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  • Taking Aim at Toxic Plaques in Alzheimer's Disease
    Last year in the US, 5.8 million adults over 65 years of age were living with Alzheimer's disease, and recent calculations show the number may triple in just a few decades. The huge increase is associated with an aging population, lifestyle risk factors, and chronic disease. Historically, studies have not had full information regarding incidence in some lower-income countries. Cases among younger individuals may also be increasing, so the actual number of global instances of dementia may even be much higher than the present estimate of 50 million. New treatments must be made available to slow down the disease.

    Earlier detectable symptoms of Alzheimer's disease include mild cognitive impairment. Thoughts, memories, and language skills are affected, and the patient's quality of life begins to degrade. When progression occurs and physical functionality is impacted, the disease becomes life-threatening. Immobility with resulting infections and issues with swallowing and aspiration are the usual circumstances that lead to death. There is no cure for the disease. Most of the common Alzheimer's disease treatments work to regulate neurotransmitters, which aids in some cases of memory loss and behavioral issues. For mild to moderate disease, donepezil, rivastigmine, and galantamine are used to combat symptoms. Individuals with moderate to severe disease are commonly prescribed donepezil, memantine, the rivastigmine patch, or a donepezil/memantine combination. While these drugs are helpful for many patients, therapy that goes beyond symptomatic treatment and instead delays or halts degradation and death of brain cells is a desired next step.

    Abnormal structures that accumulate in brain tissues are thought to cause nerve cell damage and destruction. Structures composed of the naturally occurring protein tau and beta-amyloid collect and begin to have adverse effects on brain function. Beta-amyloid deposits take shape between neurons, forming plaques. Twists of tau, called tangles, form together inside neurons. Drugs known as monoclonal antibodies are thought to be able to impede the formation of or even remove beta-amyloid plaques by mimicking the response of human antibodies to clear the protein from brain tissues. In June 2021, the first disease-modifying therapy to treat Alzheimer's disease was granted accelerated approval by the FDA. Aduhelm (aducanumab-avwa) injection, for intravenous use, is approved for use in certain patients with mild cognitive impairment or early Alzheimer's disease. As a human monoclonal antibody, Aduhelm binds to amyloid plaques, resulting in an immune response in the body that removes the plaque.

    Heightened scrutiny has been placed on the drug, which was brought up for detailed discussion at the November 2020 CDER Peripheral and Central Nervous System Drugs Advisory Committee meeting, with questions regarding whether lowering brain amyloid burden is the precisely right target for Alzheimer's disease treatment. As such, continued approval for the Alzheimer's disease indication for Aduhelm may be contingent upon verifying clinical outcomes through a confirmatory trial. To aid providers in understanding and navigating treatment with the new and debated therapy, a group of six leading Alzheimer's disease experts composed the first recommendations for the use of aducanumab. The document, " Aducanumab: Appropriate Use Recommendations," was published by The Journal of Prevention of Alzheimer's Disease at the same time as a dedicated session at this year's Alzheimer's Association International Conference. The authors concluded, "Appropriate use of aducanumab requires a commitment to patient-centered care and best practices for the safe delivery of this new treatment." In addition to the recommendations, the Alzheimer's Association has also prepared and posted an information guide, " Understanding Aducanumab An Information Guide for Patients," designed to help patients understand the new treatment.

    With new therapies emerging and new knowledge being gained through research that leads to an expanded understanding of the progression of Alzheimer's disease, additional tools for providers can help educate and offer support. Proper diagnosis and treatment begin with awareness. Alzheimer's Disease International (ADI), founded in Chicago, Illinois and based in London, England, acknowledges September as World Alzheimer's Month. Its 2021 focus is on dementia diagnosis and emphasizes the power of knowledge. As part of the campaign, the organization's World Alzheimer's Report 2021 will be published (scheduled for launch September 21). This and past reports and the other reference materials, pamphlets, and documents are available on the ADI site as resources for patients and providers. The CDC also offers materials useful for increasing knowledge and encouraging talking points with patients regarding Alzheimer's disease, such as a 10 Warning Signs of Alzheimer's poster.

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