Being told that you have Alzheimer’s disease, even in the early stages, can leave you feeling like you’ve wandered into unknown territory. Lacking a compass and guidebook—and faced with a complicated medical landscape—you may quickly end up feeling overwhelmed and emotionally exhausted.
It doesn’t need to be that way. Neurologists have developed a logical, evidence-based sequence of monitoring, testing, and therapeutic decisions based on your symptoms and the disease’s progression. The following is a timeline that can help guide conversations with your neurologist, primary care doctor, or memory care team.
0–6 Months: Getting Oriented (Early / Mild Stage)
Confirming the diagnosis and establishing a baseline
Once early Alzheimer’s or mild cognitive impairment due to Alzheimer’s is confirmed, the first step is to document where things stand right now. That means setting a “baseline” for both cognition and overall health so that future changes can be tracked accurately.
Key steps usually include:
Cognitive and neuropsychological testing – to assess memory, language, problem-solving, and spatial awareness. These results become your reference point for the future.
Routine labs and vascular risk screening – to rule out other causes of memory loss (like thyroid issues, vitamin B12 deficiency, infections, or metabolic problems) and to check for heart and blood vessel risk factors that can speed up decline.
APOE genetic testing (optional) – this can clarify risk, though it doesn’t determine your fate. Discuss with your clinician before testing.
Biomarker confirmation – doctors may use one or more of the following:
CSF testing: measuring amyloid and tau proteins in spinal fluid.
Amyloid PET scan: imaging that shows amyloid buildup in the brain.
Blood tests: a new generation of plasma biomarkers, such as the FDA-cleared pTau217/Aβ42 test, can now confirm Alzheimer’s biology with a simple blood draw.
MRI of the brain – to rule out stroke, tumors, or other structural causes and to assess changes in the hippocampus and memory regions.
Once these steps are done, your care team can start to personalize treatment and support.
Starting treatment
Most people with early Alzheimer’s begin a cholinesterase inhibitor (donepezil, rivastigmine, or galantamine). These drugs don’t stop the disease but can slow memory loss for a time.
As symptoms advance, doctors may add memantine, which works through a different pathway to support brain function.
6–24 Months: Monitoring and Adjusting
During the first two years, the focus shifts to tracking changes and adjusting care.
Repeat testing every 6–12 months helps detect shifts in attention, planning, or daily functioning — not just memory.
Biomarker re-checks may be done in some cases, especially if blood tests are available or if you’re in a research study.
Addressing other health issues — like blood pressure, diabetes, cholesterol, sleep apnea, and exercise — remains critical.
Clinical trials: this is often the best time to consider joining one. Early-stage patients may qualify for studies of new Alzheimer’s drugs and treatments.
2–5 Years: Transitioning to the Moderate Stage
If the disease continues to progress, treatment may need to be stepped up.
Add or adjust medications: if you’re not already on memantine, this is often the time to start.
New disease-modifying therapies:
Leqembi® (lecanemab) was approved in 2023 for early Alzheimer’s.
Kisunla™ (donanemab) followed in 2024.
These antibody treatments target amyloid plaques and have been shown to modestly slow decline when started early.
Monitoring: these drugs can cause side effects such as brain swelling or small bleeds (ARIA), so MRI scans are done regularly during treatment.
Follow-up cadence: most patients are seen every six months, with repeat cognitive and safety checks.
If symptoms worsen unexpectedly, your doctor might repeat imaging or advanced biomarker testing to better understand what’s happening.
5+ Years: Moderate to Advanced Disease
As the disease moves into later stages, priorities shift. The goal becomes comfort, safety, and quality of life.
Continue existing medications if they help with daily function.
Focus on nutrition, preventing falls, managing agitation or depression, and supporting sleep and mood.
Repeating advanced biomarker tests is usually no longer helpful.
Engage caregivers and loved ones in care planning, advance directives, and palliative support when needed.
At a Glance: What Happens When
Period | Key Tests / Monitoring | Focus of Care | Notes |
0–6 months | Cognitive testing, MRI, labs, optional APOE and biomarker testing | Start first medications | Confirm diagnosis and set a baseline |
6–24 months | Repeat testing, optional biomarker updates | Adjust therapy, manage comorbidities, consider trials | Detect early acceleration |
2–5 years | More frequent visits, possible antibody therapy | Combine meds, monitor side effects | Watch for ARIA and new symptoms |
5+ years | Ongoing functional monitoring | Comfort care, quality of life | Support for caregivers and patients |
Important Things to Keep in Mind
Biomarkers aren’t perfect: false positives and negatives happen. Always interpret results in the context of symptoms.
Access and cost vary: PET scans and spinal taps aren’t available everywhere, but new blood tests are helping close that gap.
Treat early: antibody therapies and cognitive supports work best before major brain cell loss occurs.
Everyone’s journey is unique: some people decline slowly for a decade; others progress faster. Use this roadmap as a guide, not a prediction.
Alzheimer’s is a long and difficult journey for patients and their families. But having this staged roadmap can enable a more proactive approach to the disease. It’s reassuring to know when to ask for a biomarker test, when to consider enrolling in a clinical trial, or when to add or shift therapies. These clear and timed steps won’t cure the disease, but they may help to slow its progression. Just as important, they can be the key to relieving the stifling emotional burden of fear and uncertainty.