As most infectious diseases have been controlled after antibiotics were discovered, and the use of vaccines against viral diseases became widespread, the 21st century faces new challenges.

One is the epidemic of diabetes, and as people live longer, the menace of Alzheimer’s. The number of Americans with Alzheimer’s is expected to nearly triple to about 14 million by 2060 according to the U.S. Centers for Disease Control and Prevention.

Up to now there was not much we could do about it. At most, there are medications expected to somewhat slow the progression of the disease. So at the 2018 Alzheimer’s Association International Conference in Chicago, the news that an experimental drug had shown positive results in human patients was greeted with cautious optimism.

The drug, BAN2401, was used over 18 months twice a day intravenously in patients with mild cognitive impairment and early Alzheimer’s disease. Those patients had about 93% less beta amyloid in their brains compared with people in the study taking a placebo, a dummy medication.

While all participants saw their mental abilities decline over the course of the study, the group on the highest dose of the drug showed significantly less disease progression than the placebo group on a range of cognitive tests. Beta amyloid is a protein that is the main component of sticky plaques that build up in the brains of Alzheimer’s patients. Beta amyloid is a normal protein; we all have it.

In healthy brains, it gets cut in the middle by an enzyme called alpha secretase, and the two pieces get cleared from the brain. In Alzheimer’s disease, two other enzymes cut the protein in other places, leaving fragments that the body does not recognize, as it does not know how to get rid of it.

These toxic fragments start to accumulate in the brain to form plaques. No drug has ever demonstrated both the ability to clear beta amyloid and slow the progression of the disease in such a short period of time, just 18 months.

Enthusiasm was muted, though, for some reasons, the main one was that the study was not broad enough to definitely demonstrate mental benefits for patients. The drug is also a disease-modifying drug, it slows the progression and course of the disease. It does not cure it.

 There were also side effects, most commonly brain swelling related to removal of amyloid from the brain. In 10% of cases patients  had headaches, visual disturbances or confusion.

Therefore, a lot more work needs to be done. Meanwhile, it is important to keep in mind that eating healthy foods and avoiding unheathy food groups, such as fried or fast food, not overeating, having a good night’s sleep, plenty of exercise, and not smoking might be a very good strategy to lower the risk of Alzheimer’s disease.

MICHAEL ROY SMITH, M.D.

MOBILE ECHOCARDIOGRAPHY

Phone: 99183-2093       E-mail: mrsmith@terra.com.br