Alzheimer Disease: Real-World Approaches to Patient Care

Alzheimer disease (AD) and related dementias remain among the most prevalent and disabling neurologic conditions worldwide. Although their societal burden continues to grow, recent advances in biomarkers and disease-modifying therapies are transforming our approach to diagnosis and treatment. Biomarkers are improving our ability to make accurate diagnoses, and the advent of amyloid-targeting therapies has expanded treatment options for people with early-stage AD.^1-2

This issue of Practical Neurology highlights several important developments in the field. First, Drs. Hakim and Schulz outline a clinical approach to patients presenting with neurocognitive symptoms. Obtaining a thorough clinical history remains the cornerstone of evaluation. Although general assessment strategies and recommended screening tests are well established, the authors provide practical guidance for recognizing specific symptom patterns and identifying non-AD syndromes that may otherwise be overlooked.

Drs. Hofmann and Schindler review the latest advances in biomarkers, an area that continues to evolve rapidly. When used in the appropriate clinical setting, these tests can increase diagnostic confidence and help guide treatment decisions, including identifying appropriate candidates for amyloid-targeting therapies. As biomarker technologies continue to mature, they may also play an increasingly important role in monitoring treatment response.

Dr. Hart discusses the development of a sustainable amyloid-targeting therapy program, drawing on one institution’s experience. She outlines key considerations for implementation, including operational planning, patient monitoring, management of amyloid-related imaging abnormalities (ARIA), and decisions regarding treatment discontinuation. The article also highlights important lessons learned from an early adopter of these therapies and offers insight into future directions for clinical practice.

Finally, Drs. Hwang and Gandy provide an excellent review of communication strategies for clinicians and caregivers. They emphasize that the diagnosis of AD is “neither discrete nor momentary” but rather a process that unfolds over time. The authors discuss practical tools, including the SPIKES protocol, to help guide difficult conversations and offer valuable recommendations for day-to-day communication with patients and families.

Together, these articles, along with others published previously in Practical Neurology,^3-5 offer both a snapshot of current practice and a roadmap for the future of dementia care. The journey begins with a thoughtful clinical evaluation and appropriate use of ancillary testing, including the evolving role of biomarkers. For selected patients, amyloid-targeting therapies may represent an important treatment option. Throughout this process, we must continue to communicate with clarity, compassion, and respect for patients and their caregivers. Thank you to the authors for sharing their expertise.