A Dangerous Silver Bullet

Drugs that hit an Alzheimer's target are gaining traction. Some neurologists remain dubious

- By Liz Seegert

ONE OF NEUROLOGIST Anelyssa D’Abreu’s least favorite tasks is giving her patients a dreaded diagnosis: early-stage Alzheimer’s disease. But it’s not quite as bad as it used to be. Today when they ask, “Is there anything we can do?” D’Abreu has a new answer: “Perhaps.”

Unlike a decade ago, when D’Abreu had little to offer her patients with Alzheimer’s, there are now drugs that may impede the disease’s progression. The difficulty with this approach, however, is that it comes with a trade-off. The new medications carry the risk of serious side effects, including brain bleeds, stroke-like symptoms and even death. Yet they also come with hope, something new for Alzheimer’s patients and their families.

Drugs in this class, known as anti-amyloid therapies, have not gained much traction. In limited studies, they have been shown to slow or even decrease one of the biological symptoms of Alzheimer’s: the accumulation of amyloid beta in the brain. Nearly four dozen studies on these drugs have been conducted since 2018, and collectively they indicate that anti-amyloid therapies may marginally reduce the rate of cognitive decline. Some experts say that could offer perhaps an additional year of independence. But the clinical trials completed to date rely on only 18 months’ worth of published data, and their success has been tempered by the drugs’ significant downsides. Additionally, the framing of these drugs’ success has come under criticism.

D’Abreu, who heads the University of Virginia neurology department's cognitive and behavioral neurology division, was initially apprehensive about offering antiamyloid treatments to her patients with early-stage Alzheimer’s.