Dr Emer MacSweeney, CEO Re:Cognition, tells Healthcare World about the promise of disease-modifying treatments for neurological conditions
With the ageing global population, Alzheimer’s disease has emerged as one of the most significant challenges facing healthcare systems worldwide. In fact, the World Health Organization (WHO) officially labelled Alzheimer’s a pandemic in 2018. Alzheimer’s is one of the leading causes of death and disability among older adults, with the condition affecting millions globally. The increasing prevalence of the disease, combined with the absence of a cure, has placed immense strain on healthcare economies. However, a series of groundbreaking developments in the treatment of Alzheimer’s has the potential to reshape the future of care for those living with the disease.
Dr Emer MacSweeney, a Consultant Interventional Neuro-Radiologist, co-founded Re:Cognition Health in 2011 to provide a specialist service for accurate diagnosis and access to the latest treatments for progressive neurodegenerative and neurodevelopmental conditions and traumatic brain injury. Re:Cognition Health has 10 centres in the UK and the USA, where individuals can enter global clinical trials for new diagnostic biomarkers and emerging brain and mind medications.
The inconsistency in diagnosing and treating patients with cognitive impairment in a clear and timely way lay behind the launch. Dr MacSweeney and co-founder Tom Dent believed a multi-disciplinary team providing the right clinical pathway to diagnose cognitive impairment was essential, along with the importance of providing hope, by making available the new and emerging international clinical drug trials in a supportive, compassionate and convenient environment. Last year alone their clinics saw 10,622 patients and now have a staff of 185 in two countries.
The promise of disease-modifying treatments
Alzheimer’s disease has long been regarded as an irreversible and progressive condition that worsens over time, leading to the death of brain cells and a decline in cognitive function. Traditionally, treatments have focused on managing symptoms, rather than halting or reversing the disease’s progression. However, new advancements in research are finally making strides. For the first time, diseasemodifying treatments are emerging – medications designed not just to alleviate symptoms, but to slow down the progression of the disease itself.
Today, Re:Cognition Health is providing treatment with the recently approved monoclonal antibodies against amyloid, leqembi™ and kisunla™ in the UK and the USA. These treatments—Kisunla (denanumab) by Eli Lilly and Lekembi (lecanemab) by Eisai—represent a pivotal shift in the approach to Alzheimer’s disease. The UAE has also recently approved monoclonal antibodies against amyloid. Their approval is a significant milestone, both for the science behind Alzheimer’s treatment and for the millions of individuals who may benefit from them in the near future.
“These drugs have recently been licenced for people with MCI, mild cognitive impairment, which can actually be very mild symptoms of cognition and what’s call mild AD dementia,” says Dr MacSweeney. “But obviously once people have progressed beyond a certain point, then those treatments designed to slow it down are no longer effective.
Understanding Alzheimer’s disease
The pathology of Alzheimer’s is driven by the accumulation of two key proteins in the brain: amyloid and tau. Amyloid protein clumps together to form plaques, which interfere with communication between brain cells and lead to cell death. Tau protein forms tangles inside brain cells, further disrupting their function and contributing to cognitive decline.
Recent research has revealed that amyloid plaques begin to accumulate in the brain up to 20 years before any symptoms of Alzheimer’s appear. Now, for the first time, biomarkers—biological indicators detectable through specialised tests—can identify the presence of amyloid and tau in the brain long before cognitive decline becomes apparent. This information opens the door to earlier treatment, potentially slowing or even preventing the onset of symptoms altogether.
Monoclonal antibodies are a class of medication designed to target and remove specific proteins in the body. In the case of Alzheimer’s, monoclonal antibodies like Kisunla and Lekembi are engineered to target and remove toxic amyloid protein from the brain. The results of clinical trials for these drugs have been promising. Not only do they reduce the levels of amyloid in the brain, but they also correlate with a slowing of disease progression and the preservation of cognitive function.
“The fantastic thing about the large studies that resulted in these two drugs being approved by FDA and MHRA, the drug regulatory authorities, is that not only do they remove the toxic levels of amyloid protein, but their use correlates with slowing a progression of disease and symptoms,” says Dr MacSweeney.
However, it’s important to note that these treatments are not a cure. The damage caused by the accumulation of amyloid and tau proteins over the years cannot be fully reversed. The goal is to catch the disease early—when biomarkers show signs of abnormal amyloid and tau build up—before irreversible irreparable damage has occurred. “Early action is the most important message because it enables us to make an accurate diagnosis using biomarkers, and then to give people the opportunity to get access to one of these medications designed to slow down further progression,” Dr MacSweeney says.
Preventing Alzheimer’s in the future
In the coming years, Dr MacSweeney believes there will be an increasing number of drugs approved for use, each targeting different aspects of the disease and offering a variety of mechanisms to slow its progression. Looking further ahead, the future of Alzheimer’s care may involve regular testing for biomarkers as part of routine health check ups. “Just as we currently test for conditions like high blood pressure, diabetes, or cholesterol, it’s quite likely that individuals will soon be tested for amyloid and tau build up around the age of 40 or 50,” she considers. “If these biomarkers are present, individuals could begin preventative treatments to delay or prevent the onset of symptoms, just as we now prevent conditions such as heart disease through lifestyle changes and medication.”
This shift toward preventative care is not as far off as it may seem. In fact, Dr MacSweeney is already undertaking clinical trials involving people who are cognitively normal. “We measure in the clinical trial whether or not they have high biomarkers for amyloid and tau already. If they do, then they can take part in a study, one of which is actually for a vaccine against tau protein. The purpose of these clinical trials today is to create a scenario for the future where sufferers can take a drug to prevent them developing symptoms.”
Such treatments could further revolutionise the approach Alzheimer’s disease, enabling intervention before symptoms even begin. “Education is also key; there are lifestyle changes such as exercise, diet including a low sugar diet, keeping your brain really active, sleep – all these are actually significant and serious, modifiable risk factors, which we should all be doing all the time,” Dr MacSweeney adds.
“The good thing is that either through clinical trials or through the drugs now on the market, if you do have mild cognitive symptoms, there is a chance to access medications that will potentially change your future,” she says. “The secret is being able to access the medications available now so that you can stay mild in terms of your symptoms. That’s why this is such a pivotal time for this disease.”
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