Better Alzheimer's Drugs Already Exist, Doctors Say

Families dealing with Alzheimer's have better options than they realize, and many doctors aren't offering them.

Two widely available medications, donepezil and memantine, provide memory benefits twice as large as the expensive new drugs making headlines. Yet only about half of Alzheimer's patients receive these proven treatments, according to Professor Rob Howard, an old age psychiatrist at University College London.

The forgotten medications cost far less and work better than recently developed amyloid antibodies like donanemab and lecanemab. Britain's NHS rejected those new drugs last year as not cost-effective, sparking outrage from some medical groups.

This week, an independent review of nine amyloid-targeting drugs vindicated that decision. Researchers concluded the new antibodies have "no clinically meaningful positive effects" on patients' daily lives, despite what brain scans and detailed memory tests suggest.

Dr. Francesco Nonino, a neurologist in Bologna, Italy, explained that while the drugs show small changes in test scores, patients and families don't notice any real difference. The new treatments also cause brain swelling and bleeding in up to a third of patients.

Why This Inspires

The real hope lies in what's coming next. Scientists are testing combination approaches that attack Alzheimer's from multiple angles, similar to how doctors now treat HIV, cancer, and heart disease.

Professor James Rowe at the University of Cambridge studies drugs that help nerve cells survive stress and communicate better. Some protect brain cells from dying, while others boost their performance under difficult conditions.

Researchers are also targeting tau, a protein that rivals amyloid as the potential root cause of Alzheimer's. A current US trial combines an amyloid drug with a tau-targeting medication to see if hitting both proteins works better than either alone.

The combination strategy makes sense to experts. "Probably to really get on top of Alzheimer's, you need to treat both in conjunction," said Rowe, adding that triple-action treatments might be necessary.

Meanwhile, doctors want their colleagues to stop overlooking existing medicines. Howard notes that fears about side effects like nausea keep some physicians from prescribing the current drugs, even though these effects are usually minor and manageable.

The two available medications can even be used together for greater benefit. They work by making patients more alert and helping nerve cells function better, providing noticeable improvements in daily life.

As case numbers grow with an aging population, the path forward combines using today's effective treatments while developing tomorrow's combination therapies. The goal of stopping Alzheimer's entirely may finally be within reach.