Lecanemab has received accelerated approval by the FDA for the treatment of Alzheimer disease in patients with mild cognitive impairment or mild dementia. The FDA is required to decide by July 6, 2023 on full approval of lecanemab based on clinical benefit. The results of a Phase 3 clinical trial indicating lecanemab's clinical benefit have been published. A second medication in the same class, donanemab, has recently been reported to slow progression of disease. All drugs used within the MGB system are subject to review by the MGB Pharmacy &Therapeutics Committee that is responsible for evaluating and providing recommendations for the use of medications.
Alzheimer’s disease is a progressive degenerative brain disease that occurs when nerve cells in the brain die. The disease often leads to impaired memory, confusion, personality and behavior changes, and impaired communication. At this time there is no cure for Alzheimer’s disease and no treatments are available to reverse its effects. There are medications available to optimize a patient’s condition and Brigham and Women’s Hospital researchers are leading groundbreaking studies to determine treatments that slow down the progression of the disease.
At Brigham and Women’s Hospital, the Clinical Care Program of The Alzheimer Center provides comprehensive evaluation and treatment for this complex and devastating disease that impacts every aspect of a patient’s life. Our multidisciplinary team of specialists in behavioral neurology, neuropsychiatry, geriatric psychiatry, neuropsychology, and social work, addresses all of the cognitive, emotional, and behavioral components of Alzheimer’s disease during each stage of a patient’s illness.
In addition to the comprehensive clinical care we provide, our Center for Alzheimer Research and Treatment (CART) is home to robust and groundbreaking research in Alzheimer’s disease. One example of our research is the Anti-amyloid Treatment in Asymptomatic Alzheimer’s Disease (A4) Prevention clinical trial. The A4 trial is a clinical study for older people between the ages of 65 and 85 who have normal thinking and memory function but who may be at risk for developing memory loss and other symptoms of Alzheimer’s disease in the future. The study is designed to evaluate the effectiveness, safety, and tolerability of an investigational drug as a method of prevention of memory loss due to Alzheimer’s disease.
Alzheimer’s disease is one of the many diseases and conditions that form the focus of our Neurosciences Center. Our multidisciplinary team of neurologists, psychiatrists, and radiologists offers the most innovative and advanced treatments and therapies for Alzheimer’s and all diseases of the nervous system. Our dedication to discoveries and research in these areas has made us the choice for patients from the region and around the world.
It is estimated that roughly 5.3 million Americans have Alzheimer's disease. And, according to the Alzheimer’s Association, this number includes 5.1 million people over the age of 65, as well as 200,000 to 500,000 people younger than 65 who have early-onset Alzheimer's and other types of dementias. The specific cause of Alzheimer’s disease is not entirely known but suspected causes include:
Although the cause is not known, research has revealed information on Alzheimer’s disease. Brigham and Women’s Hospital researcher Dennis Selkoe, MD, has shown that build-up in the brain of a protein called amyloid beta is largely responsible for the degenerative effects of the disease, but there is still much to be learned.
What is known is that amyloid-beta forms plaques and clumps, inhibiting the brain's neurons and damaging their connections to one another. Other researchers are investigating the role of a protein called tau which causes "tangles" inside nerve cells, leading to the cells' death. Though less is known about tau’s significance and its interaction with amyloid-beta, researchers are confident that the cognitive decline associated with Alzheimer’s disease is related to the abnormal processes of these two proteins.
It is important to find specialists who are experts in the complexities of Alzheimer’s care and who have access to the latest discoveries in the diagnosis and treatment of this disease.
Each individual may experience symptoms differently. The most common symptoms of Alzheimer’s disease include:
Many older individuals may complain of memory problems, but still manage to independently perform all of their day-to-day tasks. Because their memory problems do not interfere with daily activities, these people do not meet criteria for a diagnosis of dementia or Alzheimer's disease. This cluster of symptoms, in which a person experiences significant problems with memory, language or other functions severe enough to be noticeable to other people and show up on tests of memory, but not serious enough interfere with daily life, is called mild cognitive impairment (MCI). Patient’s with MCI have problems with memory or thinking that are greater than those anticipated for his or her age.
The symptoms of Alzheimer’s disease may resemble MCI or other medical conditions. However, people with MCI do not have the more severe cognitive problems or functional changes that characterize Alzheimer's disease.
In the last few years, there has been a substantial increase in the number of studies focusing on patients with complaints of early memory loss. Although much more work still needs to be done, doctors and researchers have made significant progress in characterizing these early memory problems and their potential outcomes.
There is not a single, comprehensive test for diagnosing Alzheimer's disease. By ruling out other conditions through a process of elimination, a specialist can obtain a diagnosis of probable Alzheimer's disease — the only way to confirm a diagnosis of Alzheimer's disease is through autopsy.
Comprehensive care of our patients begins with a thorough evaluation. By establishing an accurate diagnosis from the beginning and identifying all the conditions that may be contributing to a patient’s impairment, we lay the groundwork for an effective treatment plan.
During the first meeting, one of our physicians will take the time to gather a comprehensive medical history from the patient. We encourage patients to bring family members to appointments and include them in this process as they can be a vital part of the evaluation and treatment plan. Patients and family members will be given ample opportunity to express their concerns and ask questions. The clinician who initially meets with patient often serves as the team leader and key contact person throughout the time a patient is receiving care at our Center.
After a detailed history is obtained, a series of assessments will be performed to further understand a patient’s condition. The goal is to carefully define a patient's pattern of deficits in order to identify the underlying neurological condition. The assessments are used to methodically narrow the field of possibilities until a definitive diagnosis is reached. Additional tests may be performed to determine whether other medical conditions are contributing to a patient's cognitive impairment.
These evaluations may include:
Once the clinical team has established a diagnosis, they will develop a detailed treatment plan tailored to the needs of each patient. Treatment will be based on the type of memory disorder involved, the stage of the disease, contributing conditions, and the goals of the patient and their family.
Although there currently are no established treatments that can modify or reverse Alzheimer’s disease itself, medications are available to optimize a patient’s condition. FDA-approved medications are prescribed to help enhance memory and attention. Other medications may be prescribed to address mood and behavioral disorders. Often, these kinds of symptoms are managed by one of our neuropsychiatrists or geriatric psychiatrists, who are experts in this area.
Our clinical team works with patients and their families to educate them about the disease, which can help everyone affected to understand the illness and plan for the future. Our social workers assist families in preparing for each stage of the disease. This may include connecting families to community services, providing advice about modifications to the home environment, organizing safety assessments, or ensuring that financial interests are protected. Social workers and other team members also provide guidance and support to caregivers, who have to deal with the many challenges associated with a neurological disease in a loved one.
Treating other conditions
Patients with Alzheimer’s disease and related memory disorders often do not have the capacity to compensate for other medical conditions that may affect brain function. Our clinical team works to identify any other medical conditions that may negatively impact the brain, such as depression, sleep disorders, pain, or vascular/heart disease. The Alzheimer clinical team also carefully reviews medications that patients have been taking for other conditions, and assesses whether side-effects may be contributing to their impairments. If a patient has other medical conditions or medication side-effects that may be disrupting brain function, we work closely with the patient’s other physicians to address these issues and improve function.
Living with Alzheimer’s disease does have an impact on mental health and often can lead to depression. At Brigham and Women’s Hospital, Alzheimer’s disease patients have access to the services they need to cope with the challenges they face on a day-today basis.
Specialists within the Department of Psychiatry at Brigham and Women’s Hospital provide a broad range of programs, including specialized services that address the unique needs of patients living with chronic conditions, such as Alzheimer’s disease.
In addition to standard of care treatments currently available, Brigham and Women’s Hospital offers patients with Alzheimer’s disease the opportunity to participate in clinical trials of investigational agents being tested to try to slow the progression of Alzheimer’s disease. There are trials for all stages of Alzheimer’s disease, including prevention trials, mild cognitive impairment, and Alzheimer’s dementia, sponsored by the National Institutes of Health and other organizations, ongoing at Center for Alzheimer’s Research and Treatment (CART).
No patient is obligated to participate, but many are interested in the opportunity to increase our understanding of Alzheimer’s disease and potentially help us to discover more effective treatments that could benefit them or other patients.
Brigham and Women’s Hospital provides a multidisciplinary approach to patient care, collaborating with colleagues in other medical specialties. If your neurologist or neurosurgeon discovers an underlying illness or concern, you will be referred to an appropriate Brigham and Women’s Hospital physician or allied health professional for an expert evaluation.
Neurology and Neurosurgery Advances Newsletter article: Clinical Trial Evaluates Novel Approach to Alzheimer’s Disease Prevention
Watch the video Cognition and Healthy Brain Aging with Kirk Daffner, MD, Chief, Division of Cognitive and Behavioral Neurology at Brigham and Women’s Hospital. Read the transcript for this video.
Watch the video Research Updates: Amyloid Beta and Alzheimer’s Disease with Dennis J. Selkoe, MD, Co-director of the Ann Romney Center for Neurologic Diseases at Brigham and Women’s Hospital. Read the transcript for this video..
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