Alzheimer's disease: new developments, treatments, and watching for early symptoms

As people grow older, they can often experience memory loss and forget small things - this is a natural part of ageing. Short term memory loss, however, among other factors, can also be an early indication of Alzheimer's disease. Dr Emer MacSweeney, leading neuroradiologist of the Re:Cognition Health Clinic, explains early indicators of Alzheimer's, and the exciting new developments in clinical trials. 

What are the current treatments for Alzheimer's disease?

Today, the treatments available for Alzheimer’s disease are asymptomatic treatments and they are designed just to make the cognitive brain cells work more efficiently and effectively than they would otherwise. However, there is cautious optimism that new generation treatments are now being developed and are now in final phase clinical trials, which are designed to actually keep those brain cells alive by removing the abnormal proteins in the brain which destroy the brain cells in the first place. If we can manage to keep those brain cells alive, then we can slow down progression of symptoms and progression of the disease and thereby change the future and the trajectory for those currently diagnosed with Alzheimer’s disease.

What is a clinical trial and how can it be used in the treatment of Alzheimer's?

Clinical trial is the process through which every drug has to pass in order to become available on the market for general distribution. What’s exciting at the moment, particularly in terms of Alzheimer’s disease, is that many of the new drugs designed to slow down progression of disease and symptoms are in the final phase of clinical trial.

How do I know if a clinical trial is right for me?

For those individuals who are interested, they can come in to the study and get early access to these new generation medications. In the process of screening, an individual receives a very accurate and early diagnosis, as the types of medications which are given to slow progression disease must be given when symptoms are very mild. In order to detect evidence of disease when symptoms are very mild, we have to measure biomarkers and these tests are done during screening.

If you do have very early symptoms and you’re worried about your memory - particularly your short term memory - then it would be sensible to see your doctor and to read as much information as possible about these clinical trials.

What happens in a clinical trial?

When you come in to a clinical trial, the very first thing that happens is the screening period. During that period, we find out whether you’re the right person for the study, but more importantly whether the study is the right study for you. If you have very mild symptoms of cognitive impairment, then it’s important to be able to have very sophisticated tests that will detect evidence of biomarkers, particularly amyloid and tau proteins. These are measured using special brain scans and spinal fluid analysis.

Alzheimer’s disease is very difficult to diagnose, particularly in the early stages, and this has actually been one of the problems behind why people present at the advanced stages of Alzheimer’s, when they have often by that time developed dementia.

What are the early indicators of Alzheimer's?

In the very early phases, usually memory (particularly short term memory) tends to be affected. One of the things that is quite characteristic is people being unable to remember something, even when given a cue. They may forget what they did yesterday and even when someone reminds them, they can’t remember what happened. Symptoms, however, are not just related to memory - they include planning ability and calculation ability, and all sorts of executive functions that we see as our thinking ability. It’s very important to distinguish the difference between having true difficulty remembering and recalling something as opposed to just not concentrating or maybe being a little bit anxious.

Because these symptoms are so non-specific, it is very important to have tests which will provide objective evidence of whether or not somebody actually has the symptoms and this involves measuring biomarkers, and specific scans which are actually all carried out in the screening process when somebody enters a clinical trial.

What developments are underway in clinical trials?

There are two key types of medications which are now being developed for Alzheimer’s disease. The first type is symptomatic medications. These are more effective medications than the type of symptomatic medications that are on the market today. However, the new symptomatic medications work by increasing the effectiveness of the brain cells by increasing the amount of neurotransmitters that are available in the brain. So brain cells are being affected by the underlying disease but they’re able to function more efficiently.

The other types of medication are designed to actually slow down the death of the brain cells in the first place, and to lower the level of abnormal, toxic proteins in the brains. These are amyloid and tau proteins that accumulate in the brain and cause the brain cells to die in the first place.

These medications are designed to either reduce the production of the amyloid and tau protein or to increase the clearance of these proteins, or to reduce the rate at which these proteins are transmitted from one brain cell to the next.

What steps can people take to protect the brain against Alzheimer's?

Things which we know are good for us such as exercise, following a Mediterranean diet, keeping our brains very active, and using our brain just like any other muscle are all really important in terms of protective factors against Alzheimer’s and other causes of dementia.