Research highlights from the Alzheimer’s Association International Conference

Alzheimer's Association Central and North Florida Chapter
Alzheimer’s Association International Conference 2023
Amsterdam, Netherlands, July 16-20, 2023

As this year’s exhilarating week of the Alzheimer’s Association International Conference (AAIC) comes to end, the cornucopia of information confirms that this is the decade for Alzheimer’s research. Advancements are heightening our understanding about the disease and getting us much closer to new treatments, early and accurate diagnosis and better understanding of risk factors for Alzheimer’s and other dementias.

Blood Tests: The next frontier in Alzheimer’s diagnosis

Advancements in technology and practice reported for the first time at AAIC 2023 demonstrate the simplicity, transportability and diagnostic value of blood-based biomarkers for Alzheimer’s.

Dr. Randall Bateman (SEABIRD study) concludes that blood-based biomarkers with similar performance as positron emission tomography (PET) or cerebral spinal fluid (CSF) can be used to support diagnosis (presence of amyloid beta) and treatment monitoring without the need for confirmatory PET and CSF tests.

A simple, finger prick blood test — not so different from what people with diabetes do every day — shows promise in the ability to detect Alzheimer’s disease. Hanna Huber, Ph.D. (University of Gothenburg Sweden) and colleagues dried and shipped blood tests without refrigeration across counties and the samples were still viable. The practicality and accessibility of this technology is encouraging. If validated through additional research, this test could offer a quick, noninvasive and cost-effective option that is simple enough to be performed independently, or by caregivers. It may be particularly valuable for use in rural districts or other lower resourced areas.

Sebastian Palmqvist, M.D., Ph.D. (Lund University, Sweden) and colleagues conducted the first study to examine the use of blood-based biomarkers for Alzheimer’s in primary care and compare them to the diagnostic accuracy of primary care physicians. They show that blood-based biomarkers were more than 80% accurate in identifying Alzheimer’s-related biomarker changes, scientifically better than doctors in the study who did not have access to this test. The doctors were 55% accurate.

The future for immunotherapies

New, more complete data were reported by Eli Lilly from the TRAILBLAZER-ALZ 2 Phase 3 clinical trial of donanemab in early symptomatic Alzheimer’s disease. With this fuller picture of the donanemab Phase 3 results, we see additional convincing scientific evidence that thoroughly removing beta amyloid from the brain is associated with significant slowing of disease progression in people living with early Alzheimer’s. The results of this trial also further illustrate that initiating treatment as early as possible in the course of the disease enables the possibility of a bigger beneficial effect, but also that there is potential for slowing of disease progression even when treatment is started later. The progress we’ve seen in this class of treatments, as well as the diversification of potential new therapies over the past few years, provides hope to those impacted by this devastating disease.

Gene editing and Alzheimer’s

Two new therapeutic approaches for Alzheimer’s based on CRISPR gene editing were reported at AAIC. One aims to reduce the impact of the strongest known Alzheimer’s risk gene, APOE-e4. The other strives to reduce production of a toxic protein in the brain, beta amyloid, which is a hallmark of Alzheimer’s and the target of recently-approved treatments. CRISPR technology is making drug target identification faster with the goal of speeding up the drug discovery process, and building platforms for the development of next-generation treatments.

Nonpharmacological approaches to reduce cognitive decline

Non-drug interventions were also highlighted at AAIC, including results from the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study, the largest randomized, controlled clinical trial of hearing aids for reducing long-term cognitive decline in older adults. While the results were negative in the total study population, the hearing intervention slowed cognitive decline in older adults with mild to moderate hearing loss by 48% in a pre-specified segment of the study population consisting of 238 people participating in an ongoing observational study of heart health. The three-year intervention included use of hearing aids, a hearing “toolkit,” and ongoing instruction and counseling with an audiologist.

Short sleep duration, hypertension and the brain

Several researchers spoke during a session focusing on sleep and brain research. Stephanie Yiallourou (Turner Institute for Brain and Mental Health, Monash University, VIC, Australia) and colleagues conducted a study on short sleep duration and the brain. Sleep dysfunction can impede the brain. Their research shows that the combination of short sleep (<5hours/night) and hypertension is associated with worse cognitive performance (executive function/processing speed) and brain injury (higher white matter volume). The causality is unclear. The combo of short sleep and high blood pressure may lead to subclinical cerebrovascular injury leading to cognitive impairment. Further research needs to be conducted to confirm results and to examine this interaction more completely. Sleep problems and hypertension are treatable and high-risk groups could be targeted for prevention trails.

First-ever nationwide estimates of U.S. county-level Alzheimer’s prevalence

The first-ever nationwide estimates of the county-level prevalence of people with Alzheimer’s dementia — in all 3,142 United States counties — were revealed at AAIC 2023. Researchers from Rush University Medical Center in Chicago found that the eastern and southeastern U.S. have the highest prevalence of Alzheimer’s dementia (AD). Higher percentages of older people and Black and Hispanic, all groups at higher risk for the disease, may explain the elevated prevalence in those regions. Florida is one of the top ten states with a greater prevalence of AD. At the county level, Miami-Dade County is in the top five counties in the country (population 10,000+ over age 65) with the greatest prevalence of AD. Also, Miami-Dade County and Palm Beach County are in the top ten counties with more individuals with AD. The findings can help guide the allocation of resources to public health programs for individuals and families affected by Alzheimer’s in those regions.

Volunteering later in life may promote a healthy brain

Reported for the first time at AAIC 2023, researchers from University of California, Davis examined volunteering habits among an ethnic and racially diverse population of older adults and found that volunteering was associated with better baseline scores on tests of memory, thinking and planning. The researchers stated volunteering may be important for better cognition in late life and could serve as a simple intervention in older adults to protect against Alzheimer’s and other dementias.

TAKE ACTION

We must continue to push the boundaries on research to find new treatments, prevention and, one day, a cure. Here’s what you can do to take action:

Sign-up for a clinical trial.
       The Alzheimer’s Association TrialMatch® connects individuals living with Alzheimer’s, caregivers and healthy volunteers to clinical trials. This is a free service that allows you to search for research in your local area.

Learn about ISTAART.
       The Alzheimer’s Association International Society to Advance Alzheimer’s Research and Treatment (ISTAART) supports the global Alzheimer’s and dementia science community. Learn more at alz.org/istaart.

LEARN MORE

Access more highlights from AAIC: alzmindfl.org/category/aaic-2022.

If you have questions about Alzheimer’s or other dementia, please call the Alzheimer’s Association 24/7 Helpline at 800-272-3900 or visit alz.org.