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The April 26 front-page article “Hit with early-stage Alzheimer’s, but refusing to surrender” did a great job describing evidence-based lifestyle changes that people with mild cognitive impairment and early Alzheimer’s can do for their brain health. More could have been said on the lack of evidence for benefit and uncertainties of the anti-amyloid drugs.
For the drug lecanemab, a half-point change on an 18-point scale over 18 months was statistically significant, unlikely enough for patients and their families to notice in their everyday lives. The drug had even less of an effect in women, those under 65 and people with two copies of a genetic variant that increases risk for Alzheimer’s. The brain bleeding and swelling it causes happened in more than 20 percent of patients, with three dying of bleeds.
More recently, scientists are reporting brain shrinkage in patients in the clinical trials of the anti-amyloid drugs, 28 percent greater than those on placebo. Brain shrinkage is a cardinal sign of dementia and brain damage in general. Researchers are very concerned but do not know what it means at this point.
It was disconcerting to read that the article’s point person had started another Alzheimer’s advocacy organization and, as with the others, is receiving financial support from the manufacturers of the new drugs. The organization is pushing Medicare to pay for lecanemab even though her medical adviser who advised the lifestyle changes is “not a fan,” given the safety concerns.
The writer, a geriatric psychiatrist, is a former Alzheimer’s researcher at the National Institutes of Health and former Food and Drug Administration medical officer.
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