Latest Developments in Alzheimer’s Disease Management

October 30, 2017

During her presentation entitled “New Horizons in the Management of Alzheimer’s Disease: Advances in Early Diagnosis & Treatment Strategies,” Marwan N Sabbagh, MD, director of the Alzheimer's and Memory Disorders Division at the Barrow Neurological Institute, discussed the importance of early diagnosis, the current understanding of Alzheimer’s Disease pathophysiology, and the current and emerging treatments.

Dr Sabbagh explained that 5 million patients in the United States have Alzheimer’s Disease, with a projected 16 million by 2050. The disease is also the sixth leading cause of death, according to Dr Sabbagh, and costs around $259 billion annually—making it the most expensive disease in the United States.

“Many obvious benefits to early diagnosis exist, and effective pharmacological and

nonpharmacological treatments for symptoms of Alzheimer’s Disease are available,” Dr Sabbagh said while explaining the importance of an early diagnosis. She also noted that early risk factors include females, APOE-e4 genotype, hypertension, diabetes, head trauma, and family history.

The APOE‐e4 is present in about 20% of the population, according to Dr Sabbagh, which increases the risk and decreases the likely age of onset. She stressed that the gene has a modest effect on predicting the disease but is not a positive predictor 100% of the time.

She explained that currently, the main goal of treatment is to arrest the disease, slow its progress, and to achieve symptomatic benefits over time.

The currently used, well-tolerated therapies for disease management include cholinesterase inhibitors and memantine. Dr Sabbagh also highlighted some disease modifying therapies, including aducanumab, which have demonstrated theraptutic effects in clinical trails.

“Potential therapeutic effects may be larger in mild‐stage, very mild, or MCI stages than in moderate‐stage,” she said. “Increasingly, immunotherapy trials are looking to intervene at earlier stages to see if disease progression can be interrupted prior to symptomatic onset.

“Several agents with different mechanisms of action are in clinical trials to evaluate whether disease progression can be slowed.” Among these, Dr Sabbagh highlighted β-secretase inhibiors, RAGE antagonists, melatonin receptor antagonists, and an anti-tau vaccine.

David Costill

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