Weighing the Benefits and Risks of Alzheimer’s Treatment

Weighing the Benefits and Risks of Alzheimer’s Treatment

Mild cognitive impairment (MCI) caused by Alzheimer’s disease often goes undetected, with over 90% of individuals unaware of their condition. Detecting MCI early is crucial for better treatment outcomes, as every day counts in slowing down disease progression. However, there are several obstacles to early detection, such as limited capacity for Alzheimer’s specialists and PET scanners, as well as financial concerns for patients.

Medicare Part B, which covers physician-administered drugs, requires patients to pay a 20% co-payment without an upper limit. This can lead to costs of around $5,000 per year for the drug alone. While higher-income individuals can afford supplemental insurance to cover these costs, middle-income individuals often cannot. Low-income individuals eligible for Medicare and Medicaid may have their co-pays covered by Medicaid, but physicians may not accept them due to payment rules. Moreover, the burden of bi-weekly IV administration of the drug falls heavily on caregivers, even for early-stage Alzheimer’s patients.

To address these challenges, cognitive screening should be integrated into routine care. Currently, only a third of older Americans report being assessed for cognitive issues, despite Medicare’s requirement for comprehensive cognitive assessment in annual wellness visits. Increasing the emphasis on cognitive screening can help identify individuals at the highest risk for Alzheimer’s, allowing for early intervention and prevention.

The recent FDA approval of Leqembi, the first drug to slow the progression of Alzheimer’s, has sparked further discussion about the risks versus the potential benefits. The drug carries a boxed warning, highlighting potential side effects such as brain swelling and bleeding, which can be life-threatening. This raises the question of whether the small benefits of the drug outweigh the risks.

Pharmacists also play a critical role in accurately diagnosing cognitive decline. Some reversible causes of cognitive slippage, such as medications with anticholinergic profiles or sedative-hypnotic medications, can contribute to the symptoms. Collaboration between pharmacists and prescribers is essential to identify and deprescribe high-risk medications, leading to more accurate diagnoses.

In conclusion, while the approval of Leqembi offers a potential treatment for Alzheimer’s, weighing the risks and benefits remains crucial. Early detection through cognitive screening and comprehensive diagnosis is necessary to ensure timely and accurate interventions. Collaboration between healthcare professionals, including pharmacists, can contribute to improving diagnosis and treatment outcomes for individuals with cognitive impairments.


1. What is mild cognitive impairment (MCI)?

Mild cognitive impairment refers to a slight decline in cognitive abilities, such as memory or thinking skills, that is noticeable but does not interfere significantly with daily life. It is often an early sign of Alzheimer’s disease or other dementias.

2. What are the challenges to early detection of MCI and Alzheimer’s?

Obstacles to early detection include limited capacity for specialized diagnoses, financial concerns, and the burden of certain treatments requiring frequent administration or caregiver support.

3. What are the risks and benefits of the approved Alzheimer’s drug, Leqembi?

Leqembi carries potential risks of brain swelling and bleeding, leading to seizures and death. The small benefits of the drug must be carefully weighed against these risks.

4. How can pharmacists contribute to accurate diagnosis and treatment?

Pharmacists can collaborate with prescribers to identify and deprescribe high-risk medications that may contribute to cognitive decline. This can help establish a more accurate diagnosis and guide appropriate treatment plans.

5. What is the role of cognitive screening in Alzheimer’s diagnosis?

Cognitive screening plays a vital role in identifying individuals at risk for Alzheimer’s disease. It allows for early intervention and preventive measures to slow down disease progression and improve treatment outcomes.

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