Drug Approvals and Research Advances Improve Alzheimer’s Disease Treatment

This year has seen significant advances in understanding, preventing, and treating Alzheimer’s disease (AD), offering hope and new avenues for managing this challenging condition. This is excellent news for all seniors and perhaps more so for older women, given that women are disproportionately affected by this disease. Of the 6.9 million people ages 65 and older with AD in the United States, 4.2 million (or 61 percent) are women.

Clinical Trials

There are 164 clinical trials assessing 127 drugs for AD. Over half of these treatments aim to slow progression of cognitive decline. Decades of research paid off over the past two years with the FDA’s approval of lecanemab (Leqembi) in January 2023 and more recently with donanemab (Kisunla) in July 2024. These immunotherapy treatments move beyond symptom management to delaying the worsening of Alzheimer’s symptoms, such as memory loss.

“After many false starts, treatments have been introduced for Alzheimer’s disease. When given to individuals with initial signs of Alzheimer’s, these drugs, known as “biologics” (because they are made using living cells or organisms) slow down the progression of the disease to the point that improvements can be noticed in their daily lives,” says Costantino Iadecola, MD, Director of Weill Cornell Medicine’s Feil Family Brain and Mind Research Institute.

Donanemab is an anti-amyloid antibody intravenous (IV) infusion therapy that is delivered every four weeks. Lecanemab is an anti-amyloid antibody IV infusion therapy that is delivered every two weeks. Both are approved for treatment of early AD, including for people living with mild cognitive impairment (MCI) or mild dementia due to AD who have confirmation of elevated beta-amyloid in the brain. “These are not cures, but they offer women who start to have the first signs of disease the chance to slow down the progression of the cognitive deficit and live fuller lives longer,” says Dr. Iadecola. In clinical trials, donanemab slowed the speed of cognitive decline progression by up to 60 percent.

Early Detection

The importance of early AD detection cannot be overstated. “Early treatment is the key, and a reliable blood test would make early diagnosis more likely,” says Dr. Iadecola. Research presented at the 2024 Alzheimer’s Association International Conference suggests that AD blood tests are moving closer to use in physicians’ offices, and that blood tests that assess p-tau protein to identify Alzheimer’s-related changes in the brain show the most promise.

A study with over 2,700 people found that measuring p-tau217 protein in blood could help identify those at risk for Alzheimer’s, even if they don’t show symptoms yet. Another study demonstrated that using advanced blood tests in doctor’s offices could cut down the time it takes to diagnose and start treating Alzheimer’s from almost six years to less than six months, and a study using the PrecivityAD2 test (C2N Diagnostics) that included over 1,200 people showed that the test was about 90 percent accurate at identifying Alzheimer’s, compared with specialists at memory clinics, who were 73 percent accurate, and primary care doctors, who were 63 percent accurate.

Genetic Profiling

People at risk for AD may benefit from personalized medicine, which takes into account the unique aspects of each person’s condition. “Another major advance has been the discovery of genes that provide protection for people who have inherited Alzheimer’s genetic markers. Scientists, including those at Weill Cornell, are starting to develop therapies based on these protective genes. It will take time, but the payoff may be substantial,” says Dr. Iadecola.

Prevention Advances

Research suggests that GLP-1 agonist drugs, which we report on in this issue on page 3, may also help protect the brain—in addition to helping with weight loss and associated comorbidities. Scientists at Imperial College London found that liraglutide, a GLP-1 drug marketed under the names Saxenda and Victoza, may reduce brain shrinkage in areas that control memory, learning, language, and decision-making by almost 50 percent compared with placebo.

Looking Ahead

Collaborative efforts among researchers, pharmaceutical companies, and government agencies are accelerating the pace of discovery and innovation of new Alzheimer’s treatment, as evidenced by the pair of recently available immunotherapy drugs capable of slowing disease progression.

With reliable blood tests that may be administered in doctors offices on the horizon and a growing body of knowledge regarding prevention, decades of Alzheimer’s disease research is beginning to yield significant and promising results.

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