Challenges and Excitement in Alzheimer Disease

Jeffrey Cummings, MD, ScD

The past few decades have been quite difficult for clinicians treating Alzheimer disease, and there’s been frustration among the scientific community in the lack of progress, however, with that, there’s tremendous excitement and optimism with the genuine progress that has been made and the potential approval of new therapies.

While Jeffrey Cummings, MD, ScD, director of the Center for Neurodegeneration and Translational Neuroscience and director emeritus, Cleveland Clinic Lou Ruvo Center for Brain Health, admits that it’s challenging to recruit patients for clinical trials, the fact that some studies require participants not to present with cognitive symptoms so they can be treated preventatively is a remarkable scientific advantage.

In an interview with NeurologyLive, Cummings provided further insight into challenges of Alzheimer disease, as well as what he hopes to see and accomplish in the next 10 years.

NeurologyLive: What areas do you think are the most challenging in this space?

Jeffrey Cummings, MD, ScD: I think most challenging is patient recruitment. It's difficult to get enough patients in most of our trials, for example, we now have a longer period to recruit the patients than we actually treat them in the trial. Let's say we have a trial that we would treat people for one year, it takes us more than a year to recruit enough patients to do the trial, so what should be a one-year trial turns out to be longer than a 2-year trial. Recruitment is enormously difficult, it's become more difficult because we're doing earlier trials or trials earlier in the disease where patients are more mildly affected so they may not even know that they have Alzheimer disease and some trials we’re actually requiring that the patients not have cognitive symptoms because we know that they are at risk for Alzheimer disease and we are treating them in order to prevent the Alzheimer symptoms—so that's a tremendous scientific advance, but a tremendous recruitment challenge.

I would add to that the challenge of getting a more diverse population into trials is also very difficult. We have mainly Caucasian patients coming into trials and yet these drugs will be marketed to all populations and we need Hispanic participants, we need African American participants, we need a very diverse set of participants so that we can understand how best to help patients regardless of their ethnic backgrounds.

What do you hope to see in the next 5 or 10 years?

What we hope to see is that there would be cognitive enhancing agents that actually improve symptoms at the same time that we see disease-modifying therapies that slow the progression of the disease, because it's going to take both aspects to optimize patients’ lives. We have to be able to improve people who have symptoms and we have to slow the progression in all people who have the disease whether it be early or late. My goal over the over the next 10 years is to work as diligently as we can to develop both cognitive enhancing agents and disease-modifying agents using these advances in biomarkers to help guide us with ultimately the goal of having patients have cognitive integrity throughout their lifespan.

What should our physician audience know about Alzheimer disease?

I think they should, of course, use the standard of care available to them now to the best possible extent and that's cholinesterase inhibitors and memantine.

We in the scientific community understand that there's been a lot of frustration about the lack of progress but there is tremendous excitement and tremendous optimism with the likely approval at the global level this year and other drugs that I think we'll follow fairly quickly. There's genuine progress being made, and I think they should be as reassuring as possible with their patients.

Taking great care of patients means taking great care of caregivers and that we always have to remember that the care of a patient is always an alliance between the clinician, the patient, and the caregiver, and all 3 members of that alliance have to have to feel identified with our goals.

Transcript is edited for clarity.