How Can Alzheimer’s Drugs Get to the Brain Faster? 

Q. My sister is in the early stages of Alzheimer’s, and she may be a candidate for the drug Leqembi, to help slow down the progression. I read that a way to expedite the process and get Alzheimer’s drugs to the brain quicker was recently introduced. What is this all about? I am hoping that this is something that could help enhance my sister’s treatment. And is there anything else on the horizon for Alzheimer’s treatments and drugs? Thanks for your help!

A. 2023 was a strong year for innovative new drugs, with the introduction of new medications, treatments, and diagnostic tools for Alzheimer’s disease. Last year, the Food and Drug Administration (FDA) gave full approval to Leqembi (lecanemab) for patients in the early stages of Alzheimer’s disease.

Leqembi doesn’t cure Alzheimer’s disease, and it can’t improve memory and thinking. It is, however, the first drug that has been shown to slow progression of Alzheimer’s disease in people with early-stage disease. A large clinical trial of Leqembi showed that the drug slowed declines in memory and thinking by 27 percent over the course of 18 months of treatment! 

Who Is Eligible for Leqembi, and How Is It Administered? 

As you are aware, Leqembi is for people with mild Alzheimer’s disease, which means they have some problems with thinking and memory, but their symptoms aren’t severe. Right now, it hasn’t been completely determined if the drug will help people with more severe memory loss or cognitive problems, because the clinical trials only involved people with mild symptoms. The drug is given via IV infusions every two weeks at an infusion center. 

As you mentioned, scientists have recently found a way to help more Alzheimer’s drugs cross the blood-brain barrier, and more quickly. In a study at West Virginia University Rockefeller Neuroscience Institute, featured in the latest issue of the New England Journal of Medicine, three patients (two male and one female, aged 59-77) with mild Alzheimer’s disease received six standard monthly infusions of the Alzheimer’s drug Aduhelm (aducanumab) immediately followed by a focused ultrasound MRI-guided treatment helmet with more than 1,000 ultrasound transducers used to open tiny self-healing holes in the blood-brain barrier. The focused ultrasound transducers were directed to specific brain regions with high amyloid-beta plaques. “After six months of antibody treatment, researchers observed an average of 32 percent more reduction in amyloid-beta plaques in brain areas with blood-brain barrier opening compared to areas with no such opening,” Ali Rezai, M.D., lead author of the study said.  

How the Focused Ultrasound Treatment Works 

The blood-brain barrier is a protective membrane that prevents germs and other damaging substances from entering the brain from the bloodstream. The scientists used a technology called focused ultrasound to poke tiny temporary openings in the blood-brain barrier by injecting tiny bubbles into the bloodstream. Next, they beam sound waves through the helmet-like device to precise brain areas. The pulses of energy vibrate the microbubbles, which loosen gaps in the barrier enough for medications to slip in faster. 

Prior studies have found the technology can safely poke tiny holes that seal up in 48 hours. This particular study has gone a step further — administering an Alzheimer’s drug at the same time.  

Alzheimer’s drugs such as Aduhelm, Leqembi, and others in development promise to slow the symptoms of Alzheimer’s disease. They’re designed to clear away the beta-amyloid protein that builds up in certain brain regions. But they require IV infusions every few weeks for at least 18 months. “Why not try to clear the plaques within a few months?” Rezai said in his rationale for the study. 

The scientists are hopeful that the work they are doing will lead to significant improvements in outcome for patients and their families who are coping with Alzheimer’s.  

Another New Alzheimer’s Drug and Other Alzheimer’s Treatments Show Promise  

On another note, Eli Lilly could debut a new treatment for Alzheimer’s disease that targets amyloid, the protein that builds up in the brains of patients. Donanemab is expected to receive approval by the US Food and Drug Administration in the first quarter of 2024. In studies, people receiving the drug experienced 35 percent slower cognitive decline than those getting placebo and 40 percent less decline in their ability to perform daily activities such as driving or holding conversations. That’s a slightly higher efficacy than the currently existing medications, and experts are hoping that if patients start taking it early enough, they might be able to hold off the worst effects of memory loss and cognitive decline for several years! We’ll keep our readers up-to-date on this new Alzheimer’s treatment option! 

Donanemab isn’t the only promising Alzheimer’s treatment. Currently, there are over 100 different drugs in phase I, II, or III clinical trials. “A pipeline of potential new treatments offers hope for the Alzheimer’s and dementia community,” Maria Carrillo, PhD, chief science officer of the Alzheimer’s Association, said at the 2023 Alzheimer’s Association International Conference (AAIC). Here are some of the findings: 

  • Seventy-nine percent of current disease-modifying therapies are being aimed not just at amyloid, but tau, inflammation, metabolic dysfunction, cell death, synaptic plasticity, and multiple other aspects of the disease. 
  • Ongoing Alzheimer’s trials include repurposed diabetes drugs. Metformin and Ozempic, which are effective drugs against type 2 diabetes, may be ideal candidates for repurposing to address the metabolic dysfunction in Alzheimer’s disease. Diabetes drugs are also being combined with healthy lifestyle changes in a novel trial called MET-FINGER. 
  • A University of Virginia professor is collaborating on a deep brain implant that may one day be the path by which doctors treat and perhaps reverse the degenerative effects of Alzheimer’s disease. 

For an in-depth overview of additional Alzheimer’s treatments that are being evaluated and currently undergoing trials, click here.  

“No single solution will likely solve Alzheimer’s. We envision a future where multiple treatments address every aspect of this most complex disease,” Dr. Carrillo noted.” And that, once proven, the treatments can be combined in ways that complement and enhance each other to reduce risk, treat effectively, stop the progression, and eventually cure Alzheimer’s disease and all other dementia.” 

Planning for a Loved One with Alzheimer’s  

Do you have a loved one who suffers from Alzheimer’s or another form of dementia? Persons with Alzheimer’s disease and their families face special legal and financial needs. At the Farr Law Firm, we help protect a family’s hard-earned assets while maintaining your loved one’s comfort, dignity, and quality of life by ensuring eligibility for critical government benefits such as Medicaid and Veterans Aid and Attendance. If anyone in your family is facing a diagnosis of Alzheimer’s disease or any other type of dementia, please call us as soon as possible to make an appointment:  

Northern Virginia Medicaid Planning: 703-691-1888
Fredericksburg, Virginia Medicaid Planning: 540-479-1435
Rockville, MD Medicaid Planning: 301-519-8041
Washington, DC Medicaid Planning: 202-587-2797 

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.