Advances in Alzheimer's disease treatment bring hope

Alzheimer's disease (AD) is a progressive brain disorder that destroys memory and thinking, with symptoms usually appearing later in life. Alzheimer's disease affects an estimated 6 million people in the United States, most of whom are at least 65 years old. Alzheimer's disease is the seventh leading cause of death in the United States.¹

Changes in the brain can occur up to 10 years before symptoms appear. Mild AD is characterized by memory loss and other cognitive complications such as wandering thoughts, repeated questioning, and behavioral changes. Moderate Alzheimer's disease causes damage to areas of the brain that control language, reasoning, conscious thought, and sensory processing. Eventually, as the disease progresses to severe AD, changes occur throughout the brain and the brain shrinks. At this point, memory loss and confusion worsen, severely impairing the person's ability to communicate and care for themselves.¹

There is no cure for AD, but there are treatments that can slow its progression and other treatments that can alleviate symptoms. New treatments are slowing disease progression and improving symptom management, representing a major advance for patients and caregivers.

slow down progress

New drugs can slow the progression of Alzheimer's disease by impairing the biology of the disease process. For example, anti-amyloid drugs remove amyloid beta, a protein that accumulates in plaques in the brain. Each of these treatments works differently and targets amyloid-β at different stages of plaque formation. These treatments can slow the progression of AD in patients with early-stage AD and allow more time for patients to participate in daily life. However, these treatments have side effects, such as amyloid-associated imaging abnormalities (ARIA). Common side effects of ARIA are usually asymptomatic but can be severe.²

Currently available anti-amyloid therapeutics are donanemab-azbt (Kisunla, Eli Lilly) and lecanemab-irmb (Leqembi, Eisai, Biogen). Donanemab-azbt is a humanized immunoglobulin gamma 1 (IgG1) monoclonal antibody against amyloid-β. It is administered via a 30-minute intravenous infusion once every four weeks and was approved by the FDA on July 2, 2024.³ In the TRAILBLAZER-ALZ 2 (NCT04437511) study, researchers found that treatment significantly delayed clinical progression at 76 weeks, with 23 of 24 results evaluated being statistically significant. did.⁴

Lecanemab-irmb is a humanized IgG1 monoclonal antibody directed against aggregated soluble and insoluble forms of amyloid-β. It is administered by intravenous infusion over an hour every two weeks and was approved by the FDA on July 6, 2023.⁵

In the CLARITY AD (NCT03887455) trial, researchers evaluated the efficacy of lecanemab irmb in 856 AD patients with mild cognitive impairment or mild dementia and confirmed amyloid-beta pathology. Masu. Statistically significant dose- and time-dependent reductions in amyloid-beta plaques were seen in patients treated with recanemavirum.⁶

Treatment of symptoms

Cholinesterase inhibitors, such as donepezil (Aricept, Eisai), rivastigmine, and galantamine (Razadyne, Janssen), are indicated for mild to moderate Alzheimer's disease. These drugs break down acetylcholine, which supports communication between nerve cells.² Memantine (Namenda; Allergan) is a glutamine modulator approved for moderate to severe AD. It regulates glutamine and may improve memory, attention, reasoning, language, and the ability to perform simple tasks. Additionally, the combination of donepezil and memantine (Namzaric, AbbVie) is a cholinesterase inhibitor and glutamine modulator indicated for the treatment of moderate to severe AD.²

Noncognitive symptoms, or symptoms that affect behavior or personality, can similarly affect a person's quality of life. These symptoms can manifest as sleep disturbances, agitation, hallucinations, and delusions, but there are medications that may help. For example, suvorexant (Belsomra; Merck) is an orexin receptor antagonist prescribed for insomnia in patients with mild to moderate AD. It works by inhibiting orexin, a neurotransmitter involved in the sleep-wake cycle. Brexpiprazole (Rexulti, Otsuka, Lundbeck) is an atypical antipsychotic drug approved for the treatment of agitation associated with dementia. However, it is not approved for dementia-related psychosis without agitation.²

There are many non-drug treatments for AD, including:^7-10:

• A brain-healthy lifestyle can help fight dementia symptoms. This includes being physically and socially active, eating well, managing stress, and challenging your brain.
• Cognitive behavioral therapy can help with diagnosis, adjusting to depression, and planning for the future.
• Music therapy helps with communication, coordination, expression, and socialization.
• Activities such as memory and orientation training, art therapy, aromatherapy, and contact with animals can help slow the decline in mental abilities.
• Nutritional interventions can help cognitive function and function.
• Changing the environment can encourage creative solutions to dementia symptoms.
• Family caregiver training helps families adjust to the diagnosis and learn how to help their loved ones.

A study by Brown University found that non-drug interventions for Alzheimer's disease are effective and cost-effective. These can improve quality of life, reduce nursing home admission, and are not associated with adverse events.¹¹

on the horizon

Alzheimer's disease research focuses on developing new treatments to slow or stop the progression of the disease. Areas of focus for this research include reducing chronic inflammation in the brain caused by Alzheimer's disease, the role of insulin in the brain, how changes in insulin are associated with Alzheimer's disease, and the role of gut health in Alzheimer's disease. This includes research. Prebiotics and diet can help.¹²

Researchers are also working to develop new drug delivery systems, including nanoparticle-based systems and focused ultrasound techniques, to more effectively administer new treatments. Finally, as with many other medical conditions, researchers are recognizing the importance of individualized treatment plans to address patients' individual needs and challenges.¹²

Pharmacist's role

Pharmacists play an important role in the care of Alzheimer's patients and their caregivers. Due to their close relationships and frequent interactions with patients, pharmacists may notice changes in behavior, memory, and mood, and may be aware of known predisposing factors such as cardiovascular disease, diabetes, hypertension, hypercholesterolemia, hearing loss, and depression. You can also monitor certain patients.

As drug experts, pharmacists can determine whether a particular treatment is having a negative impact on cognitive function and review patient records to identify potential risks before symptoms appear. Pharmacists are also important educators for patients and caregivers, providing information about treatments, side effects, and medication compliance.

Pharmacists can work with the larger medical team to fine-tune medication regimens, ensure correct dosing, and monitor patient interactions. Patients should also be told about lifestyle adjustments that may reduce their risk of Alzheimer's disease, such as dietary changes, exercise, and cognitive activity. Finally, pharmacists can connect people with Alzheimer's disease and their caregivers with resources available in their area. of table Highlight some available resources.