Did you know Alzheimer’s disease is the leading cause of death among Australian women? Read more about the role of the GP in the early detection and ongoing management of Alzheimer’s disease in primary care.
Alzheimer’s disease (AD) is a chronic and progressive neurodegenerative disorder characterised by the formation of amyloid plaques and neurofibrillary tangles in the brain. These changes lead to memory deficits, reduced cognitive function, and global impairment of cerebral function.
AD is the most common form of dementia, accounting for approximately two-thirds of cases. However, it often co-exists with other forms of dementia, such as vascular dementia. Notably, AD disproportionately affects women, with around 257,500 women in Australia living with dementia (including AD) in 2023. Evidence suggests that women experience more rapid cognitive decline than men, and dementia remains the leading cause of death among Australian women.
General practitioners (GPs) play a vital role in the early detection of dementia, including AD. Disease onset is typically insidious, and diagnosis is primarily clinical, often requiring collateral history from a relative or close associate.
The most common presenting symptom is memory loss, often accompanied by difficulty finding words. Loss of executive function may present as challenges with reasoning, judgement, planning activities, or managing finances.
Validated cognitive assessment tools such as the Mini-Mental State Examination (MMSE) and the General Practitioner Assessment of Cognition (GPCOG) can aid in identifying cognitive impairment. While physical examination is recommended, this is often unremarkable in early AD.
A thorough personal and family history is essential, particularly since AD frequently has a hereditary component, especially in cases of early-onset AD. A detailed medical review should consider other possible causes of cognitive symptoms, such as depression or delirium. A basic dementia screening that includes haematology, biochemistry, glucose, and renal and liver function tests is recommended. For women suspected of having AD, referral to specialist services for comprehensive memory assessments and, if necessary, radiological imaging is crucial.
For women diagnosed with AD, management should address both the disease and any comorbidities. Information about the usual course of AD, available treatments, sources of support, and medico-legal considerations should be provided to both patients and their families.
Although there is no cure for AD, acetylcholinesterase inhibitors and memantine can slow cognitive decline in mild to moderate cases. Non-medical therapies — such as staying physically active, maintaining social connections, and managing stress — also play a critical role in maintaining quality of life.
Most women with AD continue to live in the community, making GPs central to providing holistic and patient-centred care throughout the disease’s progression. Management often includes addressing symptoms like agitation, distress, and depression. Communication challenges may arise in advanced AD, emphasising the importance of strong relationships with family and carers.
Early discussions about capacity, power of attorney, and end-of-life care are essential. These conversations should be approached with sensitivity and include planning for the future care needs of the patient.
By facilitating early diagnosis and providing ongoing support, GPs can significantly impact the quality of life for women with Alzheimer’s disease. A combination of medical interventions, lifestyle modifications, and psychosocial support can help manage symptoms and improve outcomes for both patients and their families.
Dr Samantha Miller, MBChB
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