The incurable brain condition that affects over six million Americans has made progress in the fight against Alzheimer’s disease after years of work. The cognitive decline associated with this disease has been reduced by a number of new medications, though the results have been modest. Dr. Richard Hodes and William Brangham talked about these advancements and the challenges that lie ahead.
Brangham, William:
An FDA advisory panel unanimously agreed earlier this month that the drug Leqembi modestly slowed the progression of Alzheimer’s disease. The FDA is expected to give the all-clear the following month.
Donanemab, a similar drug, has also shown promise in clinical trials. It could also receive FDA approval this year. These medicines don’t do much, and there are concerns about side effects like bleeding and swelling in the brain.
Therefore, Dr. Richard Hodes joins us to discuss these advancements and the challenges that lie ahead. He has been in charge of the National Institutes of Health’s National Institute on Aging for a considerable amount of time.
It’s a pleasure to have you on the show, Dr. Hodes.
You are well aware that Alzheimer’s disease researchers have been searching for a crack for decades. And with these new drugs, we now have some hope. How promising do you perceive the disease to be based on the clinical outcomes to date?
Director of the National Institute on Aging, Dr. Richard Hodes: I believe you have contextualized it very effectively.
This is the first set of results that, according to experts who reviewed the findings, have a clear and significant impact on halting the progression of disease. The extent of this change is the subject of debate.
However, I believe that we can all agree that this is a significant first step that has the potential to improve by working on this fundamental initial finding to do even better and obtain a better ratio, if you will, of positive effect, prevention treatment, and side effects, which are also a significant point of data in these findings and the recommendations that are forthcoming from them.
Richard Hodes, MD:
Yes, Alzheimer’s disease is now recognized to be a disease that progresses slowly, with abnormalities in the brain appearing years or even decades before symptoms appear.
There is also sluggish progress. It differs from person to person. This would, therefore, be an important outcome of the treatment if these treatments were capable of slowing the disease down to the point where people retain their function, their ability to be independent, interact with families, and lead high-quality, meaningful lives.
Richard Hodes, MD:
Understanding which individuals are most likely to benefit from the treatment and which individuals are at greater risk is, in my opinion, a requirement for future research.
In addition, this information serves as a foundation for patients, their families, and the professionals who provide them with care to make an individual decision regarding the cost-benefit ratio for each case. In the interim, it will be crucial for us to carry out research to better identify the ideal candidates. Who is most likely to experience negative effects?
Additionally, research of this kind is already underway.
Richard Hodes, MD:
Very significant.
Therefore, the capacity to intervene, reduce risk, and prevent is crucial in addition to the search for treatments and cures. An examination of what we knew about risk factors and how we could lower disease risk was commissioned by the National Academies a few years back.
Additionally, the control of blood pressure, the maintenance of cognitive activity, and physical activity were the three risk factors for which there was the strongest evidence that intervention could assist.
Since that report, one of them—blood pressure control—has been demonstrated in a randomized clinical trial—the gold standard of a test for causal impact—that by more intensively controlling blood pressure in people of middle age and older, lesions in the brain that are characteristic of Alzheimer’s disease and mild cognitive impairment were significantly reduced.
That stage frequently occurs prior to dementia. In terms of direct evidence that controlling blood pressure makes a difference, then, this is as good as it gets.
In the interim, ongoing trials are being conducted to determine whether controlling one’s diet, engaging in physical activity, or engaging in cognitive training will have a similar effect.
Richard Hodes, MD:
Well, it’s crucial that a few levels.
We can begin with the moral and ethical imperative that we must carry out research that has the potential to benefit all citizens of our nation and, consequently, the entire world. In order to accomplish this, we must include participants from diverse backgrounds in our clinical trials and studies.
This is not merely speculative, and it goes beyond that moral imperative. The risk posed by a genetic variant in white, Caucasian, European populations is not the same as that in African American populations, as our findings demonstrate.
Individuals from various segments of our population are likely to have distinct pathways to Alzheimer’s disease and, as a result, to benefit from treatment differently due to differences in genetics, experience, and life exposures.
That can only be determined if a diverse population is included in our research.
