…And Now Alzheimer’s

By Michael Hodin

Covid-19 therapies and vaccines may be the most visible, but they aren’t the only places we are seeing transformational research translated to profound societal needs. At this past week’s International Conference on Alzheimer’s & Parkinson Diseases 2021, hope came in the form of progress on innovations for the dreaded Alzheimer’s disease — a crisis perhaps more slowly emerging than our experience with the Covid-19 pandemic, but one deserving serious and real attention as global demographics reach 2 billion over 60 where tens of millions are at risk.

At this past weekend’s virtual conference, we were able to see the progress on Alzheimer’s innovation from Roche’s Gantenerumab to Biogen’s Aducanumab, itself surely deserving FDA approval this spring. And the scientific, geriatric, and caregiving community applauded the ground-breaking results from Eli Lilly’s Phase II clinical trial of its Alzheimer’s treatment, donanemab. As we open the first year of the Decade of Healthy Ageing, the milestone progress on Alzheimer’s detection and treatment innovation represent not just great scientific value, but also the larger hope that we can conquer this singular heavy weight on healthy aging itself.

As described in The New England Journal of Medicine, the trial finds that donanemab significantly and consistently slowed cognitive and functional decline for people with mild cognitive impairment and mild Alzheimer’s disease across a period of almost a year and a half. This means the drug made a meaningful difference, enabling people to perform better on cognitive tests and tasks of everyday living for longer. Crucially, it is disease-modifying — meaning that it changed the trajectory of the disease during the trial period, which also has consequential implications for the Decade’s goals of healthy and more active aging.

The study also includes interesting nuances that could indicate the future of Alzheimer’s treatment. It is the first study to target people based on their levels of tau protein — indicating the potential to use biomarkers to identity those most likely to benefit from certain treatments at certain stages of the disease. And study participants stopped receiving the treatment once their levels of beta amyloid had cleared, indicating the potential to remove the drug but maintain the benefit — a key consideration for payers, which itself is profoundly important as our global demographic mix shifts to more old than young.

While we look forward to further studies necessary to validate these results, this trial already points to a future where we may finally have a broad arsenal of disease-modifying therapies and other tools to address Alzheimer’s. This will enable people with Alzheimer’s to stay active and independent for longer, supporting their overall health. It will also delay or reduce the burden on caregivers — often older adults themselves — who face negative physical, mental, and financial impacts from their caregiving responsibilities. This, in turn, leads to higher medical and long-term care costs, depleted workforces, and strained public and private finances.

We are moving towards a future where Alzheimer’s can be more strongly addressed, prevented, and controlled than ever before. Here’s how we can continue to accelerate progress:

· Speed innovation. The incredibly fast development of Covid-19 vaccines and therapies and other treatments indicate that rapid therapeutic advances are possible — if policymakers and the private sector prioritize innovation. Faster progress is desperately needed in the Alzheimer’s space, where a new treatment has not been approved in nearly two decades. Thankfully, the pipeline holds promise, as there are nearly 30 Alzheimer’s treatments in Phase III trials, and around 80% of all drug candidates are disease-modifying, including what we saw this past weekend from Roche, Biogen, and Lilly.

· Embrace active aging for brain health. But we don’t have to wait for new treatments. While researchers and pharma companies are making every effort to advance therapies, health systems, policymakers, non-profits, and employers can advance public health messages that build awareness of brain health. These are the simple steps that everyone can take, every day, to reduce their risk for Alzheimer’s, such as staying active, eating healthy, and keeping socially engaged. This fits directly into the Decade of Healthy Ageing — better overall health means better brain health means less Alzheimer’s and dementia.

· Tap the potential of health technologies. Covid-19 has also illustrated the immense value of telehealth and remote care technologies. For Alzheimer’s, diagnostic tools and digital monitoring technologies help people in the early stages, and other solutions can help streamline care later in progression. Indeed, addressing cognitive decline is one of the most important areas for digital innovation, as we’ll discuss at the first-ever WSIS Forum Healthy Ageing Innovation Prize.

· Support caregivers. Alzheimer’s must be a priority not only because of the relative lack of treatment options, but because of the complex impacts on caregivers. As populations age, countries cannot afford for Alzheimer’s disease to force employee-caregivers out of the workforce and drive-up costs due to the cascading health impacts of caregiving. Efficient models like home care can help to reduce the burden on family caregivers, as well as potentially help people with Alzheimer’s to access eventual therapies.

We look forward to longer and larger trials to study the efficacy and safety of innovative medicines for Alzheimer’s disease. At a time when 100-year lives are becoming the norm, the results this past weekend are another important sign of progress on one of the foremost challenges to healthy longevity.