Case 038: Alzheimer Disease

PATIENT PRESENTATION

Chief Complaint

“Is this new medication for me?”

History of Present Illness

An 80-year-old male patient with moderate Alzheimer Disease presenting with family members inquiring about the use of aducanumab for the treatment of continued cognitive decline.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. Is Mr. Smith on optimal treatment for his Alzheimer’s disease?

   Hint: See Treatment in PPP

2. Are other alternative treatment options a possibility for the patient’s Alzheimer’s disease?

   Hint: See Treatment in PPP

3. Are any of Mr. Smith’s physical exam or ROS findings attributable to his Alzheimer Disease therapy?

   Hint: See Treatment and Table 30-7 in PPP

4. Should Mr. Smith be considered for treatment of any behavioral symptoms?

   Hint: See Treatment in PPP

5. Should aducanumab be considered as a treatment option for Mr. Smith?

   Hint: See references below

FOLLOW-UP

When should Mr. Smith’s donepezil be discontinued?

Hint: See Treatment in PPP

CASE SUMMARY

Global Perspective

Aducanumab was approved for the treatment of Alzheimer's disease in 2021, with initiation in patients with mild cognitive impairment or mild dementia stage of disease. This clarification in population to treat was based upon when the medication was initiated in clinical trials. Currently, there is no safety or efficacy data based on initiating the medication any earlier or during any later stages of Alzheimer's disease. Aducanumab was approved under the accelerated approval through the FDA based on the proposed mechanism of reducing amyloid beta plaques that are observed in patients with aducanumab. The FDA has determined that continued approval for this medication may be contingent upon verification in additional confirmatory trial(s).

Key References