Alzheimer’s disease — a cure in sight?
There is an estimated 426,000 people living with some form of dementia in Australia alone. With the rising and ageing population, it is no surprise that this figure is predicted to rise to astronomical proportions over the next few decades. At present, it is the second leading cause of death in Australia affecting 5.4% of males and 10.6% of females. It is estimated that three in 10 people over the age of 85 experience some form of dementia, whilst one in 10 over the age of 65. It is said to be the single greatest disability for people over the age of 65. It is also estimated that well over 1 million people in Australia are either directly or indirectly involved in the care of a person with dementia.
The commonest cause of dementia is Alzheimer’s disease but there are other causes such as vascular dementia and less common genetic variants that can also present with similar symptoms.
So, is there any end in sight for this horrible scourge that affects so many people? The answer is clearly, yes! In fact, a few years back a small pilot trial of only 11 patients with varying degrees of Alzheimer’s disease was published titled the MEND trial. This program involves the combination of lifestyle changes, specific vitamin supplementation based on each individual’s assessment, brain training and trans cutaneous cranial stimulation. In 10 out of the 11 patients, the disease was reversed and this did not involve any pharmaceutical therapy.
Recently at a dementia conference in Chicago two new experimental therapies were presented showing great promise for the management of Alzheimer’s disease. The first trial involved in a monoclonal antibody, BAN2401. (You always know a therapy is not available clinically because it doesn’t even have a proper name.) This treatment reduces the amyloid plaques in the brain of people with Alzheimer’s, which are an accumulation of junk proteins destroying normal nerve tissue.
856 patients with early Alzheimer’s disease were given this therapy in a placebo-controlled trial and in varying doses. After 18 months there was a 26% reduction in the clinical decline towards Alzheimer’s disease compared with placebo and 50% in those given the high-dose. Previously, the same company had released the results of a small part trial of a similar drug Aducanumab which again showed very similar results.
The second trial, albeit small, was an Australian trial of 32 patients with mild-to-moderate Alzheimer’s disease. This demonstrated that a new experimental treatment, Anavex which is a sigma-1 receptor agonist, appeared to slow and in some cases even reverse the disease. The study also looked at a variety of genetic abnormalities and found that 20% of patients had two variants of specific genes that reduced the effect of Anavex. This trial was continued for just over 12 months.
Interestingly, a few years ago the results of the Optima trial, performed in Oxford University were released. This was a placebo-controlled study of high dose B-group vitamins in 271 people with mild cognitive impairment (a precursor to Alzheimer’s disease). This 2 year study, using MRI and neurocognitive testing, demonstrated a 30% reduction in progression to Alzheimer’s disease in the people given the high dose vitamins.
There has also been some promising work using the antidepressant Cipramil and some early data for chronic non-steroidal anti-inflammatory drugs.
It is my opinion that with an integrative approach combining lifestyle modification, brain training and brain stimulation, complementary therapy and evidence based pharmaceutical drugs we are at the cusp of a new era in the management of Alzheimer’s disease. Hopefully, in the very near future, this scourge will become a thing of the past.