Patient handout

Alzheimer disease dementia

PRODUCTION

1. Your condition

This handout is for alzheimer disease dementia. Your care team identified this based on: insidious progressive episodic memory loss with functional decline (informant-corroborated).

Other reasons your team may use this plan: established mci on surveillance — amnestic phenotype progressing toward dementia; caregiver reports iadl decline (finances, medications, driving, cooking); age >=65 presenting with cognitive concern at routine or wellness visit (nice ng97).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
reversible_cause_workup	—	—	—	AAN 2018 — B12, TSH, depression (GDS-15), medication/anticholinergic burden, structural MRI (NPH/subdural/tumor) excluded/treated before AD attribution
ad_biomarker_testing	—	—	—	AA AUR 2021 — amyloid PET or CSF Aβ42/40 + p-tau181 (or plasma p-tau217); amyloid confirmation REQUIRED before any anti-amyloid mAb

Plan: Alzheimer disease care ladder — exclude reversible → non-pharm/caregiver/ACP → ChEI by stage → memantine → anti-amyloid → BPSD → deprescribe

3. When to call your provider

Contact your care team if any of the following happen:

Superimposed delirium or acute deterioration → inpatient workup (NICE NG97)
BPSD with danger to self/others not controllable in clinic → inpatient/urgent (NICE NG97)
ARIA-E/H symptomatic or significant on surveillance MRI → pause mAb + neurology (AA AUR 2023)
Rapid progression (<1-2y) → rapid-dementia workup (CJD/autoimmune/paraneoplastic) (AAN 2018)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Cognitive decline progressing to dementia over <1-2 years (or weeks-months) — atypical for AD (AAN 2018)
Acute fluctuating inattention/altered consciousness superimposed on baseline dementia (NICE NG97)(life-threatening)
Behavioral & psychological symptoms with danger to self/others or severe unrelievable distress (NICE NG97)
Antipsychotic considered/given in a patient with early visual hallucinations, parkinsonism, fluctuation, or RBD (suspected DLB) (NICE NG97)(life-threatening)
ARIA-E (vasogenic edema) or ARIA-H (microhemorrhage/superficial siderosis/macrohemorrhage) on anti-amyloid mAb, symptomatic or significant on surveillance MRI (AA AUR 2023)(life-threatening)

5. Follow-up

Advance care planning revisited at each transition; driving/finances/capacity reviewed; caregiver respite and support referral; vascular-risk and sensory optimization maintained; palliative/end-of-life planning and ChEI/memantine deprescribing decision in advanced (severe) disease (NICE NG97)

6. Sources

Guideline: 2018 AAN MCI Practice Guideline + 2021 Alzheimer's Association Appropriate Use Recommendations + 2023-2025 AD anti-amyloid appropriate-use (lecanemab CLARITY-AD, donanemab TRAILBLAZER-ALZ 2) + NICE NG97 Dementia