In this episode of The Good GP, Dr Krystyna de Lange is joined by Dr Marita Long, to discuss recent advances in the treatment of cognitive impairment, particularly mild cognitive impairment due to Alzheimer’s disease.

Dr Long outlines the approval of the first anti-amyloid therapy in Australia—approved by the TGA for use in patients with mild cognitive impairment or early Alzheimer’s dementia. Covering the evidence base for this new therapy, focusing on data from the Trailblazer Two clinical trial, which demonstrated a modest slowing in cognitive decline for patients treated with the anti-amyloid agent compared to placebo. Dr Long emphasises that these are not curative treatments, but may offer an extended period of independence and delay transition into residential care, especially if administered at an earlier stage of disease.

They also addressed the challenges in identifying suitable patients for anti-amyloid therapy, given the complexities in diagnosing mild cognitive impairment and Alzheimer’s disease. Dr Long provides practical tips for GPs on recognising early cognitive symptoms and outlines the importance of thorough cognitive assessments and timely specialist referral for further diagnostic evaluation and access to new therapies.

Accessibility and eligibility criteria for anti-amyloid therapy were also discussed, including the current requirements for specialist confirmation of an Alzheimer’s diagnosis (often via PET scan), and certain exclusions, such as high vascular risk or mixed dementia pathology.

Dr Long also provides an overview of how these new disease-modifying therapies compared to existing symptomatic treatments (such as cholinesterase inhibitors), and notes the ongoing evolution of practice as further data become available.

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