Pharmacological Management: For mild-to-moderate AD, cholinesterase inhibitors (donepezil, rivastigmine, galantamine) enhance acetylcholine levels, modestly improving memory and attention. Donepezil is also approved for severe AD. Side effects like nausea or bradycardia require monitoring. For moderate-to-severe AD, memantine, an NMDA receptor antagonist, regulates glutamate activity, potentially slowing decline. Combination therapy (donepezil plus memantine) is common for advanced stages. Aducanumab and lecanemab, anti-amyloid monoclonal antibodies, target amyloid plaques but are controversial due to limited cognitive benefits, high costs, and risks like brain edema (ARIA). Neurologists weigh these against patient suitability, often reserving them for early-stage AD with confirmed amyloid pathology via PET or CSF analysis.

Supportive Care and Monitoring: Regular assessments track cognitive (e.g., MMSE, MoCA) and functional decline, guiding treatment adjustments. Advance care planning addresses future needs. Neurologists coordinate with multidisciplinary teams, including neuropsychologists and social workers, to support caregivers, reducing burnout. Clinical trials offer access to emerging therapies, particularly for early-stage patients.

Challenges and Future Directions: Limited disease-modifying options underscore the need for early diagnosis via biomarkers. Ongoing research into tau-targeted therapies and neuroinflammation holds promise. Neurologists advocate personalized medicine, balancing modest benefits with realistic expectations, to optimize patient and caregiver outcomes in this progressive disease.