The Differential Diagnosis and Treatment of Mild Cognitive Impairment and Alzheimer Disease

Abstract

Identifying patients at risk for developing mild cognitive impairment (MCI) and Alzheimer disease (AD) remains challenging in clinical practice, even as scientific understanding of dementia advances generally. That said, successfully navigating the associated differential diagnosis in AD is essential, as various causes of cognitive impairment require different treatment strategies. In recent years, the armamentarium in AD has expanded with regulatory approval of a disease-modifying therapy—aducanumab—and may be shifting away from symptomatic treatments such as cholinesterase inhibitors and memantine. Concurrently, the role of biomarkers in AD is increasing, and these entities may soon play a greater role in determining patient eligibility for prophylactic interventions and the likelihood of disease progression. As the standard of care progresses, clinicians should educate patients and their care providers on the implications of these advances and reinforce lifestyle changes that can delay or prevent the onset of disease in those at risk of AD. In doing so, care providers can deliver the best care possible.