The Top Alzheimer’s Breakthroughs of 2019
Funding for Alzheimer's research is ramping up and we're starting to see the benefits.
Funding for Alzheimer’s research is finally catching up to the devastating reality of the disease. According to the Alzheimer’s Association, almost six million Americans currently have the disease, a number expected to rise to 14 million by 2050. But recent legislation has more than quadrupled funding for Alzheimer’s research at the National Institutes of Health (NIH) and the investment is already leading to breakthroughs.
“We’re in a golden age of dementia research,” says Keith Fargo, PhD, director of scientific programs and outreach at the Alzheimer’s Association. Check out the emerging knowledge, new drugs and potential hopes in the world of Alzheimer’s.
First disease-modifying drugs
After initially negative results, research now suggests that a recently developed drug called aducanumab may be effective in slowing cognitive decline in some patients. Aducanumab is an antibody that target beta amyloid. The findings have been submitted to the FDA for approval. If it’s approved, aducanumab would be the first drug that impacts the underlying disease process of the condition as opposed to just symptoms, says Dr. Fargo.
“I’m so encouraged by the findings,” adds Sterling Johnson, PhD, the Jean R. Finley professor of geriatrics and dementia at the University of Wisconsin School of Medicine and Public Health in Madison. “It’s not just one thing that was significantly different. It was several cognitive measures and measures of clinical progression.”
A second disease-modifying drug, BAN2041, is also in the works, adds Dr. Fargo. Learn about the difference between Alzheimer’s and dementia.
A medication for psychotic symptoms
Physicians have been relying on the same set of medications to treat Alzheimer’s for almost 20 years and those drugs, including Aricept and Namenda, target only cognitive symptoms like memory and reasoning. Psychotic symptoms in Alzheimer’s patients are currently treated with drugs “borrowed” from other disorders like schizophrenia, some of which can be dangerous says Dr. Fargo. Now a drug called pimavanserin, already approved for Parkinson’s, is set to become the first antipsychotic medication approved specifically for people with Alzheimer’s, says Dr. Fargo.
Continued research on inhaled insulin
A small study earlier in 2019 showed that people with mild cognitive impairment (MCI), which can be a precursor to Alzheimer’s, had improved cognition after taking inhaled insulin. Many more studies with similar results will need to be completed before this becomes an approved therapy. Although the exact role of insulin in Alzheimer’s is unclear, people with diabetes do have a higher risk of the disease, according to the Mayo Clinic.
New biomarkers to diagnose Alzheimer’s
There is currently no easy way to diagnose Alzheimer’s but advances this year indicate that a simple blood test to detect the disease before symptoms appear may be on the horizon. A study published in the journal Neurology reported that a blood test could accurately detect levels of amyloid-beta protein in the blood of people who had no Alzheimer’s symptoms. This protein collects in the brains of people with Alzheimer’s. “[The tests] are not as perfect as we want them to be, but the proof of concept and now it’s a matter of refining the technique and getting one that we can deploy the clinic,” says Dr. Johnson. He anticipates seeing such tests hit clinics in next few years.
More evidence for lifestyle benefits
About 35 percent of dementia cases worldwide are preventable through modifiable lifestyle factors, says Dr. Fargo. And the research keeps coming. Among the most startling new discoveries is the discovery that adopting five specific strategies can reduce your risk of developing Alzheimer’s disease by 60 percent. The five: eat right, exercise, don’t smoke, use your mind and don’t exceed one glass of wine a day. Another study found that a balanced lifestyle may even protect people who have a higher genetic risk for the disease. “We know now with the studies that continue to come forward is that engaging in a healthy lifestyle is good for the brain,” says Dr. Johnson. There are things neurologists do to prevent Alzheimer’s disease.
Updated blood pressure targets
A study appearing in the Journal of the American Medical Association in January found that aggressively lowering blood pressure levels to below 120 mm reduced the risk of developing mild cognitive impairment by about 20 percent. Unfortunately, the study didn’t find any effect on dementia, but the researchers noted the study may not have been big enough to detect an effect. In 2017, the American College of Cardiology and American Heart Association lowered the number to diagnose hypertension to 130/80 mm Hg rather than 140/90 mm Hg. There are natural ways to lower blood pressure.
Investigating the role of herpes
The once-fringe idea that certain bacteria, viruses and other microbes, including herpes simplex virus (HSV), may contribute to Alzheimer’s has moved into clinical trials, says Dr. Fargo. A large trial is currently underway to see if the anti-viral drug Valtrex (valacyclovir) can help alleviate symptoms in women with mild Alzheimer’s who have tested positive for HSV-1 or HSV-2. Don’t worry if you have herpes—most people do. “It’s not a straight line from having herpes to Alzheimer’s,” reassures Dr. Fargo.
More genetic clues
Research presented at the 2019 Alzheimer’s Association International Conference identified 11 sex-specific genes linked with Alzheimer’s. This may help explain why about two-thirds of Alzheimer’s patients in the U.S. are women. Meanwhile, a study in JAMA Neurology suggested that the APOE4 gene, which raises the risk of Alzheimer’s, may behave differently in African Americans than in white people.
A new PET tracer
Late last year, scientists reported in the Journal of Nuclear Medicine that they had identified a new PET (positron emission tomography) tracer for tau tangles in the brain. The protein tau collects and builds up in the brains of people with Alzheimer’s. The tracer — called Flortaucipir — has been used in research since 2013 and is now awaiting regulatory approval for more widespread use. Identifying tau tangles in the brain can help diagnose Alzheimer’s. Drug developers are also hoping to target these tangles with new drugs. Here are 10 early signs of Alzheimer’s.
- Alzheimer's Association: "Facts and Figures"
- Keith Fargo, PhD, director of scientific programs & outreach, Alzheimer's Association, Chicago, Illinois
- Alzheimer's Association: "Biogen to Submit Aducanumab Results in Early Alzheimer's to FDA"
- Sterling Johnson, PhD, Jean R. Finley Professor of Geriatrics and Dementia, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Alzheimer's Association: "Medications for Memory"
- Alzheimer's Association: "AAIC 2019 Highlights New Research Showing Healthy Lifestyle May Offset Environmental and Genetic Risk of Alzheimer's Disease"
- Mayo Clinic: "Diabetes and Alzheimer's linked."
- Neurology: "Screening with a high-precision blood-based assay for Alzheimer's disease."
- Alzheimer's Association: "Lifestyle Interventions Provide Maximum Memory Benefit When Combined, May Offset Elevated Alzheimer's Risk Due to Genetics, Pollution"
- Journal of the American Medical Association: "Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia"
- American College of Cardiology: "New ACC/AHA High Blood Pressure Guidelines Lower Definition of Hypertension"
- National Institute on Aging: "Valacyclovir for Mild Alzheimer's Disease"
- JAMA Neurology: "Assessment of Racial Disparities in Biomarkers for Alzheimer Disease"
- The Journal of Nuclear Medicine: "Evaluation of 18F-RO-948 PET for Quantitative Assessment of Tau Accumulation in the Human Brain"