Despite decades of study, the underlying cause of Alzheimer’s continues to evade scientists. Until recently, the only drugs available to patients targeted the symptoms of the disease, rather than underlying pathology. So, what’s the difference between treating Alzheimer’s symptoms and modifying the disease?

The FDA approvals of the anti-amyloid drugs Aduhelm and Leqembi marked significant milestones in Alzheimer’s drug development. These two drugs were made with the potential to modify the disease itself by breaking down the buildup of toxic beta-amyloid proteins in the brain. In the past several decades, other FDA-approved Alzheimer’s drugs have hit the market — but these drugs were just “band-aids” for Alzheimer’s symptoms. Until now, there haven’t been drugs to actually halt disease progression. 

While the efficacy of Aduhelm remains controversial, clinical trials of Leqembi were the first to show that reducing the levels of these plaques lead to small improvements in cognition. But what is the difference between treating Alzheimer’s symptoms and fundamentally treating the disease itself? And is this approach useful?

TREATING ALZHEIMER’S SYMPTOMS

The symptoms of Alzheimer’s often appear 10 or more years after the disease itself starts.  

By then, cell death in the brain has led to the collection of symptoms we recognize as Alzheimer’s: cognitive impairment, confusion, memory problems, trouble sleeping, and even changes in mood or personality. 

Catching these symptoms at an earlier stage — in the first signs of mild cognitive impairment (MCI) — can give people with an Alzheimer’s diagnosis more time to make lifestyle changess that might mitigate symptoms and improve their quality of life. 

In the meantime, there are a number of drugs out there designed to treat Alzheimer’s disease’s cognitive symptoms. For people with MCI or with early-stage Alzheimer’s, these symptomatic treatments can really improve day-to-day life. 

However, behind the scenes, the disease will continue to progress. Brain cells continue to die off. And gradually, these treatments become less effective. 

THE MYSTERIOUS EXTRA BENEFIT OF GALANTAMINE

While symptomatic treatments aren’t intended to target Alzheimer’s root causes, some have shown the ability to go beyond their initial “band-aid” intentions, and actually potentially slow the disease’s progression. 

Razadyne (generic name galantamine) was approved by the FDA in 2000 to treat Alzheimer’s disease’s cognitive symptoms, but it also appears to help remove amyloid plaque from the brain — just like the new wave of disease-modifying anti-amyloids that are currently in development.

A recent study published in the journal Neurology found that, compared to other symptomatic treatments, Galantamine may also reduce the risk of progressing to severe dementia. 

THE AGE OF THE ANTI-AMYLOIDS

Razadyne unexpectedly showed the ability to remove amyloid from the brain, but that was a happy coincidence, as it was designed as a “band-aid” treatment. New Alzheimer’s monoclonal antibodies on the other hand are specifically made to clear the beta-amyloid plaques. But the jury is still out on whether these drugs will make a meaningful difference for patients in the long run.

There are more anti-amyloid drugs, designed to work similarly to Lequembi and Aduhelm, in the drug trials pipeline now. Time will tell if these drugs can turn the tide against Alzheimer’s, slowing the disease or halting its progression altogether.