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Alzheimer’s disease affects about 7 million people in the United States, and that number is projected to exceed 13 million by 2050. Roughly one in nine people over age 65 has the disease.
Dr. Jennifer Pauldurai, an Inova cognitive behavioral neurologist who treats changes in thinking and memory, says recognizing symptoms early can give patients more treatment options and time to make decisions about their future.
Alzheimer’s is a neurodegenerative disease and the most common cause of dementia. It is associated in part with accumulations of abnormally folded proteins known as amyloid plaques. Those plaques, together with inflammation, changes in blood flow and other factors, can disrupt the brain.
Symptoms may include forgetfulness, mood or appetite changes, and declining ability to manage everyday activities. As the disease progresses, patients generally require more assistance.
Dementia describes a loss of brain function severe enough to interfere with essential tasks such as working, eating or managing daily affairs. It can also result from strokes, repetitive head injuries, infections, hydrocephalus and other conditions.
When memory problems warrant attention
Adults over 65 typically receive memory screenings during annual wellness visits with their primary care physicians. However, brief screenings may miss early disease because people can compensate for initial cognitive changes.
An occasional lapse when someone is tired or stressed is not necessarily alarming. Persistent brain fog or memory trouble that makes it difficult to pay bills, take medication or maintain a job deserves further evaluation.
Patients should begin by discussing their concerns with a primary care physician. A neurological assessment may include brain imaging, neuropsychological testing and blood tests to clarify dementia risks.
Early diagnosis can reveal treatable problems contributing to cognitive decline, such as untreated sleep apnea. It also allows patients to adopt targeted medical and lifestyle strategies while they are still minimally affected.
Just as importantly, an early diagnosis gives people an opportunity to decide where they want to live and what assistance they would prefer as the disease advances.
New drugs target amyloid
Two FDA-approved infusion medications, lecanemab and donanemab, are designed to slow Alzheimer’s progression by targeting amyloid and its precursors. Lecanemab was approved in 2023 and donanemab in 2024.
The treatments are intended primarily for people in the disease’s earliest stages. Their intensive programs can require infusions every two or four weeks, regular safety MRI scans and frequent clinical visits for at least a year.
Pauldurai said the medications carry substantial risks, but some patients may decide that the potential to slow the disease makes aggressive treatment worthwhile.
Research continues into amyloid and tau proteins, the mechanisms that make amyloid adhere to brain tissue, and whether glucose control, energy supplements or anti-inflammatory nutrients can limit plaque formation and brain damage. Other studies are examining traumatic brain injury, mood disorders later in life and their possible connections to dementia risk.
Daily habits can support brain health
There is no guaranteed way to prevent Alzheimer’s, but long-term health choices may delay or lessen symptoms of brain disease.
Pauldurai recommends following primary care guidance for diabetes, high blood pressure and cholesterol; getting adequate sleep; and being evaluated for sleep apnea when appropriate. She also encourages balanced nutrition, including the MIND diet, and about 30 minutes of moderate physical activity each day.
Keeping the mind socially and cognitively engaged is also important. Hobbies, community participation and other challenging or inspiring activities can help people avoid a sedentary lifestyle and support overall brain health.
Helping a reluctant loved one
Families concerned about a loved one’s memory may encounter resistance. An evaluation can feel embarrassing or threatening to a person’s independence, so Pauldurai recommends first learning what the person values and finding common ground.
Someone who does not acknowledge forgetfulness may still care deeply about remaining at home. A family could frame an assessment around that goal by suggesting a brain-health evaluation to help the person live safely at home for as long as possible.
Inova connects patients and caregivers with social services, home health care, rehabilitation, education, support groups and care navigation programs such as Medicare GUIDE. Its patient care coordinator helps families identify the next steps in managing the disease. The Alzheimer’s Association also provides local webinars, training and support groups.
Pauldurai encourages families to discuss brain health and future needs before a crisis develops. Earlier education and planning can help patients retain a voice in their care rather than forcing families to make decisions during what she called “chaos mode.”