The Amyloid Breakthrough.
After decades of failed clinical trials and research dead ends, there may be some hope on the horizon for Alzheimer’s Disease treatments. Since 2021, three anti-amyloid drugs have received regulatory approval in the United States:
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Aducanumab - The first approved, but not without controversy
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Lecanemab - FDA approved in 2023
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Donanemab - FDA approved in 2024
These drugs work by using antibodies to clear away amyloid-β plaques in the brain, improving neuronal communication and reducing cognitive decline.
Clinical trials published in 2022 and 2023 showed they can slow cognitive decline by approximately 30%. While this effect is modest, for many patients and families, even six months longer in a coherent state can mean "the difference between being able to have meaningful conversations with your children about their lives, or not,” according to neuroscientists at Amsterdam University Medical Centre.
Limitations
Whilst the breakthrough in treatment is promising, the drugs are not without their drawbacks. The main side effects include what scientists call amyloid-related imaging abnormalities (ARIA) - brain swelling or bleeding that occurs in about 21.5% of patients treated with lecanemab. Most cases are asymptomatic, but some patients experience confusion, headaches, or dizziness, with rare instances of seizures or even death.
Perhaps most importantly, these drugs appear most effective in the early stages of Alzheimer's. Once a person progresses beyond mild dementia, the clinical benefits diminish significantly, regardless of how well plaques are cleared.
The importance of brain health and Early intervention
The limitations of current treatments has taught us a valuable lesson: Prevention and early intervention are essential. Here’s why maintaining brain health throughout life matters:
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The 20-30 year window: Amyloid-Beta begins accumulating in the brain two or three decades before symptoms appear. By the time memory problems develop, significant damage has already occurred
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Prevention trials: Current trials like Ahead and Trailblazer-Alz 3 are testing whether anti-amyloid drugs can prevent symptoms onset in people who have amyloid accumulation but no symptoms yet.
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Blood Biomarkers: Advances in blood tests to detect Alzheimer’s pathology may soon make it possible to identify at-risk individuals before symptoms develop, enabling preventative treatment.
Brain health: What you can do now
While we await more effective treatments and preventative options. The emphasis needs to be on what we can do to support our brain health today:
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Regular physical exercise
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Heart-healthy diet
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Cognitive stimulation
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Quality sleep
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Stress management
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Social connection
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Regular check-ups
Conclusion
We are at a pivotal moment in Alzheimer's research. For the first time, we have treatments that meaningfully modify the disease process, even if their effects are modest. More importantly, we're gaining deeper insights into the complex mechanisms underlying this condition.
Arguably, the most important message from current research is that Alzheimer's disease begins decades before symptoms appear, making early detection and prevention our most promising strategies. By embracing brain-healthy habits throughout life and supporting research that may one day make prevention possible, we can hope for a future where Alzheimer's disease no longer robs people of their memories, independence, and dignity.