Alzheimer’s disease affects approximately 6 million people in the U.S. and over 50 million worldwide. While there is no cure yet, there is hope.
Scientists are learning more and more each day about what causes this brain disease and other forms of dementia. With that knowledge, researchers are developing new treatments that target the root cause, not just the symptoms, of this disease – and the results are promising.
Anjali Patel, MD, a cognitive neurologist at Atlantic Health System, breaks down the science behind Alzheimer’s disease and what the new research advances could mean for you and your loved ones.
Dementia vs. Alzheimer’s: What’s the Difference?
Dementia is a broad, umbrella term. It’s used to describe symptoms of cognitive (thinking, reasoning, remembering, and learning) decline significant enough to interfere with your daily life.
Alzheimer’s is a type of dementia. It’s a disease in which naturally occurring tau proteins tangle and beta-amyloid proteins clump, causing nerve cell damage and death in the brain. The amyloid build-up causes plaque to form, which blocks cell-to-cell signaling and triggers an immune response that, in turn, causes inflammation.
Most people with Alzheimer’s disease are over 65 years old, but as Dr. Patel explains, these changes begin in the brain decades before symptoms appear.
FDA Approves Anti-Amyloid Agents
While there’s still no cure for Alzheimer or dementia, progress is being made.
Prior to 2021, Alzheimer treatment was limited to medications that address symptoms of the disease only. But in June 2021, the FDA approved the first anti-amyloid agent (aducanumab) to treat one of the root causes of Alzheimer’s – amyloid plaques. In January 2023, a second anti-amyloid drug, lecanemab, was also approved.
“Both of these drugs are monoclonal antibodies (meaning, laboratory-made molecules) that attack amyloid plaque build-up,” Dr. Patel says, “But they use different mechanisms to remove amyloid plaque.”
Who Can Use Anti-Amyloids?
So far, anti-amyloid agents are only approved for people with mild cognitive impairment or early-stage Alzheimer’s. To qualify, you need to be cleared by your doctor and meet three (3) criteria:
- Score “within range of mild cognitive impairment” on the Alzheimer’s Disease Rating Scale and the Clinical Dementia Ratings chart.
- Have a recent MRI (magnetic resonance imaging) that rules out any prior brain bleeds within the past year.
- Have a recent PET scan (brain imaging) or lumbar puncture (spinal tap) that shows evidence of amyloid plaque build-up in your brain.
Are There Any Negatives?
Because these drugs are new, they are expensive and not widely available. Many private insurance carriers don’t cover them and Medicare won’t pay unless you’re part of a clinical trial.
Also, as with all drugs, there are risks associated with them. Common side effects range from infusion reactions and headaches to amyloid-related imaging abnormalities (ARIA), which can result in brain swelling or bleeding. Some people with ARIA are asymptomatic, meaning they won’t have any signs unless they have imaging studies done (which are part of clinic trials).
Dr. Patel advises that you speak with your doctor to see if the benefits outweigh the risks for your personal situation.
Are Anti-Amyloid Agents a Cure?
In a word, no. Neither drug is a cure for the disease because neither reverses amyloid build-up. New plaque can still form over time. But the clinical trials have shown that anti-amyloid agents (which are delivered intravenously, through the arm), reduce existing plaque, decrease cognitive symptoms and slow the advancement of the disease.
“Anti-amyloid agents are the first step towards fighting the cause of Alzheimer’s,” says Dr. Patel. “More research and treatment options are still needed, but we’re making headway.”
While studies continue on the existing anti-amyloid agents, Eli Lilly recently completed a very successful late-stage (phase 3) trial of donanemab, a new anti-amyloid drug that will be submitted to the FDA for approval next month.
After using the drug for 18-months, 35% of participants showed signs of reduced slowing on rating scales that measure cognitive function and activities of daily living. Participants receiving donanemab also had a 39% lower risk of progressing to the next stage of disease when compared to the placebo.
“What’s exciting is that these anti-amyloid agents can slow the progression of the disease and improve quality of life for longer periods of time,” says Dr. Patel.
Dr. Patel reminds us that new advances are being made every day and if you’re experiencing memory loss or other cognitive difficulties that are affecting your daily life, the most important thing is to be evaluated by a professional. Start with your primary care provider, and if appropriate, see a specialist. If using anti-amyloid agents appeals to you, talk to your doctor to see if you’re eligible to participate in a clinical trial.
Be Proactive About Your Health
If you’re experiencing memory loss or other cognitive difficulties that are affecting your daily life, the most important thing is to be evaluated by a professional.