Early detection is key. The sooner we recognize signs of dementia in ourselves or our loved ones, the more options we have to slow progression, improve quality of life, and plan for the future.
Today, there are disease-modifying treatments available for people in the early stages of Alzheimer’s disease. Research also shows that brain-healthy lifestyle changes—like staying active, eating well, and staying socially connected—can reduce the risk of dementia and support cognitive function.
Detecting cognitive changes early allows healthcare providers to rule out other treatable causes of memory issues, such as: Depression, Hearing loss, Medication side effects, Vitamin B12 deficiency, Infections (like Urinary Tract Infections), Stroke or cardiovascular issues, Alcohol use or overdose, Delirium or sudden confusion.
New Tools for Diagnosis
In the past, an Alzheimer’s disease diagnosis could only be confirmed after death. Today, screening and evaluation practices have improved significantly so that we can detect and diagnose the disease earlier and more accurately. There is no single test to determine if a person is living with Alzheimer’s disease or another related dementia. Health care providers use a combination of diagnostic tools combined with medical history to make an accurate diagnosis. A thorough evaluation includes a physical exam, neurological exam, cognitive testing, imaging, and biomarker fluid analysis.
Amyloid PET scans, the gold standard for detecting Alzheimer’s-related brain changes, have traditionally only been available on the continent. However, one of Hawai‘i’s largest health systems is working to bring this technology to the islands within the next couple of years. Hawaiʻi providers may more commonly order an Magnetic Resonance Imaging (MRI) of the Brain to confirm a dementia related diagnosis as this is currently more readily available in the islands.
Recent improvements in biomarkers research for Alzheimer’s disease may offer providers another helpful tool to assist in the diagnostic process and evaluation for treatment. The cerebrospinal fluid test is used to confirm the presence of tau tangles and amyloid plaques, the hallmarks of Alzheimer’s disease, before someone starts the new Alzheimer’s treatments. Recently, blood-based biomarkers tests are starting to be FDA approved. These blood tests are not yet available everywhere and are not widely covered by insurance (hopefully soon). The blood tests are currently only recommended for use in specialty clinics with access to disease modifying treatments.
Hawai‘i Pacific Neuroscience is offering a free blood biomarker test (Elecsys® pTau217) through the TRAVELLER study for individuals aged 50–90 with memory concerns. This test is comparable to a PET scan and can detect amyloid plaques—hallmarks of Alzheimer’s disease—through a simple blood draw. Call (808) 564-6141 or visit the Hawaii Pacific Neuroscience website to learn more.
Treatment Options
Leqembi (lecanemab) is a disease-modifying treatment now available in Hawai‘i through providers like Hawai‘i Pacific Health, Queen’s Health System, and Hawai‘i Pacific Neuroscience. It’s currently administered via IV every two weeks. Lecanemab can be covered under Medicare if patient is enrolled in a clinical registry and under HMSA HMO/PPO/QUEST/Medicare Advantage with prior authorization.
Leqembi was recently FDA-approved for a subcutaneous injection version which allows patients to self-administer weekly injections at home after completing the initial 18-month IV treatment. This new option offers greater flexibility and convenience for patients and caregivers, but may not be available in Hawaiʻi at this time.
Kisunla™ (donanemab) is another disease-modifying treatment that was recently approved by the FDA in 2024 and is administered via IV every month. Donanemab is not yet readily available in Hawaiʻi at this time.
Both of these disease-modifying treatments (DMT) listed above are monoclonal antibodies that are designed to remove amyloid plaques from the brain. Both DMTs have risk for amyloid-related imaging abnormalities (ARIA). These therapies are not for everyone, as only individuals in the early stages of Alzheimer’s disease are eligible. However, they represent a major shift from symptom management to slowing disease progression. While the benefits are modest, they mark the beginning of a new era in Alzheimer’s care.
Care, Support, and Planning Ahead
Early diagnosis also gives families time to learn about dementia, access caregiver training, and connect to resources. The earlier we can detect dementia, the sooner we can educate the family and train the caregiver with dementia care strategies so that they are empowered to take on this role and to find joy on the journey ahead. In Hawai’i, there are educational opportunities available in every county to learn more about dementia and how to support someone living with dementia.
Caregiving can be difficult and it’s a role that most of us are never fully prepared for. Caregiver training empowers caregivers to know what to expect, how to care for their person, how to cope and reduce caregiver burnout. The sooner we can detect dementia, the faster we can connect the person to resources, plan for care, and start eligibility processes for services so that they can access support to help them live well with dementia.
When dementia is detected early, individuals can make important decisions about their care preferences in advance. This includes completing documents like Advance Healthcare Directive and Provider Orders for Life-Sustaining Treatment (POLST). These tools ensure that loved ones understand your wishes and aren’t left to make difficult decisions alone. Advance care planning can give you piece of mind about your future care and it is a gift to the next generation.
There Is Hope
Now more than ever, we have hope. Getting a diagnosis is not the end. It’s the beginning of a new chapter. We have care options and resources to live well with dementia.
It’s okay to talk about it. Nearly everyone we meet knows someone living with dementia or knows a caregiver for someone living with dementia. You are not alone. This is a challenging road, so let’s support each other on it and find joy on the journey.
Let’s keep talking about brain health, and move forward together—with knowledge, compassion, and aloha.
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