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October 1, 2021
Aducanumab-avwa (Aduhelm): A Novel Therapy for Mild Alzheimer Disease: Aducanumab is the first anti-amyloid-beta antibody approved for the treatment of Alzheimer disease in adults with mild symptoms. The FDA’s decision to grant accelerated approval of aducanumab in June 2021 has been subject to much scrutiny given concerns with efficacy, cost, and safety. Two phase III randomized, placebo-controlled trials produced conflicting results, with one study showing improvement in cognitive symptoms with aducanumab vs placebo, while the second study showed no such benefits. Approximately 40% of patients in both clinical trials experienced cerebral edema or hemorrhaging. In addition, the list price of $56,000 for a year of therapy may limit its use, given the current uncertainty about clinical efficacy of aducanumab.
Upon completion of the chapter, the reader will be able to:
Describe the epidemiology of Alzheimer disease (AD) and its effects on society.
Describe the pathophysiology, including genetic and environmental factors that may be associated with AD.
Detail the clinical presentation of the typical patient with AD.
Describe the clinical course of the disease and typical patient outcomes.
Explain how nonpharmacologic therapy is combined with pharmacologic therapy for patients with AD.
Recognize and recommend treatment options for disease-specific symptoms as well as behavioral/noncognitive symptoms associated with AD.
Educate patients and/or caregivers about the expected outcomes for patients with AD, and provide contact information for support/advocacy agencies.
Alzheimer disease (AD) is characterized by progressive cognitive decline including memory loss, disorientation, and impaired judgment and learning. Currently, it is diagnosed by exclusion of other potential causes for dementias. There is no single symptom unique to AD; therefore, diagnosis relies on a thorough patient history. The exact pathophysiologic mechanism underlying AD is not entirely known, although certain genetic and environmental factors may be associated with the disease. There is no cure for AD; however, drug treatment can slow symptom progression.
Family members of AD patients can be profoundly affected by the increased dependence of their loved ones as the disease progresses. Advocacy organizations, such as the Alzheimer Association, can provide early education and social support for both the patient and family. The Alzheimer Association has developed a list of common warning signs, which include memory loss, difficulty completing familiar tasks, disorientation, problems with word finding, misplacing things, impaired judgment, social withdrawal, and changes in mood.1
EPIDEMIOLOGY AND ETIOLOGY
AD is the most common type of dementia, affecting an estimated 5.5 million Americans in 2017.2 The majority (5.3 million) are 65 years and older. Various classifications of dementia include dementia of the Alzheimer type, vascular dementia, and dementia due to human immunodeficiency virus (HIV) disease, head trauma, Parkinson disease, Huntington disease, Pick disease, or Creutzfeldt-Jakob ...