Industry Voices—We can't wait for a miracle Alzheimer's drug

Earlier this year, the pharmaceutical companies Biogen and Eisai announced an Alzheimer’s disease drug that showed positive results for slowing the progression of cognitive decline in a late-stage clinical trial.

[Editor's note: Back in September, Eisai made waves with the announcement that lecanemab slowed cognitive decline in the phase 3 Clarity AD trial, meeting the main endpoint and providing the data needed to support a potential regulatory nod. But, two potential treatment-related deaths have dimmed the initial glow surrounding Eisai and Biogen’s next Alzheimer’s therapy lecanemab.]

As the companies prepare to seek FDA approval, there is already debate over whether the results are modest or meaningful. But one fact is clear: This is not yet a silver bullet that will prevent or halt the disease.

The news stands on the shoulders of two decades of pharmaceutical R&D dedicated to producing a therapeutic cure for Alzheimer’s disease that yielded little success. Billions of dollars have been spent—the National Institutes of Health alone allocates more than $1 billion annually for research—yet clinical trials have had more than a 99.5% failure rate.

But waiting for a miracle drug ignores powerful solutions that are available now—therapies that families deserve to understand and access. Hope is already emerging in a flood of studies that show correlations between healthy lifestyles and a dramatic reduction in risk for Alzheimer’s.

The EXERT Study examined exercise in older adults with mild cognitive impairment (MCI) and found that after 12 months people with MCI who practiced regular aerobic exercise or stretching showed no cognitive decline, compared to adults who did neither and showed significant cognitive decline. The findings from EXERT suggest that regular physical activity may protect brain cells. It was the longest-ever phase 3 study of exercise in older adults with MCI.

That news is just the latest finding that corroborates what many of us have been advocating—and are currently providing—for people eager to reduce their risk of dementia: early testing and diagnosis combined with non-pharmaceutical intervention. Specifically, we can tackle cognitive decline with a mix of cardio and strength training exercise, following the MIND diet, (essentially a Mediterranean diet), ensuring high-quality sleep, reducing stress and staying socially and intellectually engaged. In the right “dose,” and with proper support, these are less expensive, more accessible therapies we can deploy today, with promising results. 

The groundbreaking 2014 FINGER protocol (The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability) showed tremendous cognitive gains resulting from lifestyle behavior modifications. Lifestyle interventions adopted by the study’s 1,200 participants resulted in a 25% overall cognitive improvement, 83% improvement in executive function and 150% improvement in processing speed.

In addition to the positive studies that show the benefit of lifestyle change, newer studies also show correlations between poor lifestyle and social determinants of health factors and increased rates of cognitive decline and dementia. They include eating large amounts of ultra-processed foods, experiences of racism, socioeconomic status, hypertensive disorders during pregnancy, ICU hospitalizations and long COVID.

Let’s be real: We’re all terrified of Alzheimer’s, particularly those of us with a family history. But taking action first requires finding out whether you’re at risk. Early diagnosis, when there is time to make changes and slow disease progression, is key to any intervention. This comes in the form of cognitive testing, but that testing is hard to access: Only 16% of seniors get tested, and 82% want to be tested.

Cognitive testing should become the next “vital sign'' to be measured at every physical exam, alongside blood pressure and height and weight—beginning at age 65. Digital tests can determine cognitive strength or signs of risk for decline in as few as three minutes and are simple to administer.

The Centers for Medicare & Medicaid Services is, at long last, recommending and reimbursing for diagnostic tests—an important first step in making early diagnosis a regular part of primary care for aging patients. Early diagnosis enables providers to shape the most effective treatment plans and opens the way for health coaches (who already work with diabetes and heart patients) to be trained in “brain health” for their patients.

The handful of Alzheimer’s drugs that have won FDA approval since 2003 merely alleviate symptoms—they don’t prevent, slow or reverse the disease.

Judging by the drugs coming down the pike, that pattern will continue. Pharmaceutical companies will continue to raise—and then dash—hopes with new drug breakthroughs.

The good news is that we have the ability to help ourselves—and it doesn’t come in a bottle.

Elli Kaplan is co-founder and CEO of Neurotrack, a digital health company focused on brain health and reducing the risk of Alzheimer's and other dementias.