Making Sense of the New Alzheimer Treatment Landscape, With Aaron Ritter, MD

The Alzheimer disease treatment landscape has shifted markedly in recent years, with 5 new US Food and Drug Administration (FDA) approved therapies reaching the clinic after nearly 20 years without a new option.¹ Among these, amyloid-targeting antibodies now offer the first disease-modifying effect on early symptomatic Alzheimer disease, though their benefit applies to a limited subset of patients and requires careful management of associated risks. Behavioral changes, rather than memory loss, are frequently the earliest clinical signal of Alzheimer disease; this positions psychiatrists, who often encounter these behavioral changes first, to identify the disease earlier than cognitive testing alone would allow.² In this conference conversation, Aaron Ritter, MD, discussed what clinicians can take from his SoCal Psychiatry conference session, including how to evaluate new Alzheimer therapies, recognize early behavioral warning signs, and guide families toward practical, function-based care decisions.

Psychiatric Times:Can you share some clinical highlights from your session at SoCal Psych?

Aaron Ritter, MD: My conference session focused on emerging treatments that are now available for Alzheimer disease. From 2003 to 2021, we had nothing new in the space, but now in the span of 5 years, we have 5 new FDA-approved treatments. My talk was about what we actually know about these therapies, what they can and can't do, and how to think about them when a patient is sitting in front of you.

PT: What from your session can clinicians implement clinically today?

Ritter: Amyloid-removing therapies (of which there are now 2) meaningfully reduce the risk of disease progression in early symptomatic Alzheimer disease. These are the first disease modifying therapies that have become available in the clinic. As exciting as they are, it's important to realize what they are not cures and are only effective for a small percentage of patients. These therapies represent an important step forward for the field but are insufficient to address the full burden imposed by dementia.

The second is that the side effect profile of these medications is the most important prescribing decision, which is a paradigm shift compared to other therapies. These medications cannot be given safely until the risks are understood, discussed, and monitored.

PT: What do you think clinicians might miss in treating cognitive impairment?

Ritter: It is important to note that cognition is almost always the second thing to change in Alzheimer disease. Behavioral symptoms frequently come first and are often hard to quantify. Often times it's subtle—apathy that gets mistaken for depression, a new irritability the family has tried adjusting to. Other times it can be rather dramatic: disinhibition, aggression that may be diagnosed as late onset bipolar disorder. This is not a new observation, either. When Alois Alzheimer described his index case in 1906, what stood out first was not memory loss—it was behavior. Psychiatrists are often the first clinicians to see these changes, which puts them in a position to move a patient toward an accurate diagnosis years earlier.

PT: How can clinicians have the most productive conversations with patients about treating Alzheimer disease or cognitive impairment?

Ritter: Start with function, not with test scores.

Families often focus on how the patient performed on a cognitive screen. But the more useful conversation is about how this disease impacts independent functioning. Even patients with mild symptoms almost always struggle with function. In our clinic, we tell families they need a plan for 4 things: medication management, driving, financial stewardship, and nutrition. Alzheimer disease reliably affects a patient’s ability to manage all 4 of these aspects, and we have no medication that adequately addresses any of them. Calling out these areas turns an abstract diagnosis into a set of decisions a family can actually make.

PT: What do you hope to see in the future of treatments for cognitive impairment or Alzheimer disease?

Ritter: Alzheimer disease has an Achilles heel: biomarkers give us direct evidence that the disease process is underway in the brain, as far as 2 decades before the onset of symptoms. As these biomarkers get more accurate and more accessible, we will be able to identify people earlier—and earlier is where our best chance of wiping out this disease.

Dr Ritter is board certified in psychiatry and neurology and is the Larkin family endowed chair in integrative brain health and director of the memory & cognitive disorders program in Hoag’s Pickup Family Neurosciences Institute.

References

1. FDA grants traditional approval for Leqembi (lecanemab-irmb) for the treatment of Alzheimer's disease. Press release. July 6, 2023. Accessed July 29, 2026. https://www.eisai.com/news/2023/news202349.html

2. 10 early signs and symptoms of Alzheimer’s and dementia. Alzheimer’s Association. Accessed July 29, 2026. https://www.alz.org/alzheimers-dementia/10_signs