New drug aims to reduce progression of Alzheimer’s disease

Clinical trials show a small improvement, but a cure still eludes scientists

Today's expression: Show promise
Explore more: Lesson #538
January 16, 2023:

A new drug has been shown to slow the progress of Alzheimer's disease by targeting protein buildup in the brain. While this drug makes just a small difference, it opens up a new avenue for treatments in the future. Plus, learn the English expression "show promise."

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A reason for optimism in the fight against Alzheimer’s disease

Lesson summary

Hi everyone, I’m Jeff and this is Plain English. And at Plain English, we help you upgrade your English with current events and trending topics. By joining us every week, you’ll improve your listening skills, increase your vocabulary, and learn about the world at the same time. And if you’re really looking to upgrade your English, come join us at Plain English Plus+, our membership program specifically designed to help you express your best ideas in your new language. You can get that at PlainEnglish.com/Plus .

Coming up today: Alzheimer’s is a heartbreaking disease. And researchers have been frustrated for decades in their quest to develop a drug to slow or reverse the effects of Alzheimer’s. But a new drug has shown some promise. And “show promise” is the English expression we’ll talk about in the second part of today’s lesson.

JR is the producer of Plain English and he has uploaded this full lesson to PlainEnglish.com/538. If you’re not already there…that is where you can find a full transcript of this lesson. PlainEnglish.com/538. Ready? Let’s get started.

New drug reduces Alzheimer’s symptoms

Dementia is a catch-all term for a sad set of symptoms: a slow decline in the ability to remember, to think, and to make decisions. This is more than simple memory loss associated with ageing. As people grow older, their short-term memories start to decline; it’s normal to misplace car keys, forget the names of acquaintances, or confuse a word here or there . This happens to many, if not most, people as they age, and it’s normal.

Dementia is different; it afflicts about one out of every seven people older than age 70; the percentage increases with age.

Symptoms of dementia start slowly and build over time. Not everyone experiences the same symptoms, but there are some patterns. A patient with a mild case of dementia might have trouble remembering familiar names and events. A few years later, that patient might experience more confusion in daily life. And in still more advanced cases, patients might not recognize close relatives, they might be confused frequently, they might act out of character and they might be unable to live independently. Dementia is, for now , irreversible.

Alzheimer’s is a specific brain disease and it is a type of dementia. In Alzheimer’s, proteins accumulate between the brain’s neurons. However, researchers have been unable to say for certain whether these proteins cause Alzheimer’s, or if they are simply a side effect.

Patients with Alzheimer’s experience progressively more brain impairment. In the early stages, some patients know that something is wrong. But often, especially in later stages, patients’ reasoning is impaired, so they don’t know they have the disease.

This can be heartbreaking for relatives, including the patient’s children who are, by then, often in middle age. Alzheimer’s patients require a lot of care and patience, something that families struggle to provide. Specialty hospitals and nursing homes are available, but they’re expensive.

For years, drugmakers have been searching for a way to slow, stop, or even reverse Alzheimer’s disease; these efforts have almost all been unsuccessful. The few drugs that have been approved have made a very small difference.

However, a new drug called lecanemab has shown some promise . Lecanemab works in two steps: first, it finds the proteins that accumulate between the neurons in the brain and it attaches itself to those proteins. Then, it purposely attracts the body’s immune cells that break down these harmful proteins. In other words, we all already have the necessary immune cells; the drug simply attracts them to the right place, so they can do their work on the harmful proteins.

It appears to have worked—a little. The drugmakers published the results of their clinical trial. In the trial, they recruited 1,795 volunteers with early signs of Alzheimer’s; these were confirmed with an expensive lab test. Half the volunteers were given lecanemab; the other half got a placebo.

The group that received the drug experienced a modest but statistically significant decline in the rate of impairment, compared to the group that got the placebo. That means, the group that got the drug did experience a progression in their disease; but the disease progressed slower in them than it did in the group that got the placebo.

Lecanemab is not a miracle drug, and there are other problems. First, it should be administered to patients with early symptoms of Alzheimer’s. But Alzheimer’s is a difficult disease to detect early: patients often don’t notice the early symptoms—or they hide them from relatives. The test to confirm early Alzheimer’s is expensive and intrusive. By the time many families know something is really wrong, it may be too late for this drug.

Second, the drug’s effect was small, and the trial only lasted 18 months. It’s not clear whether the small benefits can be sustained any longer. Many patients live with Alzheimer’s for many years, some as long as ten or even twenty years.

And finally, there are some nasty side effects, including bleeding and swelling in the brain. A few patients died in the clinical trial.

However, lecanemab is important because it’s a proof of concept. Remember before I said that proteins accumulate in the brains of Alzheimer’s patients? It hasn’t been clear until now whether this was a cause of Alzheimer’s symptoms or just an effect. The lecanemab trials appear to show that by targeting these proteins, the symptoms can be slowed. That might open the door to other, better antibody drugs in the future.

Big challenge: detection

To me, the big challenge would be knowing when to start on this drug—I mean, prices will be high in the short term. But assuming this works, or a drug like this works in the future, the real challenge is knowing when to start it. There’s no flashing red light at the very beginning. There’s no blood test, no effective screening. It’s not like screening for high cholesterol, or screening for colon cancer—this is all subjective. And a lot of patients, at the beginning, maybe they don’t know what their symptoms are; a lot are embarrassed; a lot don’t want to think about it. So to me, that would be the big challenge. Hopefully the drug works, and hopefully they find a better way to help people discover when Alzheimer’s is setting in .

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Expression: Show promise