For the first time in history, FDA-approved therapies can change the underlying biology of Alzheimer's disease.
From early lifestyle interventions to FDA-approved disease-modifying therapies and cutting-edge clinical trials, the treatment landscape for Alzheimer's and dementia is evolving rapidly.
For the first time in history, FDA-approved therapies can change the underlying biology of Alzheimer's disease.
Treatment strategy depends on the type and stage of dementia, individual health factors, and personal goals of care. In many cases, a combination of approaches offers the greatest benefit.
Intervening in at-risk individuals before symptoms appear. As biomarker testing improves, identifying people in preclinical Alzheimer's stages allows treatment to begin when the brain still has maximum capacity to benefit. This is the frontier of modern Alzheimer's care.
Medications and non-pharmacological approaches that manage symptoms — memory, mood, behavior, and function — without altering the underlying disease process. These remain a cornerstone of care at all stages.
A new class of treatments that target the underlying biology of Alzheimer's — removing amyloid plaques or targeting tau. Two FDA-approved drugs now available, with more in the pipeline. Most effective at the earliest stages of disease.
Symptomatic medications improve quality of life and functional ability. They do not slow disease progression but can make a meaningful difference for patients and caregivers.
| Drug Class | Examples | Used For | Mechanism |
|---|---|---|---|
| Cholinesterase Inhibitors | Donepezil (Aricept), Rivastigmine (Exelon), Galantamine (Razadyne) | Mild to moderate Alzheimer's, Lewy body dementia | Boost acetylcholine levels by blocking its breakdown — improves memory and communication between nerve cells |
| NMDA Receptor Antagonists | Memantine (Namenda) | Moderate to severe Alzheimer's | Regulates glutamate activity to protect nerve cells from overstimulation and damage |
| Combination Therapy | Donepezil + Memantine (Namzaric) | Moderate to severe Alzheimer's | Dual mechanism — combines benefits of both drug classes; evidence shows better outcomes than either alone |
| Antidepressants | SSRIs (citalopram, sertraline) | Depression & anxiety in dementia | Modulate serotonin to reduce behavioral and psychological symptoms |
| Antipsychotics (off-label) | Quetiapine, risperidone | Severe agitation, hallucinations | Used cautiously; associated with increased stroke risk in elderly — reserved for when benefits outweigh risks |
For the first time in history, we have FDA-approved medications that change the underlying biology of Alzheimer's disease by targeting and removing amyloid-beta plaques from the brain.
A monoclonal antibody that binds to and removes soluble amyloid-beta protofibrils from the brain. In Phase 3 trials (CLARITY AD), lecanemab slowed clinical decline by approximately 27% in patients with early Alzheimer's.
Who qualifies: Adults with confirmed MCI or mild dementia due to Alzheimer's with biomarker evidence of elevated amyloid. Not appropriate for moderate or severe stages.
Administration: IV infusion every two weeks. Requires amyloid confirmation via PET scan or CSF testing. Regular MRI monitoring for ARIA (brain swelling/bleeding).
Targets and removes amyloid plaques, with a unique dosing protocol that allows discontinuation once plaque clearance is confirmed. The TRAILBLAZER-ALZ 2 trial showed a 35% slowing of progression in those with low-to-medium tau burden.
Who qualifies: Adults with symptomatic early Alzheimer's and biomarker-confirmed amyloid and tau pathology. Tau level may influence expected benefit.
Administration: IV infusion every four weeks. Treatment may end upon amyloid clearance, confirmed by PET. Requires monitoring for ARIA side effects.
The next frontier. While amyloid therapies target one hallmark of Alzheimer's, tau tangles are more closely correlated with neurodegeneration and cognitive decline. Anti-tau immunotherapies, tau aggregation inhibitors, and tau PET imaging biomarkers are all under active investigation.
Combination amyloid + tau therapy ("dual therapy") is a major focus of current research, with the hypothesis that targeting both pathologies simultaneously will yield superior outcomes.
The first disease-modifying Alzheimer's drug to receive FDA approval (2021), aducanumab was discontinued in 2024 when Biogen opted to prioritize production of Leqembi. While it demonstrated amyloid clearance, clinical benefit remained contested. Its approval nonetheless opened the regulatory pathway for lecanemab and donanemab.
Participating in a clinical trial gives patients access to the most advanced therapies before they reach the general market — and contributes to the science that will help future generations.
Targeting cognitively unimpaired adults with APOE-e4 genetic risk. Investigating crenezumab for primary prevention of Alzheimer's in at-risk individuals. Represents the "Treat to Prevent" frontier. Contact ADRD Louisiana to check current enrollment status at Louisiana sites.
A landmark primary prevention trial testing lecanemab in cognitively normal individuals with elevated amyloid levels. Aims to demonstrate whether anti-amyloid therapy can prevent the onset of cognitive symptoms entirely.
Multiple Phase 2 trials combining amyloid-clearing agents with tau-targeting therapies. Louisiana sites may participate — ask your neurologist about referral to academic medical centers with active dementia research programs, including LSUHSC and Tulane.
The official U.S. registry of all clinical trials. Search for "Alzheimer's" and filter by your city or zip code to find studies currently enrolling in Louisiana. ADRD Louisiana can help you understand eligibility criteria and connect with research coordinators.
Maintaining dignity, purpose, and enjoyment of daily life throughout the disease course remains the primary goal of care at every stage.
Caregiver wellbeing directly impacts patient outcomes. Respite care, education, support groups, and counseling are essential components of a comprehensive care plan.
Early-stage diagnosis provides an opportunity to document care preferences, designate healthcare proxies, and plan for future needs while the individual can meaningfully participate.
Most people with dementia prefer to remain in their homes. Safety assessments, home modifications, and in-home support services can extend independence significantly.
Social engagement and community programs — including memory cafés, dementia-friendly activities, and peer support — reduce isolation and slow cognitive decline.
Dementia care involves multiple providers. Effective care navigation — coordinating between primary care, neurology, psychiatry, social work, and community services — is critical and often challenging.