Innovative Approaches to Alzheimer's Care: Early Detection, Multidisciplinary Support and Personalised Medicine
By Arunima Rajan
Healthcare Executive finds promising trends in memory-related care
As weekends roll in, many look forward to spending time with their friends and family, sharing laughter and creating memories. But for caregivers of those with Alzheimer's, like *Tiara, the reality is far different. Every day brings its own sets of challenges-whether it's trying to administer medication or managing emotional outbursts from a loved one who no longer recognises you. While the physical and emotional toll can be overwhelming, there's a deep struggle: the relentless commitment to provide care, even when the person you love slips further away from the life you once shared.
Alzheimer’s Prevalence
Alzheimer's disease, accounting for over 60% of dementia cases, is a neurodegenerative disorder that is alarmingly prevalent. It is a progressive degenerative brain disease that leads to problems with memory, thinking and behaviour.
Symptoms
Symptoms of Alzheimer's include loss of memory, difficulty finding the right words or understanding what people are saying, disorientation about time and place, difficulty performing routine tasks, difficulty recognising faces and surroundings, misplacing objects, problems with language, personality and mood changes. These may appear in different degrees, and it is advisable to consult a physician on noticing any of them. Diagnosis is based on clinical evaluation, laboratory tests and specialised brain imaging. With early detection, patients can benefit from available treatments to maintain their independence for extended periods.
“Alzheimer's is associated with the deposition of abnormal proteins in the brain, brain cell death, and brain shrinkage. Research has shown a loss of connections between nerve cells in the brain that results in messages not being transmitted. The exact causes are the subject of ongoing research,” says Annu Aggarwal, a neurologist at Kokilaben Dhirubhai Ambani Hospital, Mumbai.
Treatment Evolution
"Over the past few years, treatment strategies have evolved from symptomatic relief to targeting the underlying biological processes of the disease. Novel drugs, like anti-amyloid therapies that aim to reduce the accumulation of amyloid plaques in the brain, are showing promise. Two new drugs, Aducanumab and Lecanemab, have been approved recently by the US FDA, which have shown to help reduce disease progression and should be available soon in India too. Kokilaben faces the same challenges as others worldwide in finding strategies to detect Alzheimer's, Parkinson's, and other dementias at an earlier stage. Research has shown that the process of neurodegeneration starts in the brain a decade or more before its first symptoms. As mentioned, research into developing new treatments is already showing promise. Therefore, initiating these treatments before patients face difficulty would be ideal. The Holy Grail is how we identify these patients. KDAH is working with collaborators that include neurologists, geneticists, and basic scientists across the country and in Germany and the USA to identify the genetic basis of neurodegenerative diseases in India and develop new diagnostic tools. Our work and research could possibly help improve the outlook for these diseases in the coming future," adds Aggarwal.
Elder Care Startups:
Several elder care startups are also offering support systems for patients and families of Alzheimer's patients. Reema Nadig, COO and co-founder of LifeBridge Senior Care, highlights the comprehensive support systems offered by KITES Senior Care for families and caregivers. She explains that their memory care clinics provide thorough dementia diagnosis and assessment, helping families understand the progression of the disease. For those with moderate dementia, their daycare programs offer structured activities that give caregivers a break. Residential Care services provide a safe, 24/7 care environment for individuals with advanced dementia. Additionally, their clinical psychologists offer family counselling to help navigate the emotional challenges of caregiving, while their Home Care Services bring expert dementia care directly into patients' homes.
Nadig points out that the eldercare startup integrates several innovative technologies into dementia care, elevating patients' and their caregivers' quality of life. "Some of the key innovations include:
Smart Monitoring Systems: Sensor-based technologies track patient movements, detect falls, and provide real-time alerts, ensuring immediate intervention during emergencies.
Telemedicine and Digital Health Platforms: We utilise telehealth platforms for virtual consultations, regular follow-ups, and ongoing care plan adjustments, minimising the need for travel and reducing stress for elderly patients and their families.
KITES Senior Care’s forward-thinking approach combines advanced technology with personalized care, fostering independence and dignity for individuals with dementia while providing comprehensive support for families and caregivers,” adds Nadig.
45% of Dementia Worldwide is Preventable
"Memory care has progressed tremendously, especially in the last few years. Most significantly, we now have multiple disease course modifying treatments for Alzheimer's Disease with full FDA approval. While we still want even more effective treatments, this is a tremendous step forward. Second, the field of biomarkers is exploding. This means we are developing better tests, looking for abnormal protein markers in spinal fluid or blood that can help us make more accurate diagnoses. And finally, great strides are being made in the field of prevention, with a recent report from the Lancet Commission indicating 45% of dementia worldwide is preventable," says Gregory E. Cooper, M.D., Ph. D., director of the Norton Neuroscience Institute Memory Center.
Early Recognition
Cooper adds that the most pressing issue is generally early recognition of patients when we have the greatest opportunity to help. Unfortunately, many people don't make it to our clinic until their condition has progressed. Another challenge is the limited resources available for family support generally.
What are the key components that make a memory care programme successful in supporting patients and their families? Cooper explains that the most important are strong organisational support and a dedicated social worker to help families navigate these illnesses. "After this, any program requires a good working relationship with ancillary services such as PT, OT and Speech and Language Pathology, as well as the lab and radiology. A positive relationship with primary care is critical. A strong research coordinator is critical to developing a clinical trial program. And we have found that a nurse navigator dedicated to day-to-day communication with patients is critical to developing a thriving anti-amyloid therapy program," he adds.
Interdisciplinary approach is Key
"The best care is provided in a multidisciplinary way. This can be managed in a multidisciplinary clinic with a pharmacy, rehabilitation services and a social worker on-site. However, I feel the entire program needs to be multidisciplinary outside the hours of any individual clinic. Therefore, it is important to have formal and informal ties between different departments and specialists, with regularly scheduled meetings or touchpoints and continuously open communication in between," adds Cooper.
Prevention Clinic
He continues: “There are two very exciting areas of research. First, in terms of prevention, I believe we will continue refining effective strategies, which is ideal for realising significant reductions in our risk of dementia. As stated above, experts now believe that 45% of dementia is preventable. We are developing our own prevention clinic, and I expect these to become much more commonplace over time. Second, I believe we will develop additional treatment strategies that will complement anti-amyloid therapies already available. They will allow us to slow the symptoms of Alzheimer's Disease further. Further, I believe that we will increasingly employ these medications earlier in the course of disease, potentially with much greater benefit.”
Leveraging interdisciplinary collaboration to develop and implement innovative treatment strategies for Alzheimer's disease
William T. Hu, Chief of the Division of Cognitive Neurology at Rutgers Robert Wood Johnson Medical School and Robert Wood Johnson University Hospital seconds his views.
"We have genetic counsellors to collaborate on evaluating and treating people with memory and thinking disorders. Our Cognitive Neurologists have a deep scientific and clinical understanding of different brain diseases (Alzheimer's disease, Lewy body disease, frontotemporal degeneration), while Neuropsychologists provide diverse approaches to assess how the brain is functioning. Additionally, our dementia-focused Geriatricians have a broad background in the health and care of older adults, especially when it comes to other common conditions of ageing, such as heart disease and cancer. We discuss cases and exchange ideas (e.g., determining whether a patient is appropriate for anti-amyloid therapies) to influence how each serves our patients," says Hu.
Novel research initiatives
"We combine expertise from Cognitive Neurologists (neurologists specialising in mild cognitive impairment, Alzheimer's disease, and other dementia), Neuropsychologists, Geriatricians, and Nurse Practitioners. We have been leading the region in using minimally invasive spinal fluid tests to provide early and highly accurate confirmation of changes related to Alzheimer's disease and Lewy body disease. We have also provided drugs to reduce Alzheimer 's-related plaques in the brain since 2021. We have significant strengths in researching these diseases to help advance our knowledge while caring for our patients. For example, we have several NIH-funded studies to explore more recently discovered disease mechanisms in Alzheimer's, focusing on inflammation and Social Determinants of Health. We are especially invested in multicultural brain health, including clinical and research programs for Chinese and South Asian older adults in the US. Our NIH designation has recognised this as the only Resource Center for Alzheimer's and Dementia Research in Asian and Pacific Americans nationwide," adds Hu.
Collaboration is Key
Bruce Albala, an adjunct professor at UC Irvine Joe C. Wen School of Population & Public Health, holds a dual appointment in the Department of Neurology at UC Irvine School of Medicine. Dr. Albala emphasises the need for collaboration between academic institutions and the private sector to advance Alzheimer's disease (AD) research. "Progress in understanding and treating Alzheimer's relies on partnerships that can design, test, and bring new treatments to market," Albala says.
He explains that academic centres conduct much of the foundational research on AD, such as identifying biological markers and diagnostic criteria. However, pharmaceutical companies are critical in developing and testing drug candidates in large-scale clinical trials.
One successful example of this collaboration is the Alzheimer's Disease Neuroimaging Initiative (ADNI), now in its 20th year. Led by Michael Weiner, MD, ADNI has been tracking participants with memory concerns across the US and Canada, collecting data to understand better the biological factors that predict cognitive decline. This data, made available to researchers, including those in the pharmaceutical industry, has been vital in designing clinical studies for potential treatments.
Albala believes that more partnerships like ADNI are essential to finding effective strategies and treatments for Alzheimer's.
Music and Dance Therapy
Vinit Banga, Director & Head—of Neurology & Neurovascular Intervention at Fortis Escorts Hospital Faridabad, says: "Apart from conventional medical management, we do non-pharmacological management of patients with Alzheimer's disease in the form of music and dance therapy and cognitive behaviour therapy, which aims to provide the patient with holistic care."
He adds, "We use digital tools such as GPS-enabled devices and smartwatches to track patients because they tend to forget directions. We use frequent alarms with devices to remind the patient of food, bladder, and bowel habits. We are exploring the role of mental stimulation and cognitive behaviour therapy, along with the role of compassion, family, yoga, dance therapy, and music on the progression of Alzheimer's disease."
We design comprehensive programs with individualised activities Depending on the patient's history, comorbidities, family structure, likes & dislikes. We provide caregivers psychology counselling as most of these are burdened with the ongoing care of Alzheimer's patients. We also ensure they don't neglect their physical and mental health while caring for patients. We provide them with time-to-time updates and hold detailed discussions regarding the patient's progress along with short- and long-term outcomes. We have also made social support groups for patients to cater to their needs," he concludes.