Advances in the Treatment of Alzheimer's

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Yesterday, the Food and Drug Administration (FDA) approved aducanumab as a treatment for Alzheimer's. This was history-making, as it was the first medication approved to treat Alzheimer's since 2003.

Although a medication for Alzheimer’s has been desperately awaited by the Alzheimer's community at large—including individuals with Alzheimer's, their loved ones, and healthcare providers—there are several concerns about aducanumab, including whether it is truly effective (the data have not shown consistent effectiveness), the risks of taking it (side effects include brain swelling and brain bleeding, especially for those who have a genetic risk of Alzheimer's), and the cost (approximately $56,000 per year).

While the healthcare community awaits detailed recommendations for the potential use of aducanumab from leading medical groups, such as the American Academy of Neurology, one thing is clear: The approval of aducanumab has reignited a valuable dialogue about the desperate need for treatment of Alzheimer's. Thus, it is a particularly important time to review the research about existing, effective treatments for Alzheimer's.

Aducanumab: the first disease-modifying medication for Alzheimer's

Alzheimer's is a devastating disease that causes a progressive decline in memory, language, decision-making, behavior, and personality, and often involves significant disability and caregiver distress. Various prescription memory medications may be used able to potentially slow the rate of memory decline by managing the symptoms of Alzheimer's, but they are not “disease-modifying” (in other words, they do not alter the underlying cellular abnormalities in Alzheimer's, which are thought to give rise to the symptoms of the disease). Aducanumab is the first disease-modifying medication that has been approved and works by decreasing the levels of beta-amyloid protein (a naturally occurring protein that builds up and abnormally clumps together in Alzheimer's, disturbing communication between nerve cells).

The role of exercise in Alzheimer's treatment and prevention

While we await more information about aducanumab, it’s important to know that there is one other highly effective, disease-modifying treatment available right now for the treatment of Alzheimer's: cardiovascular exercise.

Although many people know that cardiovascular exercise can decrease the rate of brain aging (effectively making your brain younger than your chronological age), and may lower the risk of developing Alzheimer's in the first place (or delay its development, sometimes by a decade or more), people are often surprised to learn that cardiovascular exercise can positively influence not only the underlying cellular changes associated with Alzheimer's but also memory and daily functioning.

For example, individuals with Alzheimer's who engage in moderate to high-intensity aerobic exercise (any activity that increases heart rate, including rapid walking, dancing, etc.)—as compared to those with Alzheimer's who engaged in non-aerobic activities (e.g. stretching)—showed a decreased rate of shrinkage in the hippocampus (a core memory area in the brain that is impacted in Alzheimer's) and, importantly, a slower rate of cognitive decline (the latter was revealed in an analysis of over 800 individuals in 18 randomized controlled trials). Exercise has also been shown to improve functioning on daily tasks for individuals with Alzheimer's.

Of course, the barriers experienced by many people who want to engage in regular exercise may be exacerbated in people with Alzheimer's: There may a lack of motivation to engage, or exercise may take a backseat to other activities.

It can help to reconceptualize “exercise” as “joyful movement,” and brainstorm about activities you or your loved one find to be especially joyful (perhaps in which “exercise” is not the focus of the event!). For example, spending time with friends (perhaps in a dance class or a hiking group), pairing exercise with a positive daily event (e.g. walking to get a morning coffee), walking in a favorite park or other scenic location, integrating animals (walking a pet or visiting a zoo), asking a loved one to accompany you on a walk, or doing chair aerobics with your loved one as you listen to favorite music.

As the world awaits more information about aducanumab and other emerging medical treatments for Alzheimer's, it can be helpful to know that a highly effective, disease-modifying strategy is within your reach, free, and can infuse joy into the Alzheimer's journey.