KURZ Alexander

It is expected that the treatments that are under development for Alzheimer’s disease (e. g. anti-amyloid antibodies, secretase blockers) will slow down the progression of the neurodegenerative process, particularly if administered at the early, i. e. prodromal stage. For those who are eligible for these treatments and tolerate them this means to live several years longer with the certainty and burden of an incurable brain disease. On the other hand, the novel scenario implies more years of life, more time and better capability to adapt to and cope with cognitive and functional impairment, more years spent at mild and moderate than at severe stages of the disease, and possibly even an escape from profound dementia and dependence. As a consequence of the changing time scheme, increasing cognitive and functional impairment will collide with the needs for self-fulfillment, mastery, achievement, esteem, personal growth and purpose in life, which are alive and crucial in people who are diagnosed and treated early and long-term. For patient and carer organisations the shifting timeframe therefore creates new challenges and opportunities. Much has still to be learned how to provide the skills, courage and strength that are required for affected individuals to realise their personal aims, potentials and resources despite growing limitations. We must make the best possible use of the extra time that will hopefully be generated by early diagnosis and novel treatments.