Symptomatic Therapy Meets Disease Modification: Mapping the Alzheimer's Treatment Continuum

In this episode, 'Symptomatic Therapy Meets Disease Modification: Mapping the Alzheimer's Treatment Continuum,' the expert neurology and primary care panelists explored the following questions:

Before diving into disease-modifying therapies (DMTs), can you frame the overall treatment landscape for a managed care audience? What do the appropriate use recommendations of Alzheimer's disease (AD) look like today across lifestyle interventions, symptomatic medications, and DMTs?

Where do acetylcholinesterase inhibitors and memantine still fit in 2026, and how do they relate to anti-amyloid therapy — are they complementary or sequential?

The panelists examined the full treatment continuum for Alzheimer's disease. Scott Joy, MD, MBA, FACP, framed vascular risk factor management — blood pressure, cholesterol, and diabetes control — as a foundational layer of care, noting that what benefits the heart also benefits the brain. He explained that cholinesterase inhibitors and memantine, though studied before current biomarker-based diagnostics existed, still show a positive cognitive signal and remain reasonable initial or adjunct therapy, pointing out that up to 60% of patients in major anti-amyloid trials were also on these agents. He also highlighted newer FDA-approved options for the behavioral and psychological symptoms of dementia, underscoring that a comprehensive treatment approach must address the whole patient, not just amyloid pathology.

Throughout the conversation, the experts provided a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

The next episode in this series, 'Anti-Amyloid Therapy in Practice: Comparing Agents and Managing ARIA Safely,' features the panelists advancing their conversation on Alzheimer's disease and focusing on how lecanemab and donanemab compare and what ARIA monitoring requires of health systems and infusion programs.