Today, Wednesday 21 September, is World Alzheimer’s Day. Alzheimer’s disease is the most common form of dementia,1 it affects around 100 million people around the world and is currently the leading cause of death in England.2
We spoke to Emma Winter, a Head of Medical and Scientific Services at Spirit, about the evolving Alzheimer’s research landscape.
Can you tell me a bit about your expertise in this field?
I have previously worked on a monoclonal antibody which targets amyloid beta protein where I designed and delivered the content for advisory boards and investigator meetings. More recently, I have been working on a new disease-modifying agent for Alzheimer’s disease, which aims to stop the progression of the disease rather than just treat the symptoms. As part of a team, we have provided publication strategy and tactical publication delivery support. I was also involved in the delivery of a symposium about the evolving treatment landscape in Alzheimer’s disease and advisory boards on the potential role of neuroinflammatory pathways in disease progression.
Are there any notable recent developments in Alzheimer’s research and treatment which you would like to highlight?
The prevalence of a lot of major life-threatening conditions, such as type 2 diabetes, heart failure, and cardiovascular disease, has decreased in recent years due to the introduction of new therapies – but for Alzheimer’s disease, the opposite is true.3 People are living longer, so more people develop Alzheimer’s as they age, but there has also been an increase in people developing Alzheimer’s at a younger age.
There are currently 143 drugs in development aimed at treating Alzheimer’s disease and whilst traditionally approaches have looked to treat the symptoms of disease, more than 80% of the drugs now in development are disease-modifying treatments.4 That combination of a growing unmet need and a changing treatment landscape are making this an exciting and important area of investigation for new treatments.
Have there been any new challenges arising from that changing landscape?
I think one of the more pressing challenges will be educating physicians about potential changes to what they understand to be the pathophysiology of Alzheimer’s disease. Alzheimer’s disease is typically characterised by tau tangles and amyloid plaques, which develop further over time, causing neurodegeneration in the brain; but there is now a growing evidence base that inflammation is an also a main component of that pathophysiology. The traditional amyloid/tau/neurodegeneration (A/T/N)5 model is being replaced by a suggested A/T/N/I model, which takes into account the importance of inflammation in the development of dementia in Alzheimer’s disease.
How do you see Alzheimer’s treatment evolving in the future?
Alongside the rapidly evolving treatments of Alzheimer’s disease, and taking into account the changes in the underlying model which is used to define it, researchers are establishing a growing number of biomarkers which enable us to better understand the pathophysiology of Alzheimer’s disease. These include imaging biomarkers, cerebrospinal fluid biomarkers and plasma biomarkers; and together they are going to provide a much stronger evidence base to identify at-risk patients much earlier in the development of Alzheimer’s disease, which in turn will enable healthcare providers to intervene at a much earlier stage. If physicians are able to intervene early on in the pathophysiology, before there is a strong presence of amyloid plaques and tau tangles, they will have a better chance of providing disease modification and preventing further development of the disease.
- Alzheimer’s Society. Facts for the media about dementia. 2022. Available at: https://bit.ly/2MqVZ8T [Accessed September 2022].
- Office for National Statistics. Monthly mortality analysis, England and Wales: July 2022. 2022. Available at: https://bit.ly/3xDQIk4 [Accessed September 2022].
- GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet 2022;7(2):105-125. https://doi.org/10.1016/S2468-2667(21)00249-8
- Cummings J, Lee G, Nahed P et al. Alzheimer’s disease drug development pipeline: 2022. Alzheimer’s Dement 2022;8:e12295. https://doi.org/10.1002/trc2.12295
- Jack CR Jr, Bennett DA, Blennow K et al. A/T/N: an unbiased descriptive classification scheme for Alzheimer disease biomarkers. Neurology 2016;87(5):539-547. https://www.doi.org/10.1212/WNL.0000000000002923