Perfecting a Cocktail of Approaches to Treat Alzheimer Disease: Richard Isaacson, MD

WATCH TIME: 5 minutes

"If you want to slam on the breaks as much as you can with the progression of Alzheimer disease, we need to be aggressive about vascular risk factor modification. Whether it’s through lifestyle choices, exercise on a regular basis, healthy nutrition, Mediterranean style diet, treating with different blood pressure drugs."

Alzheimer disease (AD) is a complex neurodegenerative disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out daily tasks. The AD community has seen several significant strides in drug development in recent years, headlined by the accelerated approvals of 2 antiamyloid agents. These therapies follow the amyloid cascade hypothesis, which states that deposition of amyloid-ß, the main component of plaques seen in the brain, is the causative agent of AD pathology and that the neurofibrillary tangles, cell loss, vascular damage, and dementia follow as a direct result of this deposition.

While antiamyloid agents are designed to have disease-modifying effects, their impact on functional and cognitive outcomes remains inconsistent and in question by some in the community. Many of those who treat AD, including Richard Isaacson, MD, believe that the disease will only truly be managed through a combination of therapies that target different aspects of the disease and a mix of behavioral and lifestyle changes. There is significant industry interest too, with 187 phase 1, 2, and 3 currently ongoing clinical trials assessing 141 unique drugs. Transmitter receptors, amyloid, synaptic function, and inflammation are the most common targets of drugs in the pipeline, all with mixed effects on the pathology of AD.

Isaacson, director of the Center for Brain Health and Alzheimer Prevention Clinic at Florida Atlantic University, served as a program cochair of the 2023 International Congress on the Future of Neurology (IFN) Annual Meeting, held September 22-23, in Jersey City, New Jersey. At the meeting, he sat down with NeurologyLive® to discuss some of the top therapeutic targets the clinical community should focus on when treating AD. He spoke about the need to explore repurposed drugs, the importance of lifestyle interventions, and the various mechanisms being studied in clinical trial settings. Furthermore, he spoke about the need for clinicians to be open about new therapies, and their potential impacts on everyday quality of life for patients.

REFERENCE
1. Cummings J, Zhou Y, Lee G, Zhong K, Fonseca J, Cheng F. Alzheimer’s disease drug development pipeline: 2023. Alzheim & Dement. Published May 25, 2023. doi:10.1002/trc2.12385