Alzheimer’s disease – standard of diagnosis, treatment, care, and prevention

Abstract

Alzheimer’s disease (AD) is the most frequent cause of dementia in people > 60 years. This white paper summarizes the current standards of AD diagnosis, treatment, care, and prevention. Cerebrospinal fluid (CSF) and positron emission tomography (PET) measures of cerebral amyloidosis and tauopathy allow the diagnosis of AD even before dementia (prodromal stage) and provide endpoints for treatments aimed at slowing the AD course. Licensed pharmacologic symptomatic drugs enhance cholinergic pathways and moderate excess of glutamatergic transmission to stabilize cognition. Disease-modifying experimental drugs moderate or remove brain amyloidosis, but so far with modest clinical effects. Nonpharmacological interventions and a healthy lifestyle (diet, socio-affective inclusion, cognitive stimulation, physical exercise, etc.) provide some beneficial effects. Prevention mainly targets modifiable dementia risk factors such as unhealthy lifestyle, cardiovascular-metabolic and sleep-wake cycle abnormalities, and mental disorders. A major challenge for the future is telemonitoring in the real world of those modifiable risk factors.