Our Walk to End Alzheimer's is a little more than a week away!

Our local Walk to End Alzheimer's is October 9.  Several of you are already supporting me, but if you're not, it's not too late!  Click here.  All expressions of support are very much appreciated.

Biogen stock up 35% in one day. Does that mean something?

If you read Beating the Dementia Monster, you know that I was a bit skeptical of the prospective Alzheimer's disease antibody treatment aducanumab (marketed as Aduhelm).  But I was more hopeful about another one, BAN2401, also known as lecanemab.  We wrote about lecanemab most recently this past July, noting that Esai and Biogen had launched the phase 3 (final) trial, and we were waiting on results.

Well, the wait is over ... almost.  Biogen's stock price spiked yesterday on the news in this press release.  Things are looking pretty good for lecanemab, and for Biogen.  The news is that lecanemab reduced clinical decline by 27% in the trial compared to the placebo.  OK, so that's great.  But what does it mean?

First, reducing decline is not curing the disease.  I got much better results by joining the gym, getting better sleep, changing my diet, reducing stress, etc.  From what I can see, lecanemab just slowed the progress of the disease, it did not improve memory and cognition. 

Also, like all of the anti-amyloid antibody treatments (including Aduhelm), some patients experienced microhemorrhages of different types.  It was not clear if this was as much as with Aduhelm or better, but it was there.

We have yet to see the FDA's evaluation of the results, but they will be giving it priority review.  

The good news is (the very good news) there is no cloud over the results as with aducanumab.  At least not so far.  The results seem far less ambiguous than with aducanumab, so I think it's reasonable to expect the review process to go much more smoothly.

It sounds like we may see lecanemab on the market as early as March 2023.  What will they name it?  How much will it cost?

Look into my eyes ...

So how many clinical studies am I participating in?  I'm losing track.  We're here in Seattle right now for a session that I participated in yesterday at the University of Washington, a study to evaluate methods of diagnosing Alzheimer's disease by examination of the retina of the eye.  This is to be repeated annually and indefinitely.  But I've also been taking cognitive tests at home every week for some time now so that someone can track my decline over an extended period of time.  (I am still declining, it's just that since altering my lifestyle in 2016 my decline seems to be much more in line with normal aging.)  In Beating the Dementia Monster, we wrote about our participation in the Mayo Clinic's HABIT study, and I've participated in a couple of other one-time studies of one type or another.  From time to time I'm reminded of something I'd signed up for a long time ago but forgot about.

Yesterday's test was very interesting.  Diagnosing Alzheimer's disease remains as much an art as a science, and multiple forms of evidence are required by the diagnosis protocol.  Reports are taken from family members regarding behavior, and then cogitative tests are given.  But the diagnosis still requires biomarker evidence, something tangible.  In my case, it was an MRI that showed significant atrophy of my brain.

But, as things stand today, the final diagnosis is only made in the autopsy.

More reliable methods for evaluating biomarkers are advancing.  We've discussed blood tests before, and these are very promising.  We've also discussed the possibility that evidence of Alzheimer's disease may be found by examination of the retina of the eye.  Yesterday's tests were all about my retina.  

The whole process took about three hours.  They told me that I was subject #55, and they were hoping to eventually have 150.  After a battery of cognitive tests, they gave me an eye exam, saying that I had 20/20 uncorrected in both eyes.  (This will be news to my optometrist who says I have 20/30 in one eye and 20/40 in the other.)  Then they dilated my eyes and led me through a series of retinal exams using three different machines.  Each of the machines took different kinds of images of my retina.  

I chatted with the researchers regarding what they were looking for.  I told them I knew that UW was a pioneer in finding amyloid plaques in the retina of the eye that might be a biomarker for Alzheimer's disease.  (They said other people were working on that one, not them.)  An ophthalmologist once told me that an amazing portion of all the information coming to the brain is just via the optic nerve ... eyesight.  I don't remember the number he gave me, but it was a high percentage.  And so some consider the eye to simply be an extension of the brain.  Bad things happening in the brain proper may also be occurring in the retina.  

I should have taken notes, but I didn't, and now I can't remember everything they told me.  But I recall the last machine imaged my eye for oxidative stress.  If you read Beating the Dementia Monster, you know that part of how Alzheimer's disease proceeds in the brain is via oxidation inside neurons that kills them.  One hypothesis they are testing is oxidation proceeding in the brain should be reflected in oxidative damage in the retina.

The cognitive tests they gave me were disturbing.  I take cognitive tests every Thursday, and I feel that I do reasonably well on them.  But the tests they gave me yesterday were hard, and I'm not sure I got anything right on them.  They couldn't tell me the results, but they were going to share them with my neurologist and/or my neuropsychologist.  I'll be interested in their take.

For our trouble, they gave us a $10 Amazon gift card (a typical token of appreciation for these trials) and $40 for our gas.  They said they hoped we'd be back again next year for a follow-up.  My intention is to return, since I'm always interested in supporting Alzheimer's research.

September 21 Is World Alzheimer's Day

Today is World Alzheimer's Day, a time to consider the devastating impact of this terrible disease as well as to get information out that people need to know.  

What should they know that they may not?  There are several things about which most people are unaware.  I try to explain those on this blog and in Beating the Dementia Monster.  Here are my top few:

1. Alzheimer's disease is not a normal part of aging.  It's a disease, and not everyone will get it.

2. It is far from being purely genetic.  Genetics may predisposed someone to Alzheimer's disease, but there are other ingredients as well.  Many are controllable.

3. When we see multiple people with Alzheimer's disease in a family, it may have nothing to do with common genetics.  It's likely they simply share poor lifestyle habits.

4. Forty percent of Alzheimer's disease cases are preventable.  (That's a lot!)  This is through good lifestyle choices.

5. Alzheimer's disease begins as much as 20 years before the onset of dementia and fifteen years before the first symptoms.

6. Even after the symptoms become evident (15 years into the disease), research has shown that good lifestyle changes can slow and perhaps temporarily reverse the cognitive deterioration of Alzheimer's disease. 

7. Improvements in the following lifestyle domains can help prevent or can significantly slow the progress of the disease.  In approximate order of importance:

Physical exercise

Sleep quality

Mediterranean or similar diet

Controlling risk factors for diabetes and heart disease

Maintain or increase social activity

Control stress

So if you are developing symptoms or are otherwise at risk of developing this disease, there are things you can do.

Less promising news on my balance.

Every morning when I wake up, I can't believe it.  I recall how things were back in 2016 at the low point of my experience, and I compare it to how they are today.  I thank the Good Lord that I remember what happened yesterday, I know what's on the agenda for today, and I just feel great.  (Ummm... depending a bit on how much insomnia I had the night before).  I'm involved in several studies of memory and cognition in people with Alzheimer's disease, and I can tell that I do really well on their tests -- again, compared to how I was doing six or so years ago.

But I've whined before about how my balance went really bad about two years ago, and I really, really want it back.  Compared to what I remember of my two grandfathers when they were my age, and compared to friends who are older than me, my balance and gait have really deteriorated.

As we wrote in Beating the Dementia Monster, I first began having balance problems as long ago as 2013.  Tests of my vestibular system find that it works fine, but the Alzheimer's disease was killing the part of my brain that coordinated information from that and other sensory systems.  I learned physical therapy exercises that served me very well until my balance went so bad.  They still work some but not the way they worked before.  And the degree of instability has only grown.  I want my balance to go back to the way it used to be.

A few months ago I spent more than an hour on a Telmed Zoom call with three specialists from the University of Washington's Harborview hospital in Seattle.  One of their conclusions was I should get physical therapy from a local provider -- and we have some good ones here.

So this week I had an evaluation from a physical therapist specializing in problems like mine.  I told him that I have good days and bad days, and that day was actually one of my better days.  After 45 minutes of all kinds of tests, he told me that I was doing about as well as I could expect.  In fact, he thought I was doing quite well.  I may not like it, but the combination of my age and the neurodegeneration from the disease pretty much determine that I should be having at least as much trouble as I am.  I could come back, and he could try pursuing some specific goals, but he doubted I would experience any satisfying improvements.

Disappointing, yes.  But I need to count my blessings.  I'm totally happy with where I am with memory and cognition, and so are my neurologists.  When I do my physical therapy exercises every day, I can tell that I'm better than I would be if I didn't bother.  So I do them.

I have added one PT exercise that I do at the gym every day.  I stand on a BOSU ball for five minutes in addition to the head exercise I described in Beating the Dementia Monster.  I've come to the conclusion that the combination of these two exercises, done every day, will give me the best balance I'm going to get.

And now, exercise neutralizes those zombie cells that have been killing you.

What zombie cells?  And how are they killing me?

My friend Mike sent me this article on "senescent" cells.  These are cells that become inactive and stop replicating as the body ages.  They don't die, but accumulate in your body and start damaging healthy cells around them.  So they're called "zombie cells."  Your body tries to get rid of them, but it can't get them all.  Among many other ailments, they are implicated in the progression of Alzheimer's disease.  

While science is looking for drugs and supplements to get rid of them, so far exercise seems to be our best weapon.  Who'd have thought?  

Even stronger evidence coming for the effect of lifestyle interventions in Alzheimer's disease

In Beating the Dementia Monster we discussed some results of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER).  The study showed remarkable results with respect to controlling the advance of cognitive decline through lifestyle interventions. The Alzheimer's Association subsequently organized a network of research organizations to try replicating the Finnish results.  (We discussed the American effort, The US POINTER study.)

While there were many previous studies associating good and poor lifestyle choices with Alzheimer's disease, the FINGER study was novel in that it made actual changes to lifestyles and then measured the results.  This type of study is called a "randomized controlled trial."  Up to this point, researchers relied on a type of "longitudinal study" that simply followed the progress of a population and then tried to discern the causes of improvement and decline from what was known about the population.  The FINGER study was superior because it measured consequences of specified changes.  It also used coaches for participants to verify the lifestyle changes and to accurately record results.  These results were compared to a similar population that did not change any features of their lifestyle.

So how are these network studies going?  It's a bit early to tell for sure, but what we have so far is very encouraging.  (The US POINTER study has nothing to share yet.)  We wrote recently about the Alzheimer's Association International Congress (San Diego, July 31 -- August 4).  During the conference several studies shared some preliminary results -- the Australian "Maintain Your Brain" study, the Alzheimer's Disease Cooperative Study's (ADCS's) EXERT study, and the South Korean SUPERBRAIN-AD study.

The “Maintain Your Brain” study delivered digital personalized coaching in physical activity, diet, and brain health, finding that these boosted cognition in its participants over three years.  

The EXERT Phase 3 trial compared light versus moderate exercise in people with MCI, finding that cognition held stable in both groups over a year. The study lacked a control group, but a matched group of participants from the Alzheimers Disease Neuroimaging Initiative (ADNI) declined in that same amount of time, suggesting that both interventions may have done some good.

SUPERBRAIN-AD also reported promising findings from its suite of lifestyle interventions among cognitively impaired people with amyloid plaques.

These studies are not identical, but they may be the tip of the iceberg for ... something. 

In reading about these studies one thing that struck me was the likely influence of social connection on the results.  For example, some suggest that social interactions between subjects and the coaches in some studies may have contributed to improved memory and cognition.  You will recall that #2 in our "Dementia Toolkit" is "maintain or increase social activity."

We look forward to more news on these important studies!