Treatments for Dementia: Exploring Medications and Various Therapies
In the ongoing battle against Alzheimer's disease, two recent developments in medication have caught the attention of healthcare professionals and patients alike. These are the monoclonal antibodies Lecanemab (Leqembi) and Aducanumab (Aduhelm).
Lecanemab, approved by the FDA in January 2023, has shown more consistent biomarker and clinical benefits compared to earlier treatments. The CLARITY-AD trial demonstrated a roughly 27% reduction in cognitive decline over 18 months. In real-world studies, about 83.6% of patients with early Alzheimer's remained stable or improved after two years on lecanemab. It targets amyloid β protofibrils, leading to reduced amyloid plaques and slowed disease progression. Notable but manageable side effects include amyloid-related imaging abnormalities (ARIA), especially in APOE-4 carriers. Clinical benefits include slower decline in cognition and activities of daily living, with approximately 24-35% slower progression reported in trials [1][2][3].
Aducanumab, FDA-approved in June 2021, has a more controversial history. Its approval was based on its ability to reduce amyloid plaques, but its clinical efficacy remains uncertain. Aducanumab preferentially binds to amyloid plaques and shows measurable biomarker changes, but only modest clinical benefits. Safety concerns, particularly ARIA, were notable during its approval process [2]. Subsequent limited Medicare coverage and Biogen exiting the market in 2024 due to limited uptake and ongoing efficacy questions have further diminished its impact.
Other new drugs like donanemab have shown modest slowing of cognitive and functional decline (about 35%) in early Alzheimer's but are still not curative and typically target patients with specific amyloid and tau profiles [4].
In summary, Lecanemab currently represents a more robust recent advancement with demonstrated clinical and biomarker efficacy and a growing real-world evidence base supporting its slower progression of early Alzheimer's disease. Aducanumab's impact and use have diminished due to limited confirmed clinical benefits and safety concerns.
It's important to note that dementia, primarily caused by Alzheimer's disease, affects millions of people globally. In the United States, over 6 million people are living with Alzheimer's disease. A doctor may recommend using a combination of non-pharmaceutical treatments and medications for dementia treatment. These treatments can be applicable to people experiencing any level of dementia or any stage of Alzheimer's disease.
Cholinesterase inhibitors, a group of drugs that prevent the neurotransmitter acetylcholine from breaking down, may be recommended by a healthcare professional to treat dementia symptoms. Examples include donepezil, galantamine, and rivastigmine. For people with moderate to severe Alzheimer's disease, Namzaric, a drug that combines donepezil (a cholinesterase inhibitor) and memantine (a glutamate regulator), may be more effective than using only one.
Memantine, a glutamate regulator and one of the most recent medications for dementia symptoms to receive approval in the United States, helps improve memory, attention, language, reasoning, and the ability to perform basic actions.
Non-pharmaceutical treatments for dementia, such as dietary changes (e.g., Mediterranean diet), cognitive training, physical exercise, art-oriented therapy, reminiscence therapy, may stabilize cognitive decline and play a preventive role in dementia. These treatments typically target factors that may worsen dementia, including cardiovascular disease, depression, hearing loss, and brain injury.
Before taking any medications, it's crucial to discuss potential side effects with a doctor and report any new or unexpected side effects experienced. Aducanumab is also an anti-amyloid antibody therapy, available in the form of IV infusion, for people with early Alzheimer's disease.
In conclusion, while there is currently no cure for dementia, medications and treatments may help manage symptoms. The recent advancements in medications like Lecanemab offer hope for those suffering from early Alzheimer's disease, providing a slower progression of the disease and improved quality of life.
- Healthcare professionals are actively exploring science-based solutions for neurological disorders, particularly Alzheimer's disease, as seen in the recent approval of Lecanemab by the FDA.
- In comparison to previous treatments, Lecanemab, a monoclonal antibody, demonstrates more consistent biomarker and clinical benefits, as shown in the CLARITY-AD trial and real-world studies.
- Although Aducanumab was approved in 2021, its clinical efficacy remains uncertain, with notable safety concerns, such as amyloid-related imaging abnormalities (ARIA), particularly in APOE-4 carriers.
- To effectively manage any level of dementia or stage of Alzheimer's disease, a doctor might recommend a combination of treatments, including non-pharmaceutical options like the Mediterranean diet, cognitive training, physical exercises, and art-oriented or reminiscence therapy, in addition to medications such as cholinesterase inhibitors and Namzaric.
