Alzheimer's, what are the first signs that you shouldn't ignore?

Memory lapses, disorientation, problems expressing oneself or finding the right words, apathy: these are some of the warning signs that could herald the onset of Alzheimer's disease. Although small slips can happen to anyone, when they begin to manifest themselves with a certain recurrence, so much so that they have an impact on the daily life of the person and their family members, it may be time to seek the opinion of a doctor. Let's see what the first signs are that should not be ignored and also what are the new treatments recently approved or under evaluation by the European Medicines Agency (Ema).

The first signs not to ignore

The most common symptom of Alzheimer's disease, especially when it comes to the early stages of this disease, is forgetfulness, as Annachiara Cagnin , professor of neurology at the University of Padua, explains to Salute . "However, this is a non-specific symptom," the expert emphasizes, "in the sense that we have all experienced, to a greater or lesser extent, what it means to forget an appointment, or where our glasses or car keys are. And so forgetfulness should be considered alarming when it is persistent over time, when it is not linked to periods of particular tiredness, stress or sleep deprivation, as can often happen, when it worsens over the months and especially if people close to us, such as family or friends, point it out to us."

Other signs that should not be ignored are, for example, attention deficit disorders or the deterioration of the so-called “working memory”, that is, the fact of frequently losing the thread of a conversation, or finding yourself more often than usual in a certain place in the house without remembering why you went there, and so on. Even in this case, Cagnin specifies, a momentary and sporadic deficit should not alarm us. It is the recurring episodes that tend to worsen over time that deserve to be examined in depth together with your GP or a specialist.

New 2025 treatments under evaluation

From the point of view of treatments for Alzheimer's, at the moment there are drugs that act on the symptoms and not on the actual course of the disease. The good news, however, is that several monoclonal antibodies designed to reduce the accumulation of beta-amyloid protein, which would appear to be at least one of the triggers of the disease, are being studied. "We are talking about the arrival in Europe, and hopefully soon in Italy, of drugs that are not symptomatic, but that act by modifying the basic physiopathological process, unfortunately without stopping it completely", explains Cagnin.

Experts call them “disease modifying” drugs, that is, modifiers of the disease trajectory, precisely because they can slow it down and perhaps stabilize the situation for a while. “This is a real revolution, because for the first time we have something in our hands that can slow down a neurodegenerative process that has always been seen as unmodifiable,” adds the professor.

In particular, lecanemab was approved in 2023 by the US Food and Drug Administration (FDA) and subsequently also by the EMA . Donanemab, on the other hand, was approved by the FDA in 2024 and the EMA is re-evaluating it following an initial negative opinion issued at the end of March 2025. “Now - explains Cagnin - the ball is in the court of the Italian Medicines Agency for the first and possibly [in the event of approval by the EMA, ed.] also the second drug. We hope that between 2025 and 2026 a regulation will be defined and that the drugs will become available in Italy”.

Another monoclonal antibody under study

In addition, another monoclonal antibody, trontinemab, is currently being studied. Preliminary data from a phase 1/2 study involving 114 participants were recently presented, which seem to show a certain efficacy and speed of the drug in reducing the presence of amyloid plaques. “The results of phase 2 are particularly exciting, let's see if the efficacy will be confirmed by the trial that is starting,” comments Cagnin. In fact, phase 3 of the trial should start during 2025.