Toward a More Humane and Economically Viable Long-Term Care System
A Penn LDI Virtual Panel Looks Ahead at New Possibilities
Improving Care for Older Adults
In Their Own Words
A New Era in Treating Dementia
New Therapies Inspire Hope, Even as Access and Treatment Risks Continue to Challenge Patients and Providers
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The following excerpt is from a First Opinion published on STAT News on October 27, 2025. It is the final installment in the column, Neurotransmissions, which STAT invited Karlawish to write.
Diagnosis is interesting. Treatment is exciting.
I’ve fond memories from early in my career prescribing medications that within minutes relieved patients smothering from congestive heart failure, pulled them back from near death from septic shock, or slowed the progression of their diabetes or heart disease. In my fellowship, my prescription of carbidopa transformed the first patient with Parkinson’s disease I diagnosed. After he went from the “utter misery” of house-bound days to happily walking about the neighborhood with his wife, the couple called me their miracle worker.
My career treating people living with dementia hasn’t been as exciting. Some days, after spending an hour or more with a patient and family, I’d reflect upon the care I’d given. I’d prescribed no medications. The dementia pharmacopeia was a short list of medications to mildly palliate cognitive symptoms and relieve depression and anxiety.
I think this lack of excitement is one reason for, as I recounted in the essay that opened this series, my acquaintance’s quip he’d take a test for Alzheimer’s if it came with a gun license, and why Brian Ameche traveled to Zurich to take his lethal dose of pentobarbital. My friend’s remark and Brian’s death by his own hand are vivid responses to doctors like me. We offer no treatment that can change the relentless chipping away at consciousness that is dementia.
Read the full First Opinion here.
Author
Jason Karlawish, MD
Professor, Medicine and Professor, Medical Ethics and Health Policy, Perelman School of Medicine; Co-Director, Penn Memory Center
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