New Drugs May Be Able to Treat Alzheimer’s Before It Starts

Researchers have launched two studies in which people at high risk for Alzheimer’s disease will be treated before symptoms appear.

The new drugs target the APOE4 gene, which is believed to be a contributor to the development of Alzheimer’s disease. Getty Images

Few effective treatments are available for patients with mid-level or late-stage Alzheimer’s disease.

So researchers are increasingly looking at ways to fight the brain disease before symptoms even become apparent.

That’s why people with known risk factors for Alzheimer’s — but no signs of cognitive impairment — are being recruited for a pair of studies called the Generation Program.

“There are relatively few studies looking at people without symptoms, even though the trend is already toward doing drug interventions earlier and earlier,” Dr. Pierre Tariot, director of the Banner Alzheimer’s Institute in Arizona, told Healthline.

Banner Alzheimer’s Institute researchers want to test the effectiveness of two types of anti-Alzheimer’s medications on individuals ages 60 to 75 who carry the APOE4 gene, a biomarker for increased risk of the disease.

“This is one of just two studies looking at risk based on age and genetic vulnerability,” noted Tariot.


How the research will be conducted

Voluntary participants in the program will be screened for the presence of APOE4 through a registry called GeneMatch.

Researchers will need to screen approximately 200,000 people in order to identify the 3,400 people with the APOE4 gene required for the study, Tariot said.

The research involves experimental drugs from pharmaceutical companies Novartis and Amgen.

The early intervention is aimed at preventing the formation of amyloid plaques in the brain — a known symptom of Alzheimer’s.

One study will focus on people with two copies of the APOE4 gene.

The other will look at those who carry either two copies of the gene or one copy plus some evidence (as seen via brain scans) that amyloid plaques are starting to form.

The drugs tested will include an injected medication that prompts an immune response against amyloid creation and an oral antiamyloid drug that targets the pathological variant of the plaques.


Multiple genes equals higher risk

About 10 to 15 percent of people carry the APOE4 gene.

Having one copy of the gene increases Alzheimer’s risk two- or threefold while having two copies carried a 12 times greater risk for getting the disease, according to research published in 2014 by Daniel M. Michaelson, PhD, of Tel Aviv University.

The U.S. Food and Drug Administration (FDA) has approved several drugs that target chemical messengers in the brain and seem to improve symptoms or slow the loss of cognitive ability for some with Alzheimer’s.

No drugs have proven effective in halting disease progression in those with more advanced Alzheimer’s.

However, research that incorporates genetic biomarkers such as APOE4 and the presence of amyloid plaques is relatively recent, said Rebecca Edelmayer, PhD, director of scientific engagement at the Alzheimer’s Association.

The Generation Program studies are funded by the Alzheimer’s Association, the National Institute on Aging, foundations, and drugmakers.

“We want to start even before someone experiences symptoms and hopefully decelerate or arrest the development of the disease,” Edelmayer told Healthline.

The Banner Alzheimer’s Institute is also running a research project in Colombia, where a population of high-risk 30-year-olds is being immunized against amyloid and tracked over their lifetime for signs of cognitive decline.

“When we use drugs for treatment when the brain is already damaged, we don’t get much improvement,” said Tariot. “But if we go in before the damage is done, will it stave off the symptoms? That seems to be our best shot at treating this condition.”


Reducing your risk for Alzheimer’s

Drug therapy isn’t the only way to reduce your risk for Alzheimer’s disease and other forms of dementia, experts say.

The Alzheimer’s Research and Prevention Foundation identifies the “four pillars of Alzheimer’s prevention” as a Mediterranean diet and supplements, physical and mental exercise, yoga and meditation, and maintaining psychological well-being.

The Alzheimer’s Association also lays out “10 Ways to Love Your Brain” and reduce your risk for cognitive decline:

  • Break a Sweat (exercise)
  • Hit the Books (read and learn)
  • Butt Out (quit smoking)
  • Follow Your Heart (take steps to reduce cardiovascular disease risk)
  • Heads Up (prevent brain injuries)
  • Fuel Up Right (adopt a healthier diet)
  • Catch Some Zzzz’s (get more sleep)
  • Take Care of Your Mental Health
  • Buddy Up (be socially engaged)
  • Stump Yourself (play games and do activities that stimulate and challenge your mind)

The Alzheimer’s Association’s two-year U.S. Pointer study, launched in 2017, is a clinical study designed to evaluate whether lifestyle interventions can protect older adults at risk for cognitive decline.

“It’s never too early or too late to start these things,” said Edelmayer.

The recommendations are based more on what’s known about risk factors for cognitive impairment generally than Alzheimer’s in particular, but as Edelmayer noted: “These things can’t harm you in any way.”

Enrolling in studies via registries such as GeneMatch and the Alzheimer’s Association’s TrialMatch is another way people can work proactively toward dementia prevention, she added.

The bottom line

Alzheimer’s disease is difficult to treat once symptoms of cognitive decline are detected.

People with certain genes are at significantly higher risk for getting Alzheimer’s.

Researchers have begun two studies to determine whether some new drugs that prevent the formation of brain plaques associated with Alzheimer’s are effective when given to those at higher risk before they have symptoms.

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