Is It Working: Early Alzheimer’s

Monitoring Clinical Markers

1. Cognitive Performance

  • Global screens (MoCA, MMSE): Stable scores (≤1-point change) over 6 months.

  • Episodic memory: Better delayed recall, fewer cueing needs.

  • Executive function/attention: Trail Making, Digit Span remain stable or improve.

  • Verbal fluency: Word counts hold steady across quarters.

  • Visuospatial tasks (clock drawing, figure copy): No new disorganization or errors.

2. Daily Living Abilities

  • Instrumental ADLs: Managing meds, finances, shopping, cooking without added errors.

  • Basic ADLs: Dressing, bathing, grooming, feeding remain independent.

  • Marker: No new assistance required across 3–6 months.

3. Memory Behaviors

  • Repetitive questions/misplacing items: Frequency plateaus, not rising.

  • Route-finding: Stable navigation in familiar environments.

  • Prospective memory: Reminder load doesn’t increase.

4. Neuropsychiatric & Behavioral Symptoms

  • Apathy, anxiety, irritability: Fewer peaks; calmer evenings.

  • Sleep-related behaviors: Less sundowning or nocturnal wandering.

  • Marker: Reduced evening agitation and nighttime events.

5. Sleep & Circadian Rhythm

  • Sleep continuity: Longer uninterrupted sleep blocks.

  • Daytime alertness: Less drowsiness; fewer naps.

  • Marker: Stabilization within 2–8 weeks.

6. Mood & Energy

  • Mood scales: Fewer low-mood days.

  • Stress reactivity: Calmer baseline.

  • Energy levels: More consistent mornings and afternoons.

7. Language & Communication

  • Word-finding: Stable frequency of “tip-of-the-tongue” moments.

  • Picture naming: Accuracy remains steady.

8. Motor & Visuospatial Integration

  • Drawing/writing: Legibility consistent.

  • Gait speed & dual-tasking: Stable walking pace with or without a cognitive task.

9. Safety Markers

  • Kitchen safety: No new accidents with stoves/appliances.

  • Medication adherence: Pillbox checks accurate.

  • Falls/wandering: No new incidents.

  • Marker: Zero emergency events in a 6-month window.

10. General Health

  • Nutrition & weight: Stable appetite; no unintended weight loss >3% per quarter.

  • Hydration & bowel rhythm: Regular and balanced.

  • Physical activity: Step counts or activity minutes remain stable.

11. Optional Medical/Lab Biomarkers

  • B12, folate, TSH, vitamin D: Deficiencies corrected.

  • Inflammation/oxidative stress: CRP or homocysteine stable or lower.

  • Neuro-biomarkers (if available): Plasma p-tau, Aβ42/40, MRI hippocampal atrophy slower than typical.

12. Caregiver Markers

  • Burden score: Stable or reduced on monthly check-ins.

  • Support hours: No sudden increase in respite needs.

13. Long-Term Trajectory

  • Cognitive slope: Decline curve slower than untreated baseline.

  • Function: Same assistance needs at 6–12 months as baseline.

  • Safety: No new hospitalizations for delirium, falls, or dehydration.

  • Healthcare utilization: No increase in urgent visits.

Timeline of Expected Change

  • Weeks (2–8): Better sleep, calmer evenings, steadier energy.

  • Months (3–6): Plateau in forgetfulness and daily errors; MoCA/MMSE stable.

  • Years (6–12+ months): Slowed decline; preserved independence; fewer safety events.