Six minutes of vigorous exercise a day may delay Alzheimer’s by ten years. New blood tests may enable us to detect the disease much more quickly. And a promising Alzheimer’s drug has even been approved in the United States. The hopeful messages about the fight against Alzheimer’s follow each other in rapid succession. Is the end of the disease near?
“I am enthusiastic,” says Dinant Bekkenkamp, scientific research team leader at Alzheimer’s Netherlands, in conversation with NU.nl. “And many others with me. The outlook is more positive than in the past twenty to thirty years.”
Edo Richard, neurologist at Radboud university medical center, does not entirely agree. “I see myself as a born optimist. But if you ask me whether we are in momentum or in a stalemate, I would choose the latter.”
Both Bekkenkamp and Richard want to temper expectations for patients immediately. Each month, more than five hundred scientific publications are published about dementia, of which Alzheimer’s is the most common form. Bekkenkamp calls every research a small step. In addition, follow-up research should verify the findings. “And very little of what gets published is ultimately relevant to treatment,” adds Richard.
Wat is de ziekte van Alzheimer?
- De ziekte van Alzheimer is een hersenaandoening waarbij geleidelijk steeds meer hersenweerfsel verdwijnt. Dat leidt tot het verlies van hersenfuncties.
- Dit gebeurt doordat schadelijke eiwitten (amyloid) zich ophopen in de zenuwcellen, die daardoor kapotgaan. Dat gebeurt vaak het snelst in het gedeelte dat herinneringen aanmaakt, waardoor het kortetermijngeheugen en later ook het langetermijngeheugen verdwijnt.
- Wetenschappers proberen medicijnen te ontwikkelen die de schadelijke eiwitten kunnen aanpakken.
Follow-up research will take years
Alzheimer’s doesn’t suddenly appear. Like a silent killer, the disease disables important brain functions one by one. This happens over a period that often lasts years. Due to the nature of the disease, follow-up research costs a lot of time and money.
“For such a study, one thousand to two thousand people must be followed, over a period of four years, for example,” says Bekkenkamp. “And only then can you see whether the group that received the drug is really better off than the group that received the placebo. Ultimately, a study takes at least ten years.”
Bekkenkamp understands that all messages sound hopeful for patients and relatives, but emphasizes that they are of no practical use yet. “Take the blood test, for example. The fact that you can show that someone suffers from Alzheimer’s much earlier is very interesting and extremely necessary. But it is only really useful if we have a drug that can tackle those proteins. Only then can you make those people more healthy promise years of life.”
Richard is critical of many Alzheimer’s studies. “Take sports research, for example. It can never be said with certainty that those people have delayed the onset of Alzheimer’s thanks to sports. It is also possible that those people have other healthy lifestyles.”
Lecanemab labeled a breakthrough in the fight against Alzheimer’s
In recent months, a study with the drug lecanemab has been the hot topic in the fight against Alzheimer’s. The drug targets amyloid proteins and slows down the decline in patients. Still, it doesn’t stop the disease. “But it is scientifically regarded as a breakthrough, because we have shown for the first time that a drug can really intervene in the disease process,” says Bekkenkamp.
Richard is less positive. He points to the logistical challenges, possible serious side effects such as cerebral haemorrhage or brain swelling and the costs. “A miniscule health effect has been observed. The patient and caregiver do not even notice it.”
“On the other hand, there are possible side effects, a cost of about $ 25,000 per year per patient and all the safety measures you have to take.” The drug has to be infused every two weeks.
The neurologist also has his doubts about the result of the examination. “It could be a fluke. This question has been studied before. If you test something ten or twenty times, you can find something by chance. Many other studies that also removed amyloid proteins showed no improvements in patients. You have to draw those conclusions factor into the results of this study.”
Lecanemab will continue to be tested over the next four years. The results of long-term use of the drug are measured in one thousand to two thousand patients.
With medicine, the number of patients is increasing
If there is indeed a drug on the market that slows down Alzheimer’s, the number of patients will increase. Because of a drug they could live longer (and healthier).
“We hope that the drug will delay the worst phases of the disease, so that Alzheimer’s patients will die while they are still suffering from a milder form. It may also lead to more healthy years before the milder phases begin, but that has yet to be determined.” be proven,” says Bekkenkamp.
In the Netherlands, patients have to wait longer for lecanemab. “The producer is expected to submit a license application this spring, after which the European medicine watchdog will consider it,” says Bekkenkamp. “If approval follows, Dutch experts still have to come up with an opinion and develop guidelines. So I don’t expect it before 2025.”
Lecanemab is not the only Alzheimer’s drug under development. According to Bekkenkamp, about 120 drugs are being tested on patients. About five to seven of these are at an advanced stage of research. “But many previous attempts did not achieve the desired result.”
Richard does not expect a breakthrough in the fight against Alzheimer’s in the short term. “I don’t want to lose all hope, but I certainly don’t want to give false hope either,” he says. According to the neurologist, studies into short-term lifestyle treatments offer an interesting alternative. “You can use it anywhere. Lifestyle treatments have hardly any side effects and can also prevent other diseases.”
Bekkenkamp remains positive in the search for a medicine. “That there are signs that a medicine can work and that we can do something against dementia now: we didn’t have that yet. It’s really spectacular.”
