Dr Shane O’Hanlon, Consultant Geriatrician, Mater Private Network Dublin
A lot is changing in how doctors diagnose and treat Alzheimer’s disease. New medicines that can slow the disease down are arriving in Ireland, but understanding who can take them and how to keep your brain healthy at any age is key.
What is the difference between Alzheimer’s, dementia and mild cognitive impairment?
Alzheimer’s is a form of progressive memory loss that is more significant than the mild memory changes of normal ageing.
Dementia is an umbrella term for memory disorders that are significant enough to affect your daily activities. It includes Alzheimer’s but also other conditions such as vascular dementia, Lewy Body dementia and others.
Mild cognitive impairment or MCI is an interim stage of mild memory loss, not severe enough to be classified as dementia. It sometimes, but not always, progresses to dementia. Alzheimer’s in the early stages can be a cause.
How Alzheimer’s Is Diagnosed
There are many other causes of memory loss, so a visit to the GP is usually the first step. They can talk to you about what you are experiencing and do tests to rule out other issues like vitamin deficiencies or thyroid problems. If that doesn’t provide an answer then a referral to a specialist is usually helpful.
- Memory Assessments and Scans: Specialists use memory and thinking tests alongside MRI brain scans to see what is happening in the brain. This can check for some other causes such as stroke, narrowing of the blood vessels, or shrinkage of the brain. Sometimes an MRI can show changes suggesting Alzheimer’s but often the value is in ruling out other causes.
- Specialist Tests for Alzheimer’s: a sticky protein called amyloid builds up in the brain when Alzheimer’s is present. A spinal fluid test (lumbar puncture or LP, also called spinal tap) or a specialised PET brain scan can be performed. The LP can pick it up at an earlier stage but does involve a procedure. The PET scan comes in two forms, FDG PET that looks at brain activity or Amyloid PET that detects the amyloid protein. It is necessary to ask for insurance approval for these scans and it can take several months to get one.
What About Blood Tests?
You may have read news stories about simple blood tests that detect Alzheimer’s. While scientists are making rapid progress, these blood tests are not yet part of routine clinical practice in Ireland. We expect to start using them soon, in some cases to determine who has a definite diagnosis or who might still need further tests to confirm it.
The New Treatments: Lecanemab and Donanemab
Two newer treatments work differently from older memory medications.
Older tablets (such as donepezil or memantine) help manage symptoms, but they do not alter the underlying disease. Lecanemab and donanemab are given by regular intravenous (IV) drip and work by clearing amyloid plaques out of the brain. In clinical trials, they helped slow down the rate of memory decline by about a third, helping people keep their independence for longer.
Who Is Eligible?
These treatments are not a cure, and they are not suitable for everyone. Strict rules are in place across Europe and Ireland to keep patients safe:
- Early stages only: They are only for people with the earliest stage of Alzheimer’s disease. They do not work for moderate or advanced Alzheimer’s, or other types of dementia.
- Confirmed amyloid: Patients must have test results proving amyloid is present in the brain.
- Compulsory gene testing: Patients must have a blood test to check for a gene called APOE. People who carry two copies of the APOE4 type face a much higher risk of severe side effects and cannot receive these medications.
- Safety scans: These drugs can cause side effects called ARIA, which involve temporary swelling or small bleeds in the brain. While often harmless with no symptoms, they can sometimes be serious. Anyone taking these medicines must have regular MRI brain scans to monitor for these possible effects.
- No blood thinners: while aspirin is ok, stronger thinners called anticoagulants increase the risk of bleeding in the brain.
Availability and Cost in Ireland
At present, lecanemab and donanemab are available in Ireland only on private prescription through specialised hospital clinics with the facilities to manage infusions and regular MRI scans.
They are not funded on the public healthcare system (HSE) or via health insurers at this time. Because of the cost of the drug, the IV clinic visits, and the frequent MRI scans, private treatment involves substantial out-of-pocket expenses, which can reach around 60,000 euros a year.
Looking After Your Brain Health
Whether new medications are an option for you or not, daily habits make a measurable difference. Research shows that managing lifestyle risk factors can prevent or delay up to almost half of all dementia cases.
- Protect your heart: high blood pressure, high cholesterol, and diabetes all affect blood supply to the brain. Keep them well controlled.
- Stay physically active: daily movement—such as brisk walking, gardening, swimming, or cycling—encourages healthy brain cell connections.
- Check your hearing: unmanaged hearing loss makes the brain work much harder to process sound. Using hearing aids if you need them helps preserve memory and thinking skills.
- Eat well: a diet rich in vegetables, fruit, whole grains, beans, fish, and olive oil (e.g. Mediterranean diet) supports long-term brain health.
- Stay social and curious: chatting with friends, joining local groups, reading, and learning new skills or languages build up your “cognitive reserve.”
- Prioritise sleep: a consistent, restful sleep routine gives your brain time to clear out waste and recharge.
What to Do Next?
If you, or a family member, are worried about persistent memory slips, word-finding troubles, or changes in day-to-day thinking, book an appointment with your GP. They can carry out the first checks and, if needed, refer you to a specialist memory clinic or consultant for a full assessment. In general, the earlier the diagnosis the more control you have.
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