By Stefanie Wardlow, Senior Program Manager, Quality Initiatives, Florida Gulf Coast Chapter; Research Champion, Florida 2023 was a landmark year for … More
By Stefanie Wardlow, Senior Program Manager, Quality Initiatives, Florida Gulf Coast Chapter; Research Champion, Florida
2023 was a landmark year for Alzheimer’s disease research, including advancements in treatment, risk factors and diagnosis of Alzheimer’s and other dementias. In this new era of Alzheimer’s treatments, here are eight significant discoveries from this year.
1. New treatments became available for Alzheimer’s management
In July 2023, the U.S. Food and Drug Administration (FDA) granted traditional approval for Leqembi for treatment of mild cognitive impairment due to Alzheimer’s and mild Alzheimer’s dementia. This treatment, while not a cure, slows cognitive decline and can give people with early Alzheimer’s more time to maintain their independence.
Back in June 2021, the FDA granted accelerated approval to Aduhelm for the same purpose. At the Alzheimer’s Association International Conference (AAIC) in July 2023, Eli Lilly reported positive results for a third treatment — donanemab — in that same population. The company expects FDA action soon. .
In May, the FDA approved brexpiprazole for agitation in people with Alzheimer’s disease. This is the first FDA-approved treatment for Alzheimer’s-related agitation, which is experienced by about 45% of those with Alzheimer’s. It is the second FDA approved drug that treats a behavior in people with Alzheimer’s. Back in 2020, suvorexant (Belsomra) which was previously approved by the FDA to treat insomnia, completed clinical trials in people with Alzheimer’s dementia. Prescribing information for people living with mild-to-moderate Alzheimer’s disease for this drug.
These are just a few of the exciting management options becoming available. According to research published in May 2023, there are more than 140 therapies being tested that target multiple aspects of Alzheimer’s.
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2. Wearing hearing aids may reduce cognitive decline.
In the largest clinical trial to investigate whether a hearing loss treatment intervention can reduce risk of cognitive decline, researchers found that older adults with hearing loss, who were at higher risk of cognitive decline, cut their cognitive decline in half by using hearing aids for three years.
The intervention included use of hearing aids, a hearing “toolkit” to assist with self-management, and ongoing instruction and counseling with an audiologist. Though the positive results were in a subgroup of the total study population, they are encouraging and warrant further investigation. The researchers found that the hearing intervention also improved communication abilities, social functioning and loneliness.
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3. Blood tests for Alzheimer’s are coming soon, and could improve diagnosis and treatment.
Blood tests show promise for improving, and possibly even redefining, how Alzheimer’s is diagnosed in the future. Advancements reported for the first time at AAIC 2023 demonstrate the simplicity — perhaps just a simple finger prick! — and value to doctors of blood-based biomarkers for Alzheimer’s.
These findings are timely with the recent FDA approvals of Alzheimer’s treatments where confirmation of amyloid plaque buildup in the brain and ongoing monitoring are required to receive the treatment.
Blood tests are already being implemented in Alzheimer’s drug trials for further proof of their effectiveness. And they are incorporated into proposed new diagnostic and staging criteria for the disease. Blood tests — once verified, and approved by the FDA — would offer a noninvasive and cost-effective option in identifying blood-based markers for the disease.
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4. Miami-Dade County leads the U.S. in Alzheimer’s prevalence
The first-ever county-level estimates of the prevalence of people with Alzheimer’s dementia — in all 3,142 United States counties — were reported at AAIC 2023. For counties with a population of 10,000 or more people age 65 or older, researchers estimate the highest Alzheimer’s prevalence rates are in:
Miami-Dade County, FL (16.6%) Baltimore City, MD (16.6%) Bronx County, NY (16.6%) Prince George’s County, MD (16.1%) Hinds County, MS (15.5%)Other Florida counties made the top 100 for the highest Alzheimer’s prevalence rate. Those in this group include:
Broward County ranked #34 at 13.9%. Palm Beach County ranked #38 at 13.8%. Orange County ranked #86 at 12.7%. Highlands County ranked #89 at 12.7% Osceola County ranked #95 at 12.6%.The researchers identified certain characteristics that may explain the higher prevalence in these counties, including older average age and higher percentages of Black and Hispanic residents. According to the Alzheimer’s Association, these stats can help public health officials determine the burden on the health care system, and better pinpoint areas of high risk and high need — for example, for culturally-sensitive health support and caregiver training services.
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5. Chronic constipation is associated with poor cognitive function.
Approximately 16% of the world’s population struggles with constipation. That prevalence is even higher among older adults. This year, researchers reported that less frequent bowel movements were associated with significantly worse cognitive function.
Compared to those with bowel movements once daily, people with bowel movements every three days or more had worse memory and thinking equal to three additional years of cognitive aging. These results stress the importance of clinicians discussing gut health, especially constipation, with their older patients, including how to prevent constipation.
6. Gene editing could reduce risk of Alzheimer’s.
Two new therapeutic approaches for Alzheimer’s based on CRISPR gene editing were reported at AAIC in July. One aims to reduce the impact of the strongest known Alzheimer’s risk gene, APOE-e4. The other strives to reduce production of a toxic protein in the brain, beta amyloid, which is a hallmark of Alzheimer’s and the target of recently-approved treatments. CRISPR technology is making drug target identification faster with the goal of speeding up the drug discovery process, and building platforms for the development of next-generation treatments.
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7. Improving sleep and high blood pressure may improve brain health.
Several sleep and brain researchers presented at AAIC 2023. Stephanie Yiallourou (Turner Institute for Brain and Mental Health, Monash University, VIC, Australia) and colleagues led study on short sleep duration and the brain. Sleep dysfunction can disrupt the brain. Their study found that short sleep (less than 5 hours per night) and high blood pressure are associated with impaired cognitive function (executive function/processing speed) and brain damage (larger white matter volume). The causal relationship is not clear. The combination of short sleep and high blood pressure may lead to subclinical cerebrovascular injury leading to cognitive impairment. Further studies should confirm results and fully investigate these interactions. Sleep problems and hypertension are treatable and high-risk groups can focus on preventative measures.
8. An early diagnosis is more critical today than ever before.
We are in a new era of treatment—the biology of Alzheimer’s can now be targeted therapeutically. Brain changes associated with Alzheimer’s may begin 20 years or more before symptoms appear—early diagnosis is even more critical. The 2023 Alzheimer’s Disease Facts and Figures, an annual report released by the Alzheimer’s Association, reveals the burden of Alzheimer’s and dementia on individuals, caregivers, government and the nation’s health care system. The special report found that while only 4 in 10 Americans talk to their doctor right away when experiencing early cognitive loss, 7 in 10 would want to know early if they have Alzheimer’s disease if it could allow for earlier treatment.
If you do not currently have a doctor, the Alzheimer’s Association has resources to help you find one. Search Community Resource Finder for doctors near you or call our free 24/7 Helpline (800.272.3900).
Get Involved
Alzheimer’s Association TrialMatch® connects individuals living with Alzheimer’s, caregivers and healthy volunteers to clinical trials that may advance Alzheimer’s research. The free, easy-to-use service allows you to see which studies are a good fit for you or a family member. Search for studies, receive email notifications about new opportunities or connect with research teams. Learn more at alz.org/trialmatch. Together we can end Alzheimer’s disease.