The reconceptualization of Alzheimer's disease (AD) as a clinical and biological construct has facilitated the development of biomarker-guided, pathway-based targeted therapies, many of which have reached late-stage development with the near-term potential to enter global clinical practice. These medical advances mark an unprecedented paradigm shift and requires an optimized global framework for clinical care pathways for AD. In this Perspective, we describe the blueprint for transitioning from the current, clinical symptom-focused and inherently late-stage diagnosis and management of AD to the next-generation pathway that incorporates biomarker-guided and digitally facilitated decision-making algorithms for risk stratification, early detection, timely diagnosis, and preventative or therapeutic interventions. We address critical and high-priority challenges, propose evidence-based strategic solutions, and emphasize that the perspectives of affected individuals and care partners need to be considered and integrated.

China faces multiple obstacles in preparing to care for its fast-growing dementia population. Better understanding of patients and caregivers may mitigate these challenges by improving awareness and education.

The impact of dementia care on caregivers' professional, personal, emotional and social well-being was measured in a cohort of 1,387 caregivers in seven regions across mainland China, using a Chinese version of the Zarit Burden Interview (ZBI) and four supplementary questions. Caregivers also estimated costs of care and medical resource utilization. Caregiver burden was generally low to moderate. Dementia care had the greatest impact on caregivers' professional lives, with 25.5% reporting a reduced work schedule in the past month. Lost work time was greater for caregivers of patients with previously diagnosed dementia than for those with newly diagnosed dementia. Average monthly out-of-pocket costs of dementia care exceeded national average monthly incomes of rural and urban residents. These findings highlight the obstacles facing the country with the fastest-growing elderly population in the world.

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OBJECTIVES: Drug-Related Problems (DRPs) occur frequently with antidepressants leading to treatment failure and increased morbidity in the depressed patient. The study was designed to collect preliminary data related to antidepressant drug related problems and treatment failure in India. METHODS: A cross sectional observational study was carried out for a period of four months at a mental health facility in Udupi, India. All the prescriptions of the study population were screened for Drug Related Problems (DRPs) such as ADRs and DDIs by using a computerized database system. These data were assessed for the pattern of the ADRs with respect to patient demographics, nature of the reaction, outcome of the reactions, causality, severity and preventability. RESULTS: A total of 120 patients were enrolled in the study and 33 of them developed 50 Drug Related Problems (DRPs), in those 24 Drug-Drug Interactions (DDIs) and 26 Adverse Drug Reactions (ADRs). The overall incidence of DRPs in the present study was 27.5%. Among the 33 patients and the significant proportions of DRPs were in female with [pϽ 0.01] than in male. Most of the patients who had developed DRPs was in the age group of 36-55 yrs [pϽ0.01] followed by other age. The common ADRs observed were hyponatremia and headache. Considering outcomes, 20 (76.9%) of cases recovered from ADRs and while assessing the preventability, 20 (76.9%) of the ADRs were definitely preventable. When causality assessments were conducted, we found that that majority of ADRs were probable and were found to be mild to moderately severe. CONCLUSIONS: An ongoing drug monitoring program aimed at assessing common drug-related problems may be key in improving treatment effectiveness in patients with depression. The involvement of community pharmacists in a pilot psychiatric drug monitoring program in India assisted in the identification of common adverse drug related problems in these patients.