Hitting a Nerve

Alzheimer’s disease: To treat or not?


Mr. Jones has Alzheimer’s disease, recently diagnosed.

His wife is a retired hospice nurse, who’s seen plenty of patients and families deal with the illness over the years.

She came in recently, just herself, to go over his treatment options and what can be reasonably expected with them. So we went through the usual suspects, new and old.

Dr. Allan M. Block, a neurologist in Scottsdale, Ariz.

Dr. Allan M. Block

I intermittently stopped to ask if she had any questions. At one such break she suddenly said:

“I’d rather he die now than be treated with any of these.”

I tried to address her safety concerns with the different medications, but that wasn’t the issue. Her real, and understandable, point is that none of them are cures. They don’t even stop the disease. Realistically, all we’re doing is slowing things down for maybe a year at most.

Families are different, and no one can really know how they’ll react in this situation until it happens.

Some will want me to do a full-court press, because another year of time is more family gatherings and independence, maybe a grandchild’s birth or wedding, or just being able to keep someone at home longer before starting to look into the cost of memory care.

Others, like Mrs. Jones, don’t see a point. The disease is incurable. Why bother to prolong it when the end is the same? Is it worth adding another year of medications, adult diapers, and the occasional 911 call if they wander off?

That’s a valid view, too. She wasn’t advocating a cause, such as euthanasia, but she did have legitimate concerns.

For all the marketing hype over Leqembi today or Cognex (remember that?) in 1989, the issue is the same. We have new and shinier toys, but still no cures. Whether it’s worth it to prolong life (or suffering) is a glass half-full or half-empty question that only patients and their families can answer.

It ain’t easy.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recommended Reading

Altered gut bacteria a biomarker of preclinical Alzheimer’s?
MDedge Neurology
SSRI improves cognition, major depression in early dementia
MDedge Neurology
No link between PPIs and dementia in new study
MDedge Neurology
Regular napping linked to greater brain volume
MDedge Neurology
No link between heartburn meds and dementia
MDedge Neurology
FDA clears new biomarker assays for early Alzheimer’s detection
MDedge Neurology
Lean muscle mass protective against Alzheimer’s?
MDedge Neurology
Long COVID ‘brain fog’ confounds doctors, but new research offers hope
MDedge Neurology
New consensus on biomarkers for diagnosis of neurocognitive disorders
MDedge Neurology
Men and women react differently to acute stress
MDedge Neurology