ALZHEIMER’S AND DEMENTIA CARE


The good news is that there is a greater


understanding than ever about how de- mentia The good news is that there is a greater understanding than ever about how dementia affects the brain, experts said. As a result, there has been a growing focus on treatments that “short-circuit” the disease’s impact.


MARTI WDOWICKI Director of Clinical Operations PharMerica


“This is a great first step. We are on the right track. I think some day we will get to point where there isn’t one just drug solution but a multipronged approach to prevent cognitive decline.”


NEW DRUGS Recently, aducanumab received acceler- ated FDA approval. This, according to the Alzheimer’s Association, “was the first therapy to demonstrate that remov- ing beta-amyloid, one of the hallmarks of Alzheimer’s disease, from the brain reduces cognitive and functional decline” in people with early Alzheimer’s disease. This drug was only studied in people in the early stages of the disease; there is no safety or clinical efficacy data about how it might work in people with moderate and severe dementia. Elsewhere, the FDA has granted ac-


celerated approval to lecanemab. In trials, this drug slowed cognitive and functional decline in early-stage disease. Much like aducanumab, lecanemab works by remov- ing protein plaques from the brain. The drug has come under some controversy, including questions as to why this medica- tion is demonstrating promise when others based on similar science have failed. Also of note, an Argentum member,


BioVie Inc., has very promising initial re- sults from their phase 2 clinical trials that are based on neuroinflammation being at the heart of the biology of Alzheimer’s. Early data from phase 2 suggests their molecule NE3107 can reduce brain inflammation and appears to improve cognition, memory, and function. BioVie has just finished fully enrolling stage 3 trial and anticipates shar- ing a data readout by end of the year. While these new drugs are giving hope to


some, they are expensive and likely will be inaccessible to many patients at least for the immediate future. Nonetheless, said Marti Wdowicki, PharmD, director of clinical operations at PharMerica. “This is a great first step. We are on the right track. I think some day we will get to point where there isn’t one just drug solution but a multipronged approach to prevent cognitive decline.”


22 SENIOR LIVING EXECUTIVE MAY/JUNE 2023


There are other treatments being stud-


ied, but none of these are likely to hit the market soon. For instance, according to a new study from the National Institute on Aging, hydroxychloroquine may lower de- mentia risk in humans, although this has only been studies in mouse and cell models to date. However, researchers say that re- sults to date “could lay a strong foundation” for clinical trials involving older adults. While people are waiting for better, more


cost-effective treatments, cholinesterase inhibitors continue to be used most com- monly, said David Smith, MD, president of Geriatric Consultants in Brownwood, Texas. These medications, donepezil, riv- astigmine, and galantamine, prevent acetyl- cholinesterase from breaking down acetyl- choline, and this may help ease some signs of Alzheimer’s disease, at least temporarily. “The effects of these drugs are very


modest, and side effects are common. It is important to conduct a careful risk-benefit assessment before using them,” he said. Smith noted that people with Alzheimer’s


disease often feel depressed and are griev- ing the loss of intellect, and this may cause them to act out. Instead of jumping to medications to manage the behaviors, it is important to address underlying depression, anxiety, and other issues. He stressed that exercise and talk therapy can be as valuable as drug therapy for some of these things. Probing the depths of


this depression


and how this may manifest itself in individ- uals is also vital, especially when it comes to taking of one’s own life. “You need to ask questions and find


out how serious they are about suicide,” Smith said. If they’ve already identified a method of suicide and have trouble coming up with a reason not to take their own life, this is serious and calls for active suicide prevention measures.


OVER-THE-COUNTER CONFUSION Wdowicki noted that there are some over- the-counter products available claiming to slow or delay memory decline or sharpen cognition. These include Omega-3 fatty acids (fish oil), ginkgo biloba, turmeric, and apoaequorin. However, she stressed that these haven’t


really been clinically studied and they are not without side effects. In the end, she said,


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