It is important to establish treatment goals for patients with a probable diagnosis of Alzheimer’s disease. While treatment goals aid in recognizing treatment effectiveness and disease progression, they can also help set the patient up for success by creating routines that minimize failure and maximize the use of retained abilities.

When caring for patients with Alzheimer’s disease, an overarching treatment goal should be to set the patient up for success so that each individual functions with a minimal amount of failure and the maximal use of retained abilities. To maximize these opportunities, we encourage people with Alzheimer’s disease to continue to overlearn and repeat the activities of daily living that give them satisfaction to make it easier for them to cope when their memory is declining. As health care providers, we must be cognizant of the capabilities that patients with Alzheimer’s disease still possess and maximize those opportunities so that they can be successful and happy in their day-to-day activities. Once we suspect that something is wrong, we often tell patients that the fewer transitions they have in their life, the safer they are going to be and the less likely they are to decline.

In addition to setting our patients with Alzheimer’s disease up for success in their daily activities, we also want to maximize their health status as a component of their treatment goals, including making sure that their coexisting conditions, such as diabetes or hypertension, do not get out of hand and that they are getting good sleep. We also want them to remain physically active, because exercise is known to be a key component for a robust body and brain. All these things make a big difference in how the disease progresses. Even just walking makes a difference.

We also want our patients with possible Alzheimer’s disease to start thinking about the future and to make the decisions that they still have the capacity to make—especially with regard to power of attorney. When a person creates their will later in life, an attorney usually brings up the importance of establishing a durable power of attorney or a medical power of attorney. And it is our job as clinicians to point out to patients who have the capacity that they need to decide who is going to make not just the medical decisions but all decisions for them when they cannot.

It can sometimes be difficult for providers who see their patients with Alzheimer’s disease on a longitudinal basis to be aware of when there has been a decline in cognition. For example, when you are seeing someone every 3 months for their diabetes and hypertension, it can be difficult to know if there is also a cognitive change going on. Typically, either the patient or the family has to volunteer that information to you, or you have to objectively look for it.

It is best not to ask the patient qualitative questions (eg, “How have you been doing?”) because they may respond with, “Oh, I’m fine. I’m a little slower than I used to be.” That does not get you the information that you want to be able to assess their cognition. You want a validated objective test, even for screening. The value of psychometric testing goes beyond screening because you can follow the results over time. You can objectively evaluate whether they are normal for their age and education or whether they have lost certain capabilities while retaining others. The Medicare Annual Wellness Visit provides an opportunity for simple longitudinal testing to be done, since one of the objective components of the visit is to check for cognitive impairment.