Alzheimer's disease treatments: what's on the horizon?

Despite promising trends in this regard, there is a slowdown in the emergence of new treatments for Alzheimer's disease.

Current treatments for Alzheimer's disease temporarily improve symptoms related to memory loss and problems associated with thinking and logic.

These Alzheimer's disease treatments enhance the functioning of brain chemicals, which carry information from one cell to another in the brain. However, these treatments do not stop the decline and death of brain cells involved in the disease. And because more cells are dying, Alzheimer's disease continues to worsen.

Experts are cautiously hopeful about the design of treatments for Alzheimer's disease that can significantly stop or delay the exacerbation of the disease.

The growing understanding of how the disease damages the brain has led to the provision of potential treatments for Alzheimer's disease that interrupt the cycle of the underlying processes of the disease.

Future treatments for Alzheimer's disease could include a combination of drugs, similar to how treatments for many cancers or HIV/AAIDS include more than one drug.The following therapeutic options are among the strategies currently being studied.

Alzheimer's disease treatments: what's on the horizon?

Targeting Beta-Amyloid Plaques for Effective Treatment

Some of the new Alzheimer's disease therapies under development target microscopic agglomerates of beta-amyloid protein (plaques ) . Plaques are a characteristic sign of Alzheimer's disease.

Strategies targeting beta-amyloid include:

Reactivation of the immune system

Multiple drugs, such as monoclonal antibodies, can prevent beta - amyloid from clumping into plaques,remove the formed beta - amyloid plaques, and help the body get rid of beta - amyloid from the brain.

Monoclonal antibodies mimic antibodies produced by the body in normal conditions as part of the immune system's response to extraneous foreign bodies and vaccines.
In June 2021,the US Food and Drug Administration approved aducanumab ( Aduhelm ) for the treatment of certain cases of Alzheimer's disease.

The effect of the drug on people with early-stage Alzheimer's disease has been studied,including people with mild cognitive impairment caused by Alzheimer's disease.
The drug was adopted in the United States because it gets rid of amyloid plaques in the brain.But it has not been widely used because studies on its effectiveness in slowing cognitive decline have been mixed and focused on limited cases. 

Another drug for the treatment of Alzheimer's disease,lecanimab,has shown promising results for people with a mild degree of Alzheimer's disease and those with mild cognitive impairment as a result of Alzheimer's disease.It could become available in 2023.

Phase III clinical trials have shown that the drug successfully slowed cognitive decline by 27% in people with early-stage Alzheimer's disease.
Licanimab works by preventing the clumping of amyloid plaques in the brain.This study was the largest to date in the search for whether removing amyloid agglomerates from the brain can slow down the disease Licanemab is under review by the U.S. Food and Drug Administration.

Another study is looking at how effective the drug is for people at risk of developing Alzheimer's,including people who have first-degree relatives with the disease,such as a parent or sibling. 

Another monoclonal antibody drug that has shown promising results is dunanimab . The drug has moved to the third stage of the study.

According to a number of studies, solanzumab,a monoclonal antibody drug,has not produced any benefit for people with a mild or moderate degree of Alzheimer's disease,but it is possible that solanezumab will be more effective when the patient gets it earlier in the course of the disease's progression.

The drug has been shown to be safe,and evaluation of solanezumab is ongoing at the preclinical stage of the disease.

Prevention of spoilage

A treatment for Alzheimer's that was originally designed as a potential cancer treatment — saracatinib — is now being tested in mice.

The drug turned off the effect of one of the proteins, allowing neural connections to start working again, and the animals underwent a state of recovery from some memory loss.

Human trials are currently underway in order to use saracatinib as a possible therapy for the treatment of Alzheimer's disease.

Production blockers

These treatments can reduce the amount of beta - amyloid produced in the brain.Research has shown that beta-amyloid is produced from a "key protein" in two steps performed by different enzymes.

Many experimental drugs are aimed at limiting the activity of these enzymes.They are known as beta-and gamma-secretase enzyme inhibitors.

Recent studies have shown that beta-secretase inhibitors have not succeeded in slowing cognitive decline,and they have entailed serious side effects in patients with a mild to moderate degree of Alzheimer's disease,which led to a decrease in enthusiasm for this mechanism of action of the drug.

Avoid tangling of tau proteins 

A crucial system for transporting substances to brain cells collapses when a type of protein called tau proteins are twisted,forming microfibers called tangles, another brain defect common in Alzheimer's disease.The researchers are trying to find a way to prevent the formation of these tangles through the action of tau proteins.
Inhibitors of tau protein aggregation and vaccines for tau proteins are currently under study in clinical trials.

Reducing inflammation

Alzheimer's disease causes chronic low-level inflammation of brain cells.Researchers are studying ways to treat the inflammatory processes that cause Alzheimer's disease.

The drug Sargramostim (leucine) is currently under research. It is believed that the drug may stimulate the immune system to protect the brain from harmful proteins.

Researchers have also studied the diabetes drug pioglitazone (Actos) to see how effective it is in relieving amyloid beta and encephalitis. However, the study proved the ineffectiveness of the drug.

Research on insulin resistance

Researchers are studying the effects of insulin on the brain and the functions of brain cells, as well as insulin changes in the brain that may be associated with Alzheimer's disease.

One of the trials testing the nasal insulin spray found that the drug was not effective in slowing the progression of Alzheimer's disease.

Studies on the connection between the heart and the head

Growing evidence suggests that brain health is closely related to cardiovascular health. The risk of dementia appears to increase as a result of many conditions affecting the heart or arteries.

These include hypertension,heart disease,stroke,diabetes mellitus and high cholesterol in the blood.

There are a number of studies exploring how best to build on this connection between the heart and the head. The strategies that are still under research include:

Current drugs for the treatment of heart disease risk factors

Researchers are studying whether drugs currently used to treat vascular diseases, such as blood pressure drugs, are useful in treating people with Alzheimer's disease or reducing the likelihood of dementia or not.

Drugs were developed to reach new goals

Additional studies are looking more closely at how the relationship between heart disease and Alzheimer's disease works at the molecular level to find new drug targets. 

Lifestyle choices

Research suggests that lifestyle choices with known heart benefits,such as exercising most days of the week and eating a healthy,heart-healthy diet,can help prevent or delay Alzheimer's disease.

Estrogen-Based Hormone Therapy and Cognitive Function

In one study, estrogen-based hormone therapy for at least a year during perimenopause or at the onset of menopause appeared to provide protection for thinking and memory in women at high risk of Alzheimer's disease.
But there is more conflicting research,as some studies suggest that estrogen has not provided any benefit. Therefore, further research is needed to better understand the relationship between estrogen and cognitive function before making any recommendations.

Accelerating treatment innovation

The creation of new medicines is a slow and laborious process. The speed can be especially frustrating for people with Alzheimer's and their families who are waiting for new treatment options. To help accelerate discovery,the Consortium for the Control of Serious Diseases (CAMD), an alliance of pharmaceutical companies,non-profit organizations, and government consultants,has established a partnership that is the first of its kind to share Alzheimer's clinical trial data. The CAMD "Serious Disease Control Consortium" also cooperated with the "Clinical Data Exchange Standards Consortium" (CDISC) to develop data standards. The researchers expect that these data standards and the sharing of data from more than 6,500 study participants will accelerate the creation of more efficient processors.
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