Age-based cognitive decline, especially Alzheimer’s disease, can have a devastating impact. No one wants to go through it themselves or watch a loved one turn into a stranger. Luckily, new research offers insight into the disease, allowing for innovative strides to be made in diagnosis, treatment and prevention. T&S spoke with Sarah Lovegreen of the Alzheimer’s Association Greater Missouri Chapter to learn more about the latest advances.
diagnosis
Alzheimer’s disease is usually diagnosed through a multimodal process where doctors assess cognitive skills, functional abilities and behavior changes, while also performing tests to rule out other potential causes of memory loss and other symptoms. A positron emission tomography (PET) scan can be done to look for the build-up of amyloid-beta, a brain protein that has been connected to the disease. However, Lovegreen notes that insurance often won’t cover a PET scan, which has an average cost of between $5,000 and $8,000. “Spinal fluid also can be tested for amyloid, but a lumbar puncture is required,” she adds. “For many patients, especially those who don’t have a positive relationship with the health care system, the procedure is too invasive to be a viable option.”
Research is currently being done to find a less invasive and more cost effective way to look for early signs of Alzheimer’s. “The main target is finding a blood-based option,” Lovegreen says “Washington University currently is working on a test called Precivity AD. The research is extremely promising and encouraging.” Precivity AD determines if amyloid plaques have begun forming in the brain by looking at the ratio of the levels of the amyloid beta proteins Aβ42 and Aβ40 in the blood. While less accurate than a PET scan, the blood test could cut costs by tenfold or more and allow patients to enroll in clinical trials for treatment more quickly.
treatment
Treating patients with Alzheimer’s disease is currently focused on managing symptoms, according to Lovegreen. “While these drugs can alleviate symptoms, they only work for a limited amount of time because they are doing nothing to change the progression of the disease,” she explains.
Treatments are being developed to target the buildup of amyloid plaques. Pharmaceutical companies Eisai and Biogen recently reported the data from the phase 3 trials of the drug lecanemab. Over 18 months, the drug reduced the progression of Alzheimer’s by 27% when compared to a placebo. “Amyloid buildup is one of the telltale signs of the disease, and working to clear it out seems to have cognitive benefits for patients,” Lovegreen says. “We’ll learn more about the results as lecanemab goes forward for FDA approval, but we’re really starting to see the fruits of research into amyloid come forward.”
Tau, another protein that appears abnormal in the brains of people with Alzheimer’s, is another factor currently being targeted in research for potential interventions. Lovegreen notes that Alzheimer’s treatment will likely take a multifaceted approach, targeting various elements related to the progression of the disease. “With cancer and heart disease, multiple drugs are used to target different modalities of the condition,” she notes. “Research is actively happening in different areas for Alzheimer’s as well.”
prevention
This August, the Alzheimer’s Association hosted its annual international conference. Lovegreen notes that one of the topics covered was the connection between Alzheimer’s and certain lifestyle factors. “A study related to the impact of over-processed food was presented, and the impact of diet on cognitive health is a big area of research,” she says. “Another study looked at how racism and the resulting stress and trauma can affect cognitive decline. Researchers are really starting to look at the impact the environment and lifestyle can have on slowing the progression or preventing Alzheimer’s.”
The Alzheimer’s Association also is currently conducting the U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk (U.S. POINTER), which looks at how different lifestyles may impact or prevent Alzheimer’s disease. The study follows one conducted over two years in Finland, the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability or FINGER Study. In 2014, the FINGER Study reported that a combination of physical exercise, healthy diet, cognitive stimulation and self-monitoring of heart health risk factors had a protective effect on cognitive function. “The U.S. POINTER study is looking at the individual to see how lifestyle interventions can preserve cognitive health,” Lovegreen says. “The research is trying to point to how we can delay the onset of Alzheimer’s altogether.”