Bartecchi: New Alzheimer's Disease treatments
We are beginning to see new treatments for Alzheimer’s Disease (AD) being given accelerated approval by the FDA.
According to Yale Medicine, a very expensive drug called lecanemab (Leqembi) has been shown to moderately slow cognitive and functional decline in early-stage cases of the disease, possibly slowing AD progression by several months. This drug, given by intravenous infusion every two weeks, is expected to seek traditional FDA approval (which would allow access for qualified patients) by Eisai, its pharmaceutical company.
A recent article in the journal Brain suggested that lecanemab has proven better than a similar drug aducanumab, because it is a better amyloid targeting drug, having a better rate and degree of removal of amyloid and thus more clinical benefit. Lecanemab has shown that anti amyloid therapy works for AD. This drug has a number of side effects, but fewer than other drugs in its class. One concern mentioned in Science magazine is a loss of brain volume, for unknown reasons, with this drug.
The future is looking brighter for the development of drugs that could potentially delay or stop the gradual loss of cognitive functions, including the ability to remember, reason, use language and recognize familiar places.
A recent article in Johns Hopkins Medicine notes the emotional pain patients and caregivers suffer when one loses memories to AD. The article, however, stresses that memory loss is just the beginning and that there are other symptoms that need to be recognized and managed. These symptoms include depression, anxiety and agitation, and sleep-related problems, which if left untreated can have a significant effect on the quality of life and even on the course of the disease itself. Attention to these symptoms can also improve the quality of life of the caregivers as well. These symptoms, as discussed in the Hopkins article as well as in other sources, along with suggestive approaches to these symptoms, are as follows:
Agitation and anxiety symptoms in people with AD can include pacing and restlessness, loss of inhibition, profanity, shouting, and shoving, as well as verbal and physical aggression. These symptoms are the leading causes of assisted living or nursing home placement and caregiver distress. Agitation is among the most persistent, complex, stressful and costly aspects of care among patients with behavioral and psychological symptoms of dementia. An estimated 45% of people living with AD experience symptoms of agitation.
The FDA has recently granted supplemental approval of the drug, brexpiprazole (Rexulti), for treating agitation linked with AD. It is the first drug approved to treat agitation symptoms associated with AD It has side effects and a higher risk of death, but has shown statistically significant and meaningful improvement, reported by caregivers. The FDA has given this drug a Fast Track designation which is designed to facilitate the development and review of this potentially important drug. For anxiety, antidepressants can often help and citalopram (Celexa) has been found to be effective for anxiety in a recent Hopkins clinical trial.
Depression: as many as 50% of AD patients have been found to experience depression. Some depression is related to changes in the brain, and early in the disease, to the shock of the diagnosis. Treatment usually involves medications called selective serotonin reuptake inhibitors (SSRIs) which can also help with anxiety and agitation.
Sleep Disruption: AD patients spend more time awake than those without AD. A change in sleep pattern may be an early sign of AD. Sleep disturbances may be due to AD impact on the brain. One needs to rule out other causes of sleep disturbances such as depression, restless leg syndrome, sleep apnea or problems related to caffeine, alcohol and nicotine. Sleeping pills should not be used. If patients are up or awake more at night and sleeping during the day, encourage daytime activities, exercise such as walking and adult day centers with social activities, to keep them busy.
AD, according to the FDA is not a normal part of aging. Evidence is emerging that healthy behaviors can lower the risk of AD. The symptoms and complications of AD, along with the lack of an effective cure, the complications and expense of medications and the distress caused in patients, caregivers and families should encourage us to employ the emerging evidence that healthy behavior can lower the risk of AD.
The FDA suggests that you can reduce your risk of AD by making healthy lifestyle choices such as: Prevent and manage high blood pressure, manage blood sugar, maintain healthy weight, be physically active, quit smoking, avoid excessive drinking, prevent and correct hearing loss, and get enough sleep. According to a recent editorial in the journal Nature Medicine, studies in high income countries have shown a decrease in the prevalence of dementia linked to modifiable dementia risk factors.
Dr. Carl E. Bartecchi, MD, is a Pueblo physician and clinical professor of medicine at the University of Colorado School of Medicine.
This article originally appeared on The Pueblo Chieftain: Bartecchi: New Alzheimer's Disease treatments
