Alzheimer’s Disease is a form of dementia that currently affects six million Americans and is expected to increase to nearly 14 million Americans having this disease in the year 2060.
What is dementia?
Dementia happens when an individual suffers a cognitive decline to a degree that affects their daily functioning. There are many diseases that may cause dementia, but Alzheimer’s is the most common form.
Dementia is characterized by the deposition of certain proteins that cause the disease. These proteins, called Amyloid Beta and Tau exist in the brain naturally but become misshapen or altered in a way that disrupts brain function. Early in the disease, these proteins exist in limited parts of the brain that affect primarily memory, but over time will spread to affect multiple parts of the brain and the ability to function and perform tasks.
Treatments for Alzheimer’s Disease
For the past two decades, treatments for Alzheimer’s have included medications that make the functioning neurons work better. These medications increase the transmission of Acetylcholine, a chemical that carries messages from your brain to your body through nerve cells. Another medicine provides stability and efficiency to nerve transmission.
In recent years, doctors have been able to detect the pathologic changes of Alzheimer’s disease in earlier stages of memory loss by way of special imaging or analysis of cerebrospinal fluid (CSF), a clear, colorless, watery liquid that flows in and around the brain and spinal cord.
Early detection and accurate diagnosis have allowed the testing of treatments that can slow down the specific pathology of Alzheimer’s. In the past two years, two new medications have become available, one of which, Lecanemab, has shown benefit in slowing down the rate of decline of the progressive nature of Alzheimer’s.
How these medications work
These medications work by targeting amyloid proteins for removal, which is felt to be a driver in the progressive cascade of Alzheimer’s disease. Unfortunately, the removal of this protein can increase the risk of bleeding and swelling in the brain, which may be severe.
Some patients may be more at risk for these side effects than others. For this reason, patients may need to be pre-screened for genetic risk with a test that looks for Apolipoprotein E (ApoE), a protein that carries cholesterol and supports lipid transport and injury repair in the brain. Certain forms of this gene increase the risk of bleeding or swelling with these treatments. It is also important that patients be monitored with MRI scans done at periodic intervals during treatment.
Who is eligible for new treatments
Given these limitations, these current treatments are not appropriate for all patients. The medications were tested on those with early or mild memory issues related to Alzheimer’s and not those with more advanced disease.
The diagnosis of Alzheimer’s requires either imaging confirmation with a test called an amyloid PET scan or a spinal tap to analyze the spinal fluid for the amyloid and tau proteins. Individuals who have already suffered bleeding in the brain, are at risk of bleeding, or are taking blood thinners, would not be eligible for these treatments. Lastly, those with certain genetic traits (carriers of ApoE 4) would be at higher risk of side effects with treatment.
The cost of these treatments is also a consideration, currently estimated to be about $32,000 a year for testing and infusions. Although Medicare has agreed to cover this treatment, not all Medicare plans will cover it (those managed by insurance companies, for example).
Hope for the future
The approval of monoclonal antibodies for the treatment of Alzheimer’s disease is an exciting and important first step, however, it still is only one small step in the fight against this devastating disease. Despite some of the risks, drawbacks, and limitations of this new treatment, the progress that has been made after decades of failed advancement remains a reason for optimism in the treatment and perhaps one day, cure, of this disease.
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