A new class of medications (monoclonal antibodies that attack amyloid plaques) are currently being celebrated in the media as being a new cure for Alzheimer’s, the most common type of dementia.
Bottom line assessment: There is no pharmaceutical cure; yet. Researchers are in fact making significant strides in understanding and treating this debilitating neurodegenerative disease. However, based on the actual data provided, this latest round of Alzheimer’s cures are likely to do more harm than good (numerous unbiased studies over the next decade will be needed to determine their true efficacy). Meanwhile, lifestyle factors that have repeatedly been shown to prevent and improve dementia are being overlooked (daily exercise, social interaction, mental stimulation, good nutrition, as well as the avoidance of smoking and drugs). For a detailed list of good habits and foods for the brain, please see the end of this article.
In-depth assessment: Scientifically speaking, the most complex object in the known universe is the human brain. However, like our other more simplistic organs, the brain degenerates over time with trauma, stress, inactivity, smoking/alcohol/drugs, and an inflammatory diet. In response to the ensuing degeneration of neurons, it appears that the brain develops plaques of beta amyloid (extracellular) and tangles of tau (intracellular), which are hallmarks of Alzheimer’s. These two proteins have been somewhat vilified in the media, but it must be noted that they are natural support proteins of the human brain in a healthy person. Obviously, if they degenerate into unhealthy plaques and tangles, it is possible that they could be the cause of dementia. But it is also possible that they are the brain’s scar tissue; i.e. correlational, not causal.
The new class of monoclonal antibodies successfully attack these plaques in the hopes of alleviating Alzheimer’s symptoms. Do they work? They are proven to reduce the plaques. Do they help the patient? At this point, that is highly debatable. The statistical analysis done by pharm shows the medication slows mental decline in patients with mild dementia by 27% in the first 18 months. That is a good starting point, and it is encouraging. Unfortunately, a closer look reveals less encouraging news. First of all, the medicine does not work in patients with moderate to severe dementia. Next, it is not a cure for even mild dementia, it only slows decline (possibly). The raw data show that on a 144-point scale, the medicated group lost 6 points over 18 months, and the placebo group lost 9 points. This is not a large difference, especially when considering that placebo patients in IV trials have a tendency to figure out that they are receiving placebo, and therefore have no expectation of gain.
The daily ‘benefit’ of these new drugs to the lives of patients and their loved ones has a high probability of being imperceptible. Also, so many patients in the medicated group suffered from brain swelling and brain bleeds, that the FDA has given the drugs a Black Box Warning, which is its highest level of concern. Three patients in the medicated group of this study died from effects of the medication. 26% had significant transfusion reactions from the IV infusions of these medications. Many unbiased experts have questioned the overall benefit of these new medications, and a recent JAMA issue was rife with discontent.
The cost is also concerning. The baseline cost of the medication is $26,000 a year, but that is just the tip of the financial iceberg. The patients must be diagnosed with PET scans and possible lumbar punctures, and then followed with frequent MRI’s to check for brain bleeds/swelling. The infusions are twice monthly, and the side effects will also require costly treatment. Beyond money, there are significant costs to the patients, such as extensive time in the hospital/infusion clinics, significant radiation to the brain (PET scans) which increase cancer risk, and unknown long-term side effects of the new ‘accelerated-approval’ drugs. Furthermore, keep in mind that the previous generation of expensive Alzheimer’s drugs sold to patients for decades proved to do little more than cause dizziness.
However, the good news is that science is truly gaining a greater understanding of this disease, and this current breakthrough will potentially lead to effective treatments in the future.
Lifestyle & Nutrition options: Alzheimer’s is a degenerative and inflammatory disease, which means that there are things that everyone can do to help prevent it, as well as improving the symptoms when it occurs.
To prevent dementia, avoid smoking, excess alcohol, drugs and excess medications, head trauma, red meat/pork, junk food, and obesity.
Improve brain function by exercising daily, outdoor walks, swimming, stretching/yoga, staying mentally active (crossword puzzles, chess.com, reading, etc.), using a hearing aid if needed, staying socially connected, organic gardening, good nutrition, and staying well-hydrated (the brain is 80% water, while blood is only 51% water).
Best brain and anti-aging foods: Omega 3’s (wild Alaska salmon, fish oil capsules, flaxseed, chia seeds, etc.), vegetables (especially leafy greens & broccoli), avocados, olive oil, nuts (especially almonds, walnuts & pecans), pumpkin seeds, berries (especially blueberries), pomegranates, whole grains (especially brown rice), turmeric, ginger, green tea, and dark chocolate.
As always, I wish you the best of health!
Brandon Heiberger, MD
HeibergerMD.com 