer’s disease includes primary care, neurology, geriatrics, neuropsychology, palliative care, and several other caregivers
The responsibility of leading the care team and coordinating treatment for Alzheimer’s disease should rest almost exclusively on primary care clinicians
While PCPs should exercise shared decision-making with patients, specialists should dictate to patients what treatments they should take
Generally, in a patient with Alzheimer’s disease, cardiovascular health is not a factor in overall treatment goals
A 77-year-old man was diagnosed with MCI 5 years ago and has progressed to mild dementia likely due to AD. He asks if there are treatment options that may help delay future cognitive decline, specifically bringing up disease-modifying therapy. You discuss the potential future use of amyloid-targeting treatments, which the patient is interested in pursuing. Which of the following points are important to make when considering disease-modifying therapy for this patient?
Agents from this class would not be appropriate given this patient’s previous diagnosis of MCI
Interval monitoring with brain MRI is not needed with anti-amyloid therapy
There are currently two available FDA-approved agents that may be appropriate – lecanemab and donanemab
There are currently no FDA-approved agents that target amyloid – he would have to enter a clinical trial
Which of the following would most frequently fall under the care of a neurologist or subspecialist, while the others could readily be conducted by primary care clinicians?
Recognizing signs, symptoms, and clinical patterns of AD and related disorders
Using Tier-1 studies including labs and structural imaging to assess for contributing conditions and potential causes (etiology)
Cognitive, behavioral, functional, and sensorimotor assessments
Managing patient and caregiver expectations and addressing fears
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