Best Drugs For Alzheimer’s

Who Is A Candidate For Aducanumab

Based upon the clinical trials in which it was studied, the drug can be potentially considered for use in individuals with early-stage Alzheimers disease. This means individuals who have Alzheimers in its mild cognitive impairment or mild dementia stage. Individuals in this early stage of Alzheimers may be able to function normally, or they may require a little bit of help with complicated activities like paying bills, grocery shopping, preparing meals, or balancing their checkbook. Individuals who need help with dressing, bathing, or other basic activities would be beyond the early stage and the drug would not be indicated for them.

Note that not everyone with mild cognitive impairment or mild dementia has Alzheimers disease. There are other causes of these problems as well. To determine if Alzheimers is present, you need to get either an amyloid PET scan or a lumbar puncture to be sure you have the amyloid plaques of Alzheimers. Currently, a lumbar puncture is generally covered by insurance, but an amyloid PET scan is not.

The Effectiveness Of Memory

The effectiveness of memory-enhancing drugs is a topic of ongoing debate in the scientific community. While some studies have found that certain drugs and supplements can improve memory and cognitive function, others have not found a significant benefit.

One of the most commonly used prescription drugs for memory enhancement is cholinesterase inhibitors, such as Donepezil , Rivastigmine and Galantamine which are used for mild to moderate Alzheimers disease, these drugs work by increasing the levels of a neurotransmitter called acetylcholine in the brain, which is thought to be important for memory and cognitive function.

These drugs have been shown to improve memory and cognitive function in some individuals with Alzheimers disease, but their effectiveness in healthy individuals is not well-established.

Another class of drugs that are used to enhance memory are the N-methyl-D-aspartate receptor antagonists, such as Memantine , which is used for moderate to severe Alzheimers disease, it works by blocking the NMDA receptor, which is thought to play a role in the formation of memories and the maintenance of cognitive function.

These drugs have also shown some improvement in memory and cognitive function in individuals with Alzheimers disease, but their effectiveness in healthy individuals is not clear.

Cognitive enhancers such as Modafinil and Methylphenidate are also used to enhance memory, focus, and concentration.

Will Crispr Spark Biotech Stocks

The world is also on the threshold of a potential first approval in CRISPR. Unlike the RNA approaches, CRISPR provides a permanent genetic change to disease.

Crispr Therapeutics and Vertex expect to finish submitting their application for FDA approval of a CRISPR treatment for sickle cell disease and beta thalassemia in the first quarter.

The two blood diseases are caused by an inherited mutation that impacts hemoglobin, a protein within red blood cells.

“I believe that gene editing and CRISPR will be a mainstay in medicine and wouldn’t be surprised if, in the next 10 years, it accounts for a third of the full pharma market,” Crispr CEO Samarth Kulkarni told IBD.

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A New Alzheimers Drug Has Been Approved But Should You Take It

• By Andrew E. Budson, MD, Contributor

On June 7, 2021, the FDA granted accelerated approval to aducanumab , the first drug in 18 years for Alzheimers disease. Since then the FDA has modified the original language of the approval to recommend that it only be used in certain patients with mild cognitive impairment or early Alzheimer’s disease.

Concerns over the FDA approval of Aduhelm have led to further investigation into its safety, effectiveness, and cost. Some insurers are declining to cover it and some medical centers have decided not to prescribe it.

The Top Five Dementia Medications For Seniors

• Finding Memory Care Near You

Dementia is a common disease seen in older adults, affecting over 50 million people around the world, according to the World Health Organization . But, it is not a normal part of aging. Examples of typical memory loss experienced by people of all ages include occasionally forgetting but later remembering events, names, and phone numbers. When memory loss becomes disruptive to your daily life, it might be time to see your medical team about your cognitive health and discuss possible medications to help combat the symptoms of dementia, as well as check for physical signs of Alzheimers disease and related dementias.

Through careful research, we have created this guide to educate you on Alzheimers disease and related dementias, the top dementia medications as well as less-targeted dementia medications that can be useful in treating symptoms, and alternative options you might want to discuss with you or your loved ones doctor.

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Do Medicines For Dementia Work

Alzheimer’s disease: medicines can’t cure Alzheimer’s disease, but they may slow it down for a while and make it easier to live with.

• Cholinesterase inhibitors may be used in people with mild to moderate Alzheimers disease or mixed dementia. These may give temporary help with memory, motivation, concentration and daily tasks.
• Memantine may be useful in the moderate or severe stages of Alzheimers disease, to help with attention and daily tasks, and possibly ease distressing or challenging behaviours.

How Long Should Alzheimer’s Drugs Be Taken For

These drugs are usually prescribed for a trial period of 3 to 4 months to see if they show signs of helping.

There is no clear view as to how long they should be taken. If the condition progresses in spite of treatment, there may come a point when you and your doctor decide that there is little point in staying on them.

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Limiting Your Loved Ones Med

Your loved one may need to keep taking meds listed in this article. But their doctor may be able to deprescribe or replace these drugs and others on the list of potentially inappropriate medications for older adults from the American Geriatrics Society Beers Criteria.

If youre unsure about your loved ones exposure to these drugs, bring a bag of all their medications to their next appointment. Be sure to include any over-the-counter meds they take not just their prescriptions.

A geriatrician will be able to give age-related expertise on your loved ones medication regimen.

Want to learn more? Keep reading about other well-known drugs and their connection to dementia:

New Uses For Mrna Technology

The Covid pandemic offered a paradigm shift for companies using mRNA technology. Among those de facto leaders, Moderna, is now turning its sights back to cancer. In a recent study, Moderna added its personalized cancer vaccine to Merck‘s blockbuster cancer drug, Keytruda. The combination reduced the risk of relapse or death by 44% in patients with melanoma.

In cancer, the way tumor cells mutate is highly individualized. So, Moderna is creating bespoke cancer vaccines targeted to each patient’s own tumor mutations. The vaccine prompts the immune system to create T cells capable of taking on those specific mutated tumor cells. If they return, the body’s defense system is ready.

BioNTech, meanwhile, just started a Phase 1 study to test a vaccine that would prevent herpes. The study will enroll 100 healthy volunteers, ages 18-55, in the U.S. It’s being developed with the University of Pennsylvania.

Anzalone, Arrowhead’s CEO, is more skeptical of mRNA.

“I don’t think we’ll see more interesting uses of it next year,” he said. “It’s a powerful technology and I’ve always thought that the low-hanging fruit with mRNA is vaccines. That makes total sense to me. I think we still are a breakthrough or two away from applying this to other disease states.”

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But Does The Drug Work

In a prior blog post I reviewed the publicly available data and the daylong FDA hearing on aducanumab. In a nutshell, there were two large clinical trials to assess effectiveness, side effects, safety, and how the drug might be used in clinical practice. One of the studies was positive, meaning that the drug worked to slow down the decline of thinking, memory, and function that is usually impossible to stop in Alzheimers. The other large study was negative. In my view and that of the FDA advisory panel these results mean that we dont know if the drug works or not.

Another factor to consider is that the potential benefit if the drug works as well as it did in the positive study was fairly small. Looking at the two objective measures, in the positive trial, the high dose made a 0.6-point change on the 30-point Mini-Mental State Examination. On the 85-point Alzheimers Disease Assessment ScaleCognitive Subscale-13, the high dose made a 1.4-point change.

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Why These Drugs Have A Stronger Effect In Older People

As we age, our ability to process medication changes. The kidneys and liver clear drugs more slowly, so drug levels in the blood remain higher for a longer time. People also gain fat and lose muscle mass over time. Both these changes affect the way drugs are distributed to and broken down in body tissues. And because these drugs are stored in body fat, they can continue to produce effects days after people stop taking them, especially in people with a higher proportion of body fat. In addition, older people tend to take more prescription and over-the-counter medications, each of which has the potential to suppress or enhance the effects of the others.

Practical Tips On Medications To Manage Difficult Behaviors In Dementia

You may be now wondering just how doctors are supposed to manage medications for difficult dementia behaviors.

Here are the key points that I usually share with families:

• Before resorting to medication: its essential to try to identify what is triggering/worsening the behavior, and its important to try non-drug approaches, including exercise.
• Be sure to consider treating possible pain or constipation, as these are easily overlooked in people with dementia. Geriatricians often try scheduling acetaminophen 2-3 times daily, since people with dementia may not be able to articulate their pain. We also titrate laxatives to aim for a soft bowel movement every 1-2 days.

• No type of medication has been clinically shown to improve behavior for most people with dementia. If you try medication for this purpose, you should be prepared to do some trial-and-error, and its essential to carefully monitor how well the medication is working and what side-effects may be happening.

• Antipsychotics and benzodiazepines work fairly quickly, but most of the time they are working through sedation and chemical restraint. They tend to cloud thinking further. It is important to use the lowest possible dose of these medications.

• Antidepressants take a while to work, but are generally well-tolerated. Geriatricians often try escitalopram or citalopram in people with dementia.

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What Are The Side Effects

The most common side-effects are feeling sick, loss of appetite, tiredness, diarrhoea, muscle cramps and sometimes poor sleep. These may be reduced or avoided by increasing the dose slowly, or taking the medicine after food.

The side-effects usually fade after a few weeks and will go away if the medicine is stopped. More information about side-effects can be obtained from your doctor or by reading the leaflet that comes with the tablets.

Other Genetic Medicines In The Works

But Anzalone says other genetic medicines are ready for their day in the sun.

In Arrowhead’s case, this means using RNA interference, or RNAi, to silence genes. While mRNA tells the body to make something â in the case of the Covid vaccines, a spike protein â RNAi turns off genes. The firm is using the technology to stop the production of specific proteins.

“It’s a strikingly powerful technology because there are a number of disease states characterized by the overproduction of something,” Anzalone told IBD.

In 2023, Arrowhead expects to begin Phase 3 studies of its gene-silencing technology, in patients with alpha-1 liver disease, with partner Takeda Pharmaceutical . The company also expects to begin final-phase studies of two drugs in cardiovascular diseases.

and Amgen are using drugs that block RNA to lower LDL cholesterol and lipoprotein A. Amgen licensed its drug from Arrowhead.

Arrowhead also expects to have initial data from its efforts to deliver RNA-interfering drugs into the lungs. If successful, it would be “revolutionary for the field,” Anzalone said.

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How Do You Take The Drug And Is It Safe

To take the drug, you need an intravenous infusion every four weeks forever. Thirty percent of those who took the drug had a reversible swelling of the brain, and more than 10% had tiny brain bleeds. These side effects need to be watched closely by an expert neurology/radiology team who understand how to monitor for these events and know when to pause or stop the drug.

What Were The Results Of The Phase 3 Clinical Trial For Lecanemab

Porsteinsson: This is one of the largest clinical trials in Alzheimer’s disease and was unique in that it had higher participation of historically underrepresented groups than in previous studies. It also allowed volunteers with more medical comorbidities to enter the study. Usually participant populations in studies like these are healthy, so this created a more representative sample of the Alzheimer’s population in the real world.

The volunteers underwent a battery of tests that measured cognitive performance, functional performance, and behavior, and brain imaging and monitoring of biomarkers of the disease. The drug was associated with extremely robust amyloid plaque clearance most of the participants at 18 months had no detectable plaques in their brain. Other downstream effects associated with Alzheimers, like tau and neuronal inflammation biomarkers, also looked like they moved more towards normal.

About 12.5 percent of participants showed evidence of mild to moderate localized brain swelling, but this was not life threatening, rarely clinically evident, and resolved over several weeks when the medication was temporarily halted. We also saw a higher rate of micro hemorrhages, or pinhead bleeds, that we often see in patients with Alzheimer’s disease, so the treatment requires careful clinical and MRI monitoring, particularly in the first 6-12 months.

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Fdas Accelerated Approval Program

Aducanumab was approved through the FDAs Accelerated Approval Program, which provides a path for earlier approval of drugs that treat certain serious conditions. This helps people living with the disease gain earlier access to the treatment. The approval of aducanumab was based on the ability of the drug to reduce amyloid in the brain. When using the accelerated approval pathway, drug companies are required to conduct additional studies to determine whether there is in fact clinical benefit after the drug is approved. If the follow-up trial fails to verify clinical benefit, the FDA may withdraw approval of the drug. Results of the phase 4 clinical trial for aducanumab are expected to be available by early 2030.

Who Can Prescribe Alzheimer’s Drugs

A specialist, rather than your GP, will prescribe the medicine during this trial period.

You will usually see the specialist in a hospital clinic. You may need blood tests and a brain scan to exclude any other causes for the memory loss.

In some areas, the specialist will continue to prescribe the drug if they conclude that it is working. In other areas, the GP will prescribe it after the trial period.

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Heart And Brain Connection

More evidence seems to link the brain and the heart as an extremely important connection in Alzheimers patients. Population studies reveal that people whose blood pressure is controlled and who lead a healthy lifestyle have a far lower risk of AD compared to populations who have high blood pressure and live an unhealthy lifestyle. Hence, the current emphasis is on adopting a positive lifestyle in the hopes of preventing AD in the first place. This means eating healthy, exercising regularly, discontinuing smoking, maintaining a healthy weight, and keeping blood pressure within normal limits. Speak to your healthcare provider if you want to know more about lowering your risk of getting diagnosed with Alzheimers disease. Preventing AD in the first place is a far better option than treating it later.