Dementia, including Alzheimer disease, is a significant and growing concern globally, particularly among the elderly population. According to the World Health Organization (WHO), more than 55 million people worldwide are living with dementia, and this number is expected to rise to 88 million by 2030 and 139 million by 2050 [1]. Alzheimer disease is the most common form of dementia, accounting for 60% to 70% of cases. In the United States alone, the Alzheimer's Association reports that more than 6 million Americans older than 65 years of age are living with Alzheimer disease, a number projected to reach nearly 13 million by 2050 [2,3]. This condition not only leads to a progressive decline in cognitive function, severely impacting memory, thinking, and social abilities, but also places a substantial emotional, physical, and financial burden on families and caregivers. Early detection and diagnosis are crucial for managing symptoms, planning for the future, and improving the quality of life for those affected. Understanding the different types of dementia, their symptoms, and the importance of early intervention is essential for providing compassionate and effective care to those living with these conditions.

Dementia, including Alzheimer disease, is a significant and growing concern globally, particularly among the elderly population. According to the World Health Organization (WHO), more than 55 million people worldwide are living with dementia, and this number is expected to rise to 88 million by 2030 and 139 million by 2050 [1]. Alzheimer disease is the most common form of dementia, accounting for 60% to 70% of cases. In the United States alone, the Alzheimer's Association reports that more than 6 million Americans older than 65 years of age are living with Alzheimer disease, a number projected to reach nearly 13 million by 2050 [2,3]. This condition not only leads to a progressive decline in cognitive function, severely impacting memory, thinking, and social abilities, but also places a substantial emotional, physical, and financial burden on families and caregivers. Early detection and diagnosis are crucial for managing symptoms, planning for the future, and improving the quality of life for those affected. Understanding the different types of dementia, their symptoms, and the importance of early intervention is essential for providing compassionate and effective care to those living with these conditions.

Early detection and diagnosis of dementia are crucial for managing symptoms, planning for the future, and improving the quality of life for those affected. Understanding the prevalence and impact of dementia is essential for developing effective strategies and support systems to address this growing public health challenge.

Choosing the right tool depends on the patient's clinical presentation and the cognitive domains needing assessment. Other factors to consider include the patient's language proficiency, cultural background, and any sensory or motor impairments that may affect their performance on the tests. Healthcare providers should also consider the psychometric properties of the tools, such as their sensitivity, specificity, and reliability, to ensure accurate and meaningful results. The MMSE is good for quick screenings, the MoCA for comprehensive evaluations, and the CDT for executive function and visuospatial skills. Multiple tools can enhance diagnostic accuracy, with the MoCA being particularly sensitive for early impairment detection [15,18].

Billing for cognitive assessment and care planning is essential for ensuring that healthcare providers are reimbursed for the time and resources spent on these critical services. The Centers for Medicare & Medicaid Services (CMS) have established specific billing codes for cognitive assessment and care planning services. These codes allow healthcare providers to bill for the time spent on comprehensive cognitive assessments and care planning for patients with cognitive impairment, including Alzheimer disease and other dementias [4]. The primary codes include [19]:

Pharmacological treatments for dementia focus on managing symptoms and slowing disease progression. The main medications include cholinesterase inhibitors (donepezil, rivastigmine, galantamine) and anN-methyl-D-aspartate (NMDA) receptor antagonist, memantine. Cholinesterase inhibitors increase acetylcholine levels, improving cognitive function and behavioral symptoms in mild-to-moderate Alzheimer disease [2]. Memantine regulates glutamate activity and is used for moderate to severe Alzheimer disease. These medications can improve cognition, mood, and daily functioning but may have side effects. Cholinesterase inhibitors can cause nausea, vomiting, diarrhea, dizziness, and sleep disturbances, while memantine may cause dizziness, headaches, and constipation [10]. Although they do not cure dementia, they can temporarily improve symptoms or slow their worsening [26].

Pharmacological treatments for dementia focus on managing symptoms and slowing disease progression. The main medications include cholinesterase inhibitors (donepezil, rivastigmine, galantamine) and anN-methyl-D-aspartate (NMDA) receptor antagonist, memantine. Cholinesterase inhibitors increase acetylcholine levels, improving cognitive function and behavioral symptoms in mild-to-moderate Alzheimer disease [2]. Memantine regulates glutamate activity and is used for moderate to severe Alzheimer disease. These medications can improve cognition, mood, and daily functioning but may have side effects. Cholinesterase inhibitors can cause nausea, vomiting, diarrhea, dizziness, and sleep disturbances, while memantine may cause dizziness, headaches, and constipation [10]. Although they do not cure dementia, they can temporarily improve symptoms or slow their worsening [26].

In 2021, the FDA granted accelerated approval to aducanumab for the treatment of Alzheimer disease [27]. It is the first new treatment approved for Alzheimer disease since 2003 and is the first therapy that targets the fundamental pathophysiology of the disease. Approval of aducanumab was based on evidence showing a significant reduction of beta amyloid plaque in those receiving the drug (compared with placebo) [27]. Preliminary studies have been conflicting, and the FDA's decision to grant accelerated approval to aducanumab was controversial. The manufacturer discontinued aducanumab in 2024 [29]. In 2023, the FDA granted accelerated approval to lecanemab for the treatment of Alzheimer disease [21]. Like aducanumab, lecanemab is an anti-amyloid monoclonal antibody, and the presence of amyloid beta pathology should be confirmed prior to treatment initiation. Lecanemab is an intravenous infusion given every two weeks at an infusion center, but subcutaneous delivery is being studied in trials.

Patient A's physician develops a comprehensive care plan, which includes pharmacological and nonpharmacological treatments. He prescribes donepezil, a cholinesterase inhibitor, to help manage her symptoms. Additionally, he recommends cognitive stimulation therapy (CST) and encourages Patient A to engage in regular physical exercise, maintain a healthy diet, and stay socially active.

1. How was Ms. S involved in the care planning process, and why is caregiver involvement important?

Answer: Ms. S was actively involved in the care planning process by participating in discussions about treatment options, goals of care, and preferences for care. Caregiver involvement is important because it ensures that the care plan is tailored to the needs and preferences of both the patient and the caregiver, providing necessary support and education.