Both drugs act on the amyloid deposits in the brain. The concentration increases as the patient ages. In patients with Alzheimer’s disease, the protein clumps together instead of being broken down as it is in healthy people. Lecanemab attacks the protein before it forms plaques, while Donanemab fights existing plaques. “Both drugs are a major breakthrough,” Frank Jessen explains, “because existing medications treat the symptoms but not the causes.” However, both of the treatment options still need to be proven effective through widespread use.
In an effort to combat the disease at an early stage, research teams around the world are exploring further options. Researchers at Harvard Medical School recently demonstrated that a deficiency of the trace element lithium can accelerate the brain changes typical of Alzheimer’s disease — at least in mice. The lack of lithium causes nerve cells to age more quickly, making them more susceptible to damage. However, Frank Jessen does not recommend taking the drug as a precautionary measure: “There is no proven effect of lithium in the treatment of Alzheimer’s disease. Long-term studies have yet to prove whether, or at what dose, it can be effective as a preventive measure. And we should not ignore the side effects of high doses of lithium.”
However, diabetes medication could be helpful in preventing the disease, as it can reduce inflammation in the brain. Good oral hygiene is also important, as chronic inflammation such as periodontitis is also a possible risk factor for dementia.
Taking control of your health
Here’s the good news: there are many risk factors we have control over. Frank Jessen is researching exactly how personal lifestyle influences individual risk. The statistics prove how successful prevention can be. “Although the number of Alzheimer’s patients is increasing purely because of the aging population, proportionally fewer people are suffering from the disease today than thirty years ago,” the psychiatrist explains. The reason for this is that people are taking better care of themselves. “A healthy diet, exercise, good vision and hearing care, social interaction and enjoyment of cognitive challenges are the best preventative measures,” explains Jessen. “You can largely influence your risk of dementia.”
Poor hearing is a good example of an age-related ailment that’s misunderstood. Hearing loss not only leads to fewer cognitive stimuli in the brain. People with poor hearing often avoid social contact, which reduces stimuli even further. Yet it is precisely these stimuli that train the brain. According to Frank Jessen, “We do not hesitate to solve the problem of failing eyesight with glasses. But people tolerate gradual hearing loss for far too long.” Incidentally, this sometimes begins as early as middle age.
Speaking of middle age... “If you only forget things occasionally, you are aging appropriately,” Jessen reassures us. “But if you notice a consistent deterioration in your memory over several months, you should get tested.” This is because the greatest opportunities for intervention are at an early stage. There is only a small window of opportunity before the brain becomes irreparably damaged. Relatives or friends can help direct those who are reluctant to be examined to their GP at an early stage. Unfortunately, the inability to recognize the illness is sometimes part of the illness. The Cologne Center for Memory Disorders at the University Hospital, which is run jointly by its Departments of Neurology and Psychiatry, offers early diagnosis and treatment.
The next generation of drugs
Alzheimer’s research could go even further if it had more funding at its disposal. Ramírez and Jessen agree on this. What’s standing in the way? “Alzheimer’s is often not seen as a brain disease, but primarily as a care issue,” Frank Jessen summarizes. Alfredo Ramírez also calls for more funding: “It is important to recognize the need to channel a lot more money into research so that we can make as many strides with dementia as we have with cancer.” For example, projects that generate large amounts of data need investments. Their analysis harbours a wealth of scientific knowledge. “This is doubly important because there are also genes that apparently protect against Alzheimer’s,” adds Ramírez. “This could help us develop new therapies.”
The Alzheimer’s experts in Cologne are continuing to research new ways to prevent, detect, and delay the progression of the disease. Alfredo Ramírez and his team have a goal: “We need to better understand which genes are affected and how they correlate with each other.” However, a lot also happens by chance. Ramírez is therefore careful not to raise false hopes of a miracle drug that will cure everyone. “Some Alzheimer’s patients suffer severe side effects or, in the worst case, cannot tolerate certain medications at all. That’s why we also need to develop a second or third generation of drugs with fewer side effects, which could be done through genetic research.” It would be a breakthrough to be able to detect Alzheimer’s at an early stage using biomarkers. According to the researcher, these would help many people avoid reaching an advanced stage of dementia at all.
One thing is certain: in ten to thirty years, the forms of therapy will become more differentiated and individualized. Personalized medicine could lead to customized therapies based on individual genetics and biomolecular profiles. This approach is all the more important because it can take into account gender differences in the onset and course of the disease.
Then there is artificial intelligence. Changes in language and motion will be easier to analyse, and the development of medication is also likely to become more efficient. “AI will play a decisive role in developing new research approaches,” Alfredo Ramírez explains. “In future, genetics and biomarkers could help develop algorithms that can be used to identify people at risk of Alzheimer’s at a very early stage.”
What could help fight Alzheimer’s today? Frank Jessen laughs and says: “A retirement age of 70! The longer our brain is challenged, the more protection it has against dementia.”
