Alzheimer's Treatment: Progress, Challenges and Hope
Alzheimer’s dementia currently affects about 6.9 million Americans aged 65 and older, a number expected to double to 13.8 million by 2060 without medical breakthroughs. It is the fifth-leading cause of death among older Americans, with deaths increasing by over 140% from 2000 to 2021, while deaths from stroke, heart disease and HIV declined. In 2023, more than 11 million unpaid caregivers provided 18.4 billion hours of care to people with Alzheimer's or other dementia, valued at $346.6 billion.
In India, around 8.8 million people aged 60 and older have dementia, with projections suggesting this could exceed 14 million by 2050.
Despite numerous promising leads, the development of new treatments for Alzheimer's disease remains a slow and complex process. Current therapies temporarily alleviate symptoms by enhancing brain chemicals responsible for communication between neurons. However, these treatments do not halt the underlying decline and eventual death of brain cells, leading to the continued progression of the disease.
Researchers remain cautiously optimistic about emerging treatments aimed at delaying or stopping Alzheimer's progression. Future therapies may involve a combination of drugs, similar to treatments for cancer or HIV/AIDS. These innovative strategies seek to target the disease at multiple levels, offering potential breakthroughs in treatment.
One major avenue of research focuses on beta-amyloid plaques, a hallmark of Alzheimer's disease. Monoclonal antibodies such as lecanemab (Leqembi) and donanemab (Kisunla) have shown promise in slowing cognitive decline in individuals with early-stage Alzheimer's by preventing plaque formation. However, these treatments come with risks, including brain swelling and bleeding, particularly for individuals carrying the APOE e4 gene. The FDA recommends genetic testing and regular brain imaging to monitor for adverse effects.
Another research strategy involves preventing neuronal destruction. Saracatinib, initially developed as a cancer treatment, has demonstrated potential in reversing memory loss in animal models by reactivating synaptic function. Clinical trials are now underway to determine its efficacy in humans. Additionally, researchers are exploring beta- and gamma-secretase inhibitors to reduce beta-amyloid production, though early studies have raised concerns about side effects and limited effectiveness.
Beyond amyloid plaques, scientists are investigating tau protein tangles, another defining feature of Alzheimer's. Tau aggregation inhibitors and vaccines are currently in development to prevent these destructive structures from forming. Researchers are also studying inflammation in the brain, with medicines like sargramostim (Leukine) being tested for their potential to protect neurons by stimulating immune responses.
The connection between cardiovascular health and Alzheimer's risk is gaining increased attention. High blood pressure, heart disease, and diabetes have been linked to a greater likelihood of developing dementia. As a result, clinical trials are examining whether blood pressure medications and other cardiovascular treatments can provide neuroprotective benefits. Lifestyle factors such as regular exercise and a heart-healthy diet are also being investigated as potential preventive measures.
Efforts to accelerate drug development have led to collaborations such as the Critical Path for Alzheimer's Disease (CPAD) consortium. By fostering data sharing among pharmaceutical companies, nonprofit organizations, and government agencies, CPAD aims to streamline clinical trials and improve the efficiency of developing new therapies. While progress remains slow, these efforts offer hope that more effective Alzheimer's treatments will emerge in the near future.