Patient Introduction

Hello, my name is John, and I’m 69 years old. My wife, Anita, has been showing a handful of early signs of dementia, and we’re both pretty worried about it. She sometimes forgets words when she’s talking and loses her train of thought completely. Not all the time, but enough to notice. She sometimes forgets people’s names, even close friends who she sees regularly. She has a busy schedule with volunteering at an elementary school and local library, and the last time we went to our doctor she said her symptoms were likely related to stress. We managed okay for a while, but at a recent outing with friends, Anita forgot one of her friend’s names. She became really frustrated and we ended up leaving. Anita was really embarrassed. We told our doctor, who referred us to a neurologist and a geriatric psychiatrist. I’m here to provide you with a sample of a discussion we recently had with one of Anita’s clinicians on how she’s doing and what steps we’re taking going forward.

Question #1

The test results showed amyloid plaques in your wife’s brain and she’s been diagnosed with early stage Alzheimer’s disease. How do you feel about this diagnosis?

Answer

Question #2

Well, let me start by saying that it’s encouraging to have found this at an early stage. That’s a good thing. And hats off to you for seeing a problem and doing something about it. Not everybody does.

Answer

Question #3

We usually start with things like regular exercise, healthy diet, cognitive training, and maintaining social engagement. These are all important aspects of treatment.

Answer

Question #4

Yes, any treatment plan will focus on her quality of life. We’ll keep asking what we can do to provide benefit and maintain autonomy while slowing progression. Are either of you aware of the medications for early-stage Alzheimer’s disease?

Answer

Question #5

There are several medications to help manage her symptoms. Two new agents – donanemab and lecanemab – were specifically approved recently early stage Alzheimer’s disease to potentially slow disease progression: donanemab and lecanemab.

Answer

Question #6

Yes. I’ll give advice on things that may be a good fit. But the biggest part is understanding what matters most to you and your wife. And I most certainly won’t make Anita take anything she doesn’t want to take.

Answer

Question #7

Well, for one thing, they’re disease-modifying when given at sufficient doses for sufficient durations. This means that they actually remove plaques in the brain in patients with early-stage Alzheimer’s disease, rather than just manage symptoms.

Answer

Question #8

They’re generally very safe. They’re given through IV infusion so sometimes mild infusion reactions occur. There is also something called amyloid-related imaging abnormalities, or ARIA. This is usually asymptomatic and resolves on its own.

Answer

Question #9

Serious symptoms – seizures, for example – are rare. We’d monitor Anita closely with MRIs, especially in the first months. We’ll address any significant issues by pausing the agent and re-evaluating. There are recommendations for safe and appropriate use of these agents.

Answer

This activity is provided by Med Learning Group.
This activity is supported by an educational grant from Lilly.
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Scientific Council

Marc Agronin, MD

Chief Medical Officer
Frank C. and Lynn Scaduto MIND Institute and Behavioral Health
Miami Jewish Health
Miami, FL

Liana G. Apostolova, MD, MSc, FAAN

Associate Dean of Alzheimer’s Disease Research
Indiana University Distinguished Professor
Barbara and Peer Baekgaard Professor of Alzheimer's Disease Research
Professor in Neurology, Radiology, Medical and Molecular Genetics
Indiana University School of Medicine
Department of Neurology
Indianapolis, IN

Alireza Atri, MD, PhD

Chief Medical Officer, Banner Research
Banner Alzheimer’s and Research Institutes
Pheonix, Sun City, and Tucson, AZ
Director, Banner Sun Health Research Institute
Sun City, AZ

Ariel F. Cole, MD, FAAFP

Program Director, AdventHealth Geriatric Fellowship
Winter Park, FL

Brad Dickerson, MD, MMSc, FAAN, FANPA

Professor of Neurology, Harvard Medical School
Director, Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital
Boston, MA

James M. Ellison, MD, MPH

Professor of Psychiatry and Human Behavior
Sidney Kimmel Medical College
Co-Director, Comprehensive Alzheimer’s Center
Vickie & Jack Farber Institute for Neuroscience
Thomas Jefferson University
Philadelphia, PA

Richard M. Dupee, MD, MACP, AGSF

Clinical Professor of Medicine
Tufts University School of Medicine
Clinical professor, Department of Public Health and Community Medicine, Tufts University
Chief, Geriatrics Service, Tufts Medical Center
Senior Physician, Pratt Diagnostic Center
Dean ex officio, Office of International Affairs, Tufts University School of Medicine
Boston, MA

James E. Galvin, MD, MPH

Professor of Neurology
University of Miami Miller School of Medicine
Miami, FL

David S. Geldmacher, MD

Professor and Director
Division of Memory Disorders and Behavioral Neurology
Department of Neurology
Heersink School of Medicine
University of Alabama at Birmingham
Birmingham, AL

George T. Grossberg, MD

Henry & Amelia Nasrallah Endowed Professor
Director of Geriatric Psychiatry
Department of Psychiatry & Behavioral Neuroscience
Saint Louis University School of Medicine
St. Louis, MO

Scott A. Kaiser, MD

CEO, Determined Health
Director of Geriatric Cognitive Health, Pacific Neuroscience Institute
Adjunct Professor, USC Leonard Davis School of Gerontology
Los Angeles, CA

Lynn E. Kassel, PharmD, BCPS

Associate Professor of Pharmacy Practice
Drake University College of Pharmacy & Health Sciences
Des Moines, IA

Diana R. Kerwin, MD, CPI

President, Kerwin Medical Center
Chief, Geriatric Medicine, Texas Health Presbyterian Hospital
Dallas, TX

Alka Khera, MD

Assistant Professor
UT Southwestern Neurology
Dallas, TX

Chi-Ying (Roy) Lin, MD, MPH, FAAN

Director, CurePSP Center of Care for PSP, CBD, and MSA
Assistant Professor of Neurology
Alzheimer's and Parkinson's Disease Centers
Baylor College of Medicine
Houston, TX

Catherine A. Madison, MD

Founding Director Ray Dolby Brain Health Center
San Francisco, CA

Scott McGinnis, MD

Assistant Professor of Neurology, Harvard Medical School
Center for Alzheimer Research and Treatment
Brigham and Women's Hospital
Frontotemporal Disorders Unit
Massachusetts General Hospital
Boston, MA

Kristin S. Meyer, PharmD, BCGP, FASCP

Professor of Pharmacy Practice
Drake University College of Pharmacy and Health Sciences
Des Moines, IA

Manisha Parulekar, MD, FACP, AGSF, CMD

Director, Division of Geriatrics
Co-director, Center for Memory Loss and Brain Health
Hackensack University Medical Center
Hackensack, NJ

Giulio M. Pasinetti, MD, PhD

The Saunders Family Chair and Professor of Neurology
Director of the Center for Molecular Integrative Neuroresilience,
Professor of Psychiatry and Neuroscience
Professor of Geriatrics and Adult Development
Department of Neurology and Friedman Brain Institute
Icahn School of Medicine at Mount Sinai
New York, NY

William D. Rhoades, DO, FACP

Chief Medical Officer
Advocate Good Samaritan Hospital
Downers Grove, IL

Marwan Noel Sabbagh, MD, FAAN, FANA

Moreno Family Chair for Alzheimer’s Research
Vice Chairman for Research and Professor
Department of Neurology
Barrow Neurological Institute
Phoenix, AZ

Paul E. Schulz, MD

Rick McCord Professor of Neurology
Umphrey Family Professor of Neurodegenerative Disorders
Director, Memory Disorders and Dementia Clinic
UTHealth Houston
Houston, TX

Neil Skolnik, MD

Professor of Family and Community Medicine
Sidney Kimmel Medical College
Thomas Jefferson University
Philadelphia, PA

R. Scott Turner, PhD, MD

Professor of Neurology
Director of the Memory Disorders Program
Georgetown University
Washington, DC

Chuck Vega, MD, FAAFP

Health Sciences Clinical Professor
UC Irvine Department of Family Medicine
Director, UCI Program in Medical Education for the Latino Community
University of California Irvine
Irvine, CA

Geoffrey C. Wall, PharmD, FCCP, BCPS

John R. Ellis Distinguished Chair of Pharmacy Practice
Professor of Clinical Sciences
Director, Drake Drug Information Center
Drake University College of Pharmacy and Health Sciences
Internal Medicine Clinical Pharmacist
Iowa Methodist Medical Center
Des Moines, IA

David A. Wolk, MD, FAAN

Professor of Neurology
Director, Penn Alzheimer’s Disease Research Center
University of Pennsylvania
Philadelphia, PA