Implications and future work
Alzheimer’s disease, cognitive or functional decline, dementia, cognitive impairment
DISEASE
We add to accumulating evidence that interventions to delay cognitive or functional decline in early dementia or mild cognitive impairment are ineffective. So far, drug therapies, cognitive stimulation, exercise, and rehabilitation therapies have, at best, a small impact on functional activities and quality of life and do not appear to change the course of the disease. Recent data on lecanemab, the monoclonal antibody drug used in the treatment of Alzheimer’s disease, found small benefits in activities of daily living (2 points on a 90 point scale over 18 months).We need to think again about how we support people with dementia to live well. A more supportive approach to care may be required. Healthcare interventions should focus on solving practical problems and crises. Emphasis should be on helping individuals with dementia to live well despite their limitations; minimise intervention burden; maintain personhood, inclusion, and occupation; provide psychological and emotional support; and support family and other carers. Restoration of independence in activities may be unrealistic; adapted or supported functioning (compensatory approaches) may be more achievable.