Crypto News: Preventing Alzheimer's

Hi, it's Bob in New York. Neurologists have set an ambitious goal of developing drugs that could prevent Alzheimer's. But first...

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This fall, Eisai Co.'s lecanemab became the first drug to unambiguously slow Alzheimer's disease in a large trial. It's expected to get US approval next year.

Now neurologists are shifting their longer-term focus to how amyloid-lowering drugs like lecanemab could help delay the onset of the disease or maybe even prevent it altogether. Amyloid, an abnormal protein, starts building up in the brain decades before someone has dementia. That is thought to lead to an increase of a second protein called tau and also to inflammation, which contributes to the death of brain cells.

This process is believed to be well underway by the time symptoms of cognitive decline are obvious. It's no wonder that lecanemab was only able to slow cognitive decline by 27% over 18 months in its study. Researchers hope that treating people with high amyloid levels before they get sick will have a much bigger impact over time, as I wrote today in Businessweek.

The goal of these new trials is to neutralize the process that's sparking Alzheimer's disease "before the damage is done to the brain," says Randall Bateman, a neurologist at Washington University in St. Louis who has been involved in multiple prevention studies.

Older people often turn to board games to slow cognitive decline. Photographer: Nathan Laine/Bloomberg

Some prevention trials focus on people with rare genetic variants that cause Alzheimer's at an early age. In my reporting, I looked at trials in the broader population of healthy, older people with lots of amyloid in their brains. Big trials are going on now with three different drugs: lecanemab, an older amyloid-lowering drug made by Eli Lilly called solanezumab, and Lilly's newer drug, donanemab.

Numerous questions remain, most notably whether the drugs will actually stave off disease. And unlike low-cost cholesterol-lowering pills used to prevent heart attacks, these amyloid-lowering drugs must be infused and are expected to be quite expensive. The newer drugs are also more potent and come with significant risks of swelling and bleeding in the brain.

But with millions of aging baby boomers at risk for developing Alzheimer's each year, new treatments could have a tremendous impact. — Robert Langreth

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