New series from The Lancet offers roadmap for Alzheimer’s treatment in a changing therapeutic landscape

New research published in The Lancet as part of its Alzheimer's Disease Series outlines strategies for integrating emerging and existing treatment approaches for Alzheimer's disease.

Forty international experts contributed to this three-part series. UC Davis Geriatric Psychiatrist Helen C. Kales is the only U.S. psychiatrist among this expert group and is a co-author of one of the new papers.

"Our findings underscore the urgent need to bring evidence-based, person-centered care into real-world dementia settings," Kales said. "We need to prioritize non-pharmacological strategies and caregiver support while thoughtfully incorporating new disease-modifying therapies for dementia, such as lecanemab and donanemab."

Kales is the chair of the UC Davis Department of Psychiatry and Behavioral Sciences and the Joe P. Tupin Professor of Psychiatry. She is the co-creator of the DICE Approach (describe, investigate, create and evaluate), a method that helps caregivers assess and manage dementia-related behaviors.

Developing customized integrative treatment plans for Alzheimer's patients

The key findings in The Lancet paper include:

• Over 90% of individuals with Alzheimer's disease experience behavioral and psychological symptoms (BPSD), such as agitation, depression and psychosis.
• Non-pharmacological approaches like DICE - which consists of personalized activities and caregiver training - are often more effective and safer than psychotropic drugs, yet remain underused.
• Medical professionals should recognize cases when psychotropic drugs are needed for the treatment of BPSD symptoms. Still, they should use the drugs cautiously and follow clear guidelines.
• Anti-amyloid monoclonal antibodies (donanemab and lecanemab) represent a historic shift in Alzheimer's treatment, slowing cognitive decline for the first time; however, the drugs raise complex questions about eligibility, safety and long-term impact.
• Combining symptomatic treatments (such as cholinesterase inhibitors and memantine) with disease-modifying therapies may offer additive benefits, though more research is needed.

The study also presented strategic recommendations, including:

• Support infrastructure development for Alzheimer's disease biomarker testing and access to brain scans.
• Fund caregiver training and non-pharmacological programs in both community and institutional settings.
• Establish registries to monitor real-world outcomes and safety.
• Prioritize equitable access through pricing models, public funding and global partnerships.
• Engage in public dialogue about the societal value of investing in Alzheimer's care.

"By integrating emerging therapies with proven care strategies, supporting caregivers, and ensuring that innovation translates into improvements in our patients' lives, we can make meaningful progress in the diagnosis and treatment of this disease," Kales said.

A complete list of authors appears in the paper.

Resources

• Read the paper in The Lancet
• The DICE Approach
• The Lancet Series on Alzheimer's disease