"New therapies are a milestone" - will Alzheimer's now be curable?

Leipzig. Alzheimer's cannot be cured. But new therapies are about to be approved. Antibodies have been shown to cause the amyloid plaques in the brain to disappear. This can slow down the progression of the disease, but not make it irreversible. However, in combination with early diagnosis, symptoms can be effectively halted, says Prof Dr Dorothee Saur, neurologist at Leipzig University Hospital. In this interview, she answers what this development means for patients.

Prof. Saur: This is a real milestone, we have been waiting a long time for this. Until now, we have had no effective therapies to influence the process of cognitive decline that begins with dementia. The two therapies now awaiting approval address precisely this issue - they slow down the loss of brain and memory function. This is achieved by administering antibodies that stimulate the immune system so that it attacks and removes the existing amyloid deposits in the brain, the plaques. This can be easily understood with special PET brain scans - existing deposits disappear almost completely. However, this has not yet stopped the progression of the disease, only slowed it down considerably. For those affected, however, this makes a big difference: it could mean more years of life with fewer limitations.

Does this apply to all Alzheimer's sufferers, or are there limitations?       

Prof. Saur: It opens up completely new possibilities, especially for people with a very early stage of dementia. Thanks to modern diagnostic methods, we can now recognise very precisely whether an early form of Alzheimer's disease is present. Those affected do not yet notice much of the disease in everyday life and may have very slight cognitive impairments, but these are not significant. However, using PET scans or cerebrospinal fluid diagnostics, we can already see that the disease process has already begun. With the new drugs, we can start treatment at this stage and slow down the progression by up to 30 per cent. This is a real advantage for the patients, whose brain functions, which are still largely intact, may not deteriorate as quickly. The effect would therefore be greatest for this group, so we assume that the therapies will be approved for early treatment, even if the approval criteria are currently still open.

When do you expect the therapies to arrive in the clinic? 
Prof. Saur: We expect this to happen in Germany in the spring of 2024. And then we need the right conditions for the very complex therapies: Imaging and cerebrospinal fluid analyses for early diagnosis and treatment plans. On the one hand, the multiple infusions involved must be administered regularly at intervals of two to four weeks. We are talking about a treatment that will last for several months, although the exact duration is not yet known. Patients must be well looked after during this time, with regular MRI examinations to monitor progress, especially at the start of treatment. Although the therapy is generally considered to be well tolerated, everyone reacts individually and there are also undesirable reactions that need to be recognised and treated in good time.

How do you deal with this in neurology at the UKL, do you prepare for it?  

Prof. Saur: The topic is keeping us on our toes. The German Alzheimer's Society estimates that 430,000 new cases of dementia are diagnosed in Germany every year. Around three quarters of these cases are Alzheimer's disease. Alzheimer's therapeutics could therefore quickly become one of the most prescribed drugs.
However, the structures are not yet prepared for this. We are currently working on changing this and becoming a pioneer in this area. The neurologists in private practice will be able to do a lot here, but will undoubtedly not be able to cover everything.
We are expecting a great deal of demand, for which we want to equip our dementia consultation hours accordingly.
However, we are also preparing to conduct further accompanying research in this area. We do not yet know what effects the therapies will have in the long term; this needs to be observed and analysed.
But overall, this is a big step. What we are experiencing here is just the beginning. There will be further approaches, for example for diagnostics using a blood test, and also for therapy. Because even if we can now combat amyloid deposition, development is not yet as advanced against the second disease trigger in Alzheimer's, the altered tau proteins.

Specialist event on the topic 

For an interested specialist audience, the neurologists at Leipzig University Hospital are offering a specialist symposium on this topic on 29 November 

More information can be found here: Clinical Neuroscience Colloquium: Mini Symposium "Dementia" (uniklinikum-leipzig.de)

Source: Press release Leipzig University Hospital from 02 November 2023