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Aducanumab for Alzheimer’s disease

The US Food and Drug Administration approved the drug Aduhelm (aducanumab, Biogen) for the treatment of mild Alzheimer’s disease on June 7 2021.  This drug is designed to remove toxic forms of the Alzheimer’s beta-amyloid protein from the brain.  In one small and two large studies, the drug was effective in reducing the amount of toxic brain amyloid proteins in people with mild cognitive impairment (MCI) due to Alzheimer’s disease or mild Alzheimer’s disease dementia (MMSE of 24 or greater).  In the two large studies which enrolled enough people to determine if treatment could lead to improved thinking and memory, the drug succeeded in slowing down the cognitive decline in one study.

Because the drug specifically targets the amyloid protein, it should only be given to people with “biomarker-confirmed” Alzheimer’s disease.  This means that, in addition to a clinical diagnosis of MCI or mild Alzheimer’s disease by a physician, additional spinal fluid testing or PET scan is necessary.  The Division of Cognitive Neurology already offers the spinal fluid examination to people with MCI and mild Alzheimer’s disease dementia during their evaluation, and we will be expanding our capacity for this test.  While most insurance companies cover the procedure to obtain spinal fluid, they generally do not pay for a PET scan.

If you have been diagnosed by your physician with MCI or mild Alzheimer’s disease dementia, you can obtain a spinal fluid test through the Division of Cognitive Neurology by calling 732-235-7733.  You will be asked to obtain from your regular physician a recent MMSE test score and a brain MRI before we can proceed with the spinal fluid test.

 

Other pharmacological options

Cholinesterase inhibitors (donepezil, rivastigmine, galantamine)

These drugs improve the level of one chemical (acetylcholine) in the brain by preventing its breakdown.  It is quite effective in Lewy body dementia/disease and somewhat effective in MCI and mild Alzheimer’s disease dementia.  This medication can sometimes be associated with side effects such as GI symptoms, leg cramps, vivid dreams.

Memantine

This drug blocks the action of another chemical in the brain.  It is somewhat effective in Alzheimer’s disease, and can be associated with headaches.

Psychiatric medications

Depending on symptoms of dementia, some psychiatric medications for mood, anxiety, and irritability may be helpful.

 

Non-pharmacological options

Exercise

What is good for the heart is probably good for the brain, and exercise has been shown to improve brain health.  The CDC recommends 60 minutes of aerobic exercise three times a week, and strength/resistance training of 150 minutes a week.

Quality sleep

Sleep is when the brain gets rid of the toxic proteins from the brain.  Make sure you get at least 6-7 hours of sleep every night.  If you have sleep apnea or suspected sleep apnea, you may need to see a sleep specialist for treatment.

Adequate light exposure

Light during the day is important for regulating your internal clock and helping you sleep better at night.  We generally recommend getting 10-12 hours of light exposure (natural light through the window or bright lamps) a day.

Combined social and cognitive activities

Research has shown that playing games only or socialization only is not enough to improve brain health.  However, doing both at the same time can be beneficial to the brain.  An example of this is volunteering, and some cities are having Volunteer Corps to help older adults with their brain health.