to find them. Decreased or poor judgment: Individuals may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money or pay less attention to grooming or keeping themselves clean. Making a bad decision or mistake once in a while, such as neglecting to schedule an oil change for a car. Withdrawal from work or social activities: People living with Alzheimer’s disease may experience changes in the ability to hold or follow a conversation. As a result, they may withdraw from hobbies, social activities or other engagements. They may have trouble keeping up with a favorite sports team or activity. Sometimes feeling uninterested in family and social obligations. Changes in mood, personality and behavior: The mood and personalities of people living with Alzheimer’s can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or when out of their comfort zones. Developing very specific ways of doing things and becoming irritable when a routine is disrupted. *For more information about the symptoms of Alzheimer’s, visit alz.org/alzheimers-dementia/10_signs. Signs of Alzheimer’s Dementia Compared With Typical Age-Related Changes* table 2 12 Alzheimer’s Association. 2022 Alzheimer’s Disease Facts and Figures. Alzheimers Dement 2022;18. Treatments The U.S. Food and Drug Administration (FDA) has approved six drugs for the treatment of Alzheimer’s disease. Five of these drugs — donepezil, rivastigmine, galantamine, memantine and memantine combined with donepezil — temporarily treat Alzheimer’s symptoms but do not change the underlying brain changes of Alzheimer’s or alter the course of the disease. With the exception of memantine, they improve symptoms by increasing the amount of chemicals called neurotransmitters in the brain. Memantine protects the brain from a neurotransmitter called glutamate that overstimulates neurons and can damage them. These five drugs may have relatively mild side effects, such as headache and nausea. The sixth drug, aducanumab, was approved by the FDA in June 2021 and is the first FDA-approved drug to address the underlying biology of Alzheimer’s disease rather than the symptoms. It does this by reducing beta-amyloid plaques in the brain. It is not a cure for Alzheimer’s disease and is not appropriate for all individuals living with Alzheimer’s disease. The drug was studied in people with early Alzheimer’s disease — which includes people with MCI or mild dementia due to Alzheimer’s disease — who also have evidence of a buildup of amyloid plaques in the brain. Treatment with aducanumab may be appropriate for people with MCI or mild dementia due to Alzheimer’s disease. There is no safety or effectiveness data on initiating treatment at earlier or later stages of the disease than were studied. To help physicians determine if an individual is a candidate for aducanumab, appropriate use recommendations were published soon after FDA approval.50 Information for clinicians and patients is also available online from the Alzheimer’s Association. Unlike the other drugs approved to treat Alzheimer’s disease, aducanumab is associated with an increased risk of a serious condition called amyloid-related imaging abnormalities (ARIA), which can be an indicator of brain swelling.51 Individuals receiving aducanumab should be monitored closely so ARIA is quickly identified and safely managed should it arise. It is important to note that aducanumab was approved through a process called the accelerated approval pathway. This approval pathway provides individuals with a serious disease earlier access to drugs when there is an expectation that the drug will have a clinical benefit.52 The accelerated approval pathway requires the company that makes the drug to verify clinical benefit in a post-approval trial. If the sponsor cannot verify clinical benefit, the FDA may initiate proceedings to withdraw approval of the drug. There are also non-drug treatments for Alzheimer’s disease. Non-drug treatments do not change the underlying biology of the disease. They are often used with the goals of maintaining or improving cognitive function, overall quality of life and engagement, and the ability to perform activities of daily living. Non-drug treatments include cognitive stimulation, music-based therapies and psychological treatment (for example, cognitive behavioral therapy). Non-drug treatments may be used with the goal of reducing behavioral symptoms such as depression, apathy, wandering, sleep disturbances, agitation and aggression. A review and analysis of nonpharmacologic treatments for agitation and aggression in people with dementia concluded that nonpharmacologic interventions seemed to be more effective than pharmacologic interventions for reducing aggression and agitation.53 In practice, nonpharmacologic interventions are the primary tools used to address agitation and aggression, as they are typically more effective than pharmacologic interventions and pose minimal risk or harm. If non-drug treatments are not successful and behavioral and psychiatric symptoms have the potential to cause harm to the individual or others, physicians may prescribe drugs approved for similar symptoms in people with other conditions.