The Next Alzheimer’s Success Will Take More Than Just Science

Alzheimer’s research is entering a new phase, when the treatment that has taken decades begins reaching out to the sick. But this breakthrough for humanity will depend on more than just scientific progress, according to a pioneering Alzheimer’s researcher. John Hardy.

Speaking to WIRED Health in April, Hardy, chair of Molecular Biology of Neurological Disease at University College London, said that along with more effective drugs, better research and policy are still needed to treat Alzheimer’s disease. “We have to recover,” he said.

Hardy helped identify the major role of amyloid, a type of protein found in the brain and body, in Alzheimer’s disease in the 1990s. He and his colleagues helped develop the idea that amyloid deposits form plaques around brain cells. These compounds are thought to disrupt brain function, increase activity and trigger an inflammatory response.

At the time, he said he was “unreasonably optimistic” about how this discovery could help get medical treatment sooner. “But now, finally, we have reached somewhere,” he said.

The results led to the development of antibodies to prevent amyloid deposits from forming. But these early methods “did not remove amyloid from the brains of people who had the disease,” he said. “That was a mistake (scientists).”

“Now we know what drugs are supposed to do,” Hardy said. In recent years, researchers have developed drugs such as Donanemab and Lecanemab that can remove amyloid deposits that have already formed in the brain.

A clinical trial of Lecanemab, the results of which were published in 2022, showed for the first time that the drug can reduce cognitive decline in people with Alzheimer’s disease.

“The problem: It hasn’t stopped the disease, it’s slowed it down,” said Hardy.

Typically, Alzheimer’s disease lasts eight or nine years, Hardy explained. The prediction is that Lecanemab can slow down the process, extending the time to 11 or 12 years. “It changes time,” he said. “But we have to get better.”

The theory of amyloid is often controversial, and some researchers argue that the focus on it has slowed progress. Now, many agree that amyloid plays a role, even though it is at the center of the problem.

For Hardy, progress toward a cure for Alzheimer’s will require scientific and political commitment.

Controlling the disease is very important, especially through the use of genetics and biomarkers, which can be used “to look at the blood fluid of people who develop the disease.”

“We can use biomarkers (for Alzheimer’s) the same way we use cholesterol levels as a biomarker for heart disease,” he said.

Medicines like Lecanemab are now used for treatment, although in the UK only special patients have access to them. In the US, Lecanemab has been approved by the FDA and is available through Medicare.

Trials of another anti-amyloid drug, Gantenerumab, initially failed to show strong results, but new studies suggest that higher and longer doses may help reduce symptoms. It now “seems very promising for a specific treatment for Alzheimer’s disease,” according to Hardy.

However, disease control will require funding for dementia care, in the UK and elsewhere.

Alzheimer’s disease is the most common form of dementia, but outside of specialty hospitals, patients are often diagnosed with dementia in general rather than Alzheimer’s in particular. “About 60 percent of people diagnosed with dementia have Alzheimer’s disease,” Hardy said. “You have to be good at diagnosing real diseases. That costs money.”

He said: “We scientists have things to do. We need to change the politics to use dementia services.”