What we learned about Alzheimer’s in 2023

2023 was a landmark year for Alzheimer’s disease research, including advancements in treatment, risk factors and diagnosis of Alzheimer’s and other dementias. In this new era of Alzheimer’s treatments, here are seven significant discoveries from this year regarding the seventh-leading cause of death:

1. There are now three newly approved treatments for Alzheimer’s, with a fourth on the way. In July 2023, the U.S. Food and Drug Administration (FDA) granted traditional approval for Leqembi for treatment of mild cognitive impairment due to Alzheimer’s and mild Alzheimer’s dementia. While not a cure, this treatment slows cognitive decline and can give people with early Alzheimer’s more time to maintain their independence.

Back in June 2021, the FDA granted accelerated approval to Aduhelm for the same purpose. At the Alzheimer’s Association International Conference (AAIC) in July 2023, Eli Lilly reported positive results for a third treatment: donanemab. Phase 3 trial data for donanemab (monoclonal antibody that targets amyloid, a sticky neuron-damaging protein in the brain) among patients in the early stages of Alzheimer’s showed a 60% slowing of cognitive decline compared to patients on placebo. Nearly half (47%) of study participants at the earliest stage of the disease who received donanemab had no clinical progression at one year.

FDA action on donanemab is expected by the end of 2023.

In May, the FDA approved brexpiprazole for agitation in people with Alzheimer’s disease. This is the first FDA-approved treatment for Alzheimer’s-related agitation, which is experienced by about 45% of Alzheimer’s patients. According to research published in May 2023, there are currently more than 140 therapies being tested that target multiple aspects of Alzheimer’s.

2. Hearing aids slow cognitive decline. Hearing loss is present in 65% of adults over age 60, according to researchers. This study looked at a subgroup of older adults with hearing loss who were at higher risk for cognitive decline (about ¼ of the total study population). This study showed that those participants at highest risk for cognitive decline who utilized hearing aids and hearing counseling for three years cut their cognitive decline in half (48%).

3. Gut health & constipation: 16% of the world’s population struggles with constipation – more among older adults due to fiber-deficient diets, lack of exercise and the use of certain medications. Researchers found that bowel movements of every three days or less was associated with 73% higher odds of subjective cognitive decline and long-term health issues like inflammation, hormonal imbalances and anxiety/depression.

4. Advances in blood tests for Alzheimer’s – A simple finger-prick blood test, similar to what people with diabetes do daily, shows promise in the ability to detect Alzheimer’s disease. Researchers in Sweden collected blood samples and shipped them overnight, without temperature control or cooling, and found the results for detecting warning signs of tau and other elements consistent with Alzheimer’s risk to be comparable to standard blood collection.

  • The ability to collect blood samples remotely, without refrigeration, will significantly increase the accessibility of these tests, particularly to rural areas.
  • In a related Swedish study, primary care physicians (PCPs) correctly identified the presence of Alzheimer’s-related changes in 55% of cases while the blood test did so in more than 85% of cases.

5. New use of opioids increases risk of death in older adults with dementia – This study of the entire population in Denmark age 65 and older diagnosed with dementia between Jan. 1, 2008, and Dec. 31, 2018, found a fourfold increased excess mortality risk among participants within 180 days after their first opioid prescription. Strong opioids (including morphine, oxycodone, ketobemidone, hydromorphone, pethidine, buprenorphine and fentanyl – used to relieve pain when milder medicines are not effective) were associated with a sixfold increased mortality risk. Among those who used fentanyl patches as their first prescription, 64.4% died within the first 180 days compared with 6.4% in the unexposed group.

6. Cognitive benefits of volunteering – Volunteering in late life is associated with better cognitive function. A University of California-Davis study found that volunteering was associated with better baseline scores on tests of executive function and verbal episodic memory.

  • University of Colorado studyA study by University of Colorado researchers of an adult population aged 70 to 79 showed that volunteering was related to 16% lower odds of developing dementia (24% lower among women). While there are benefits to remaining cognitively active through employment after the traditional retirement age, researchers noted that volunteering may provide added benefits because volunteering “is mentally and emotionally rewarding.”

7. First-ever county-level Alzheimer’s prevalence statistics – the Alzheimer’s Association released the first Alzheimer’s prevalence statistics for all 3,142 counties in the United States. The average for the U.S. among adults 65 and older is 10.7%, but higher rates were found in numerous areas in the East and Southeast. Miami-Dade County was highest at 16.6%. Statewide, Colorado’s rate is 10.4%. Age is the leading risk factor for Alzheimer’s, but Blacks and Hispanics are at higher risk for developing the disease due in large part to factors including higher rates of heart disease and diabetes.

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