What to know about alzheimer's disease risk factors

One test, called the PrecivityAD, is already available in most of the U.S. It went on the market in late 2020, after being approved under the federal government's general rules for

commercial labs, but it does not yet have authorization from the Food and Drug Administration (FDA). The test detects the presence of beta-amyloid plaques in the brain and is meant to be

used by health providers who are evaluating people 60 and older who have cognitive or memory problems. Several other tests are also close to market, Weiner says. He predicts that a variety

of tests to help diagnose Alzheimer's will be available to patients in the next few years. Early detection of Alzheimer's is key because the brain may start changing as early as 20

years before symptoms appear, says Rudolph Tanzi, a neuroscientist at Harvard Medical School and codirector of the McCance Center for Brain Health at Massachusetts General Hospital. Many

researchers believe that intervening before symptoms develop offers the greatest potential for halting or delaying disease progression. Right now “we don't diagnose Alzheimer's

until the brain has degenerated to the point of dysfunction ... that has to change,” Tanzi says. “Once you have symptoms, the brain is on fire with neuroinflammation. ... We have to become

as proactive about Alzheimer's disease as we are about heart disease, diabetes and other age-related diseases.” STAGES OF ALZHEIMER'S DISEASE Although everyone experiences the

condition differently, understanding the trajectory of it can help patients and their caregivers know what to expect. Alzheimer's typically progresses in three general phases: * EARLY

STAGE The person still functions independently. He may still drive, work and be part of social activities. But the individual forgets familiar words or the location of everyday objects with

increasing frequency. Symptoms may not be widely apparent, but family and close friends may notice early signs and voice concern. * MIDDLE STAGE The individual can still participate in daily

activities but may need extra help. She gets confused more easily or experiences personality changes, like getting angry or acting out in unexpected ways. During this stage it's

important to determine what the person living with Alzheimer's still enjoys doing and find ways to engage her in those activities. You want to help the individual maintain the best

quality of life for as long as possible. * LATE STAGE The patient loses the ability to respond to his environment, to carry on a conversation and, eventually, to control movement. As memory

and cognitive skills worsen, significant personality changes take place and extensive care is required. The end stage of Alzheimer's can last for several weeks or years; it can be

extremely demanding and emotionally draining for families. CURRENT TREATMENTS In June 2021 the FDA approved the first new treatment for Alzheimer's in more than a decade. Called

aducanumab (brand name Aduhelm), it's a monoclonal antibody drug that could potentially slow the progression of the disease. Aduhelm is not a cure for Alzheimer's and does not

reverse it. But data show that the drug can break up sticky plaques in the brain that are a hallmark of the disease. If the drug can help remove those plaques, it may help slow the rate of

cognitive decline in people in the early stages, experts say. The FDA's approval, however, was conditional. The drug's maker, Biogen, will need to complete a large clinical trial

to confirm that removing the plaque has cognitive benefits, the agency said. If the study fails, as some experts are quick to point out it could, the FDA has the authority to rescind its

approval. For patients and their families, Aduhelm offers hope, but it's unclear how many people will benefit initially. The therapy, which is a monthly infusion, is expected to cost

$56,000 a year, and it's not yet known whether Medicare and private insurance will cover it. Other FDA-approved medications can help manage the symptoms of Alzheimer's. Drugs

called cholinesterase inhibitors — including galantamine (Razadyne), rivastigmine (Exelon) and donepezil (Aricept) -— may help with short-term memory loss or confusion for a limited time.

For those with moderate or severe Alzheimer's, a drug called memantine (Namenda) may help some to perform daily functions for longer than without the medication. The FDA has also

approved a combination of donepezil and memantine (Namzaric), which is taken as a capsule. Another medication, called Belsomra, is authorized to help with insomnia, and sometimes other

drugs, including antidepressants, are prescribed to help control behavioral symptoms. ON THE HORIZON: NEW TREATMENTS SHOW PROMISE In recent years tremendous gains have been made in

understanding the basic biology of Alzheimer's, including how brain cells work and what goes wrong in the brain to cause the disease, says Heather Snyder, vice president of medical and

scientific relations at the Alzheimer's Association. "As our understanding of the underlying biology has increased, we are seeing many new interventions moving into clinical

trials,” she says. Several new drugs in development have the potential to be game changers, Snyder says. Some of the most promising are other monoclonal antibody drugs, with names like

gantenerumab, lecanemab (BAN2401) and donanemab. Like Aduhelm, they're designed to stick to the molecules that form plaques in the brain and mark them, so that the immune system can

recognize them and clear them out. Donanemab had impressive early results. In a study of 257 patients whose brain scans showed Alzheimer's, those who took the drug had a 32 percent

slower rate of decline over a two-year period than those who received a placebo. Dozens of other drugs that use different mechanisms for stopping the disease are also being tested, Snyder

says. Because Alzheimer's is so complex, experts say there may never be just one drug or intervention that will cure it. Instead, Snyder says, “it's likely going to take a

combination approach of lifestyle interventions and medications."