Alzheimer’s disease (AD) affects numerous aspects of a patient’s life. While treatment for AD often begins with a patient’s primary care physician (PCP), optimal care also incorporates other health care providers, including a neurologist, a psychiatrist, a psychologist, an occupational therapist, and/or others, depending on individual patient needs.

Often, a patient or their loved one may mention to the patient’s PCP that they have been noticing changes in the patient’s memory. It is recommended at that time that the PCP use a simple screening test, such as the Mini-Cog test, to identify cognitive impairment. This instrument can help screen, but it certainly will not pick up on everything. If that screening test indicates some type of issue with the patient’s cognition, then that should prompt a referral to specialized care for more evaluation. It is also not uncommon for a patient’s concern about their memory to prompt an automatic referral to a specialist. While this is not necessarily bad, it can strain the capacity of specialists.

When I first see a patient, I will, at a minimum, perform cognitive testing, obtain a good history, perform a neurologic examination, obtain brain imaging, and order some basic blood tests to look for other causes of or contributions to the patient’s cognitive problems. If a patient does relatively well on the screening test but there are still concerns, I will then perform a more formal evaluation of cognition with neuropsychological testing.

Let us say that a diagnosis of mild dementia due to AD is made. What happens next? That depends on patient preferences, how far a person has progressed within the stage of mild dementia, and other patient issues. Potential treatment with 1 of the new monoclonal antibodies currently requires 1 of the following 2 options to confirm the presence of amyloid in the brain: a lumbar puncture with cerebrospinal fluid (CSF) testing or a positron emission tomography (PET) scan. (There are blood tests that may be US Food and Drug Administration [FDA] approved soon that may take the place of a PET scan or CSF testing.) Treating a patient with a monoclonal antibody is rather involved and takes a lot of monitoring; it requires a treatment team, including nurses, checking in on the patient’s symptoms. Further, patients on monoclonal antibody therapy need regular magnetic resonance imaging scans, especially early on during treatment, and this is done as a team, with a main-treating neurologist and sometimes a psychiatrist overseeing all of that.

We also want to treat other symptoms or issues that come along with AD, including sleep disturbances, and we always address mood. Let us say that a patient is on 2 antidepressants at the maximum doses but they are still having issues and need more specialized expertise. I may refer that patient to a geriatric psychiatrist for some additional help in managing those symptoms. Additionally, we think about patient safety. For example, if there is a concern that driving is an issue for the patient but they still want to continue driving, then we make a referral to an occupational therapist to perform a driving evaluation. Managing vascular risk factors, such as diabetes and blood pressure, is also important.

These are aspects of AD management that I want to work on with the patient’s PCP to make sure that they are addressed fully to promote stability. Again, it takes a team to optimally manage AD, and the members of each treatment team vary, depending on the specific situation and goals of any individual patient and family. It is not up to only specialists or PCPs; it really needs to be a comprehensive team doing the best we can to provide access to all these new diagnostic tools, treatments, and other therapies that continue to become available.