Texas ranks 4th for Alzheimer’s cases. Why new drug Leqembi is cause for hope and concern
The state health services department says Texas ranks fourth in the U.S. for cases of Alzheimer’s disease and second for deaths from the disease. So, the recent FDA approval of the drug Leqembi as a treatment for early-stage Alzheimer’s is good news.
Dr. Claudia Perez, a neuro-intensivist in Fort Worth with Texas Health Physicians Group and Neurocritical Care Associates, explains how Leqembi works and why you should have some concerns about it.
It's a monoclonal antibody directed against beta-amyloid, which is what creates toxic plaques in the brain in patients who develop Alzheimer's disease.
Slow or slow down is the operative word here, not stop.
Definitely. This is not a cure. In the trial, we didn't see a reversal of cognitive impairment. We didn't see a stopping of cognitive impairment. What we saw was that in the patients who received what can be compared to the control group, we saw 27% less cognitive decline in those patients. So, not a cure yet.
How does mild cognitive impairment differ from the cognitive decline many of us may experience as we get older?
If you have a decline in your memory and thinking skills that are more than what's expected for your age, you're in that mild cognitive impairment range.
If you're actually having the effects of your activities of daily living, you're actually in the dementia range.
Dementia isn't one size fits all. What a lot of the doctors will use is a clinical dementia rating scale that tells us how affected are you by this decline in memory and thinking skills. And that could range from mild all the way to severe.
But if we're just talking about I forgot where I left my keys yesterday or I've done it more than once, that might not necessarily be a big deal.
As long as it's not affecting your daily living. If you've progressed to the point where you're maybe requiring assistance to find those keys every time - more forgetfulness than just the keys - then you may enter that greater progression of the disease.
But the caveat here was that you had to have evidence of amyloid in the brain, either by studies of the fluid in your brain, or by pet imaging or scans of your brain that actually showed that amyloid change or the patients who had early Alzheimer's, mild dementia, and then had those changes.
As an intensivist - a neuro ICU doctor - this is going to be important for me to know about because of some of the side effects of the medication. What we would see is a development of swelling in the brain, sometimes in these patients, and bleeding in the brain of some of these patients.
Considering the side effects and the cost, I guess you really have to have a good long talk with your doctor before using Leqembi.
Now that it's available, we need to make sure that for the long-term this is going to be a safe medication.
This is a discussion to have with your physician:
- One. Are you in that early stage of the disease?
- And, two, do you actually have the target that the medication seeking that amyloid that's present in the brain?
- And if so, are you even a candidate for it?
- And the other thing with the swelling and the micro bleeds is are you at a higher risk of just developing these bleeds?
And so that's going to be a discussion with your physician because there are some things that may make you more prone to having some of these side effects.