With a growing aging population, Alzheimer’s disease is becoming the greatest health issue facing our country for the coming decades.
The Centers for Disease Control and Prevention projects the burden of Alzheimer’s disease will nearly triple from the current five million to 14 million cases by 2060. The overall cost to society is overwhelming, as well as the cost to patients and their families in terms of physical and emotional suffering. In 2019, the estimated cost of Alzheimer’s and other dementias will cost in healthcare, long-term care, and hospice a total of $290 billion.If we do not solve this health crisis, the associated costs could be as much as $1.1 trilliondollars in the coming decades.
Old and new approaches
For many years, most drugs reaching late stage trials had a single target: the misfolded beta-amyloid proteins that constitute plaques. Unfortunately, therapeutic attempts have been largely unsuccessful in altering the disease course of Alzheimer’s disease with anti-amyloid drugs, leading many of us in the field to explore new approaches.
One of those approaches has led me to be more excited than ever about the state of research and drug discovery. Why? Because it is based on the biology of aging, which is gaining ground as an effective approach to prevent and treat Alzheimer’s disease. This approach stands out in a recent clinical trials report conducted by the Alzheimer’s Drug Discovery Foundation.
That age-old question
Aging is the greatest risk factor when it comes to the disease, and decades of research have revealed common processes relevant to understanding why the aging brain is vulnerable to Alzheimer’s. For example, as people age, they are more likely to have chronic systemic inflammation and neuroinflammation, which is associated with poorer cognitive function and Alzheimer’s disease.
Other aging malfunctions include impaired clearance of toxic misfolded proteins, mitochondrial and metabolic dysfunctions (associated with diabetes), vascular problems, epigenetic changes (changes in gene regulation without alterations in the DNA sequence), and loss of synapses (points of communication between neurons) — many of which make people vulnerable to Alzheimer’s as well.
Where to go from here
To defeat Alzheimer’s disease, we need to advance the diverse pipeline of drugs aimed at these targets. Like other diseases related to aging, including cancer, it is likely a combination of drugs addressing multiple target pathways will be needed to effectively treat the disease.
Our understanding of Alzheimer’s is more robust than ever before. Heightened awareness must continue to keep Alzheimer’s disease a national health priority among the government, industry, medical/scientific, philanthropic, and patient communities. We all share a common vision of a healthy old age, and we must marshal our resources to achieve it.
I am certain that one day soon, we will have drugs that are safe and effective in preventing, treating, and curing Alzheimer’s disease.
Howard Fillit, M.D., Founding Executive Director and Chief Science Officer, Alzheimer’s Drug Discovery Foundation, [email protected]