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Understanding Alzheimer’s Treatment: New Insights on Patient Independence

In recent years, the Food and Drug Administration has granted approval for two innovative therapies aimed at Alzheimer’s disease. Lecanemab and donanemab, both designed to target and eliminate amyloid proteins linked to plaque formation in the brain, have shown promise in clinical trials by slowing the disease’s progression. While some in the research community welcomed these advancements, many patients have reacted with uncertainty. Healthcare providers report that patients often struggle to grasp clinical trial metrics, such as “percent decrease in the rate of cognitive decline,” and how these figures translate into tangible changes in their lives.

Researchers at Washington University School of Medicine in St. Louis have developed a method to convey the impact of these new Alzheimer’s medications in terms that are easily understood by both patients and their families. By analyzing data on the progression of Alzheimer’s disease alongside the clinical trial results, the researchers have provided a clearer picture of what treatment can mean in practical terms. Specifically, they determined how many additional months of independent living patients might expect if they choose to undergo treatment. The expected benefits varied based on the specific drug and the patient’s initial symptoms. For instance, a patient with very mild symptoms might anticipate an additional 10 months of independent living with lecanemab, compared to eight months with donanemab.

This study, published on February 13 in Alzheimer’s & Dementia: Translational Research & Clinical Interventions, offers critical information that can aid patients and families in weighing the potential advantages against the treatment’s costs and risks.

“Our aim was to distill this information into something meaningful that could assist individuals in making informed decisions about their treatment options,” stated senior author Sarah Hartz, MD, PhD, a psychiatry professor at WashU Medicine. “Patients want practical answers regarding their independence rather than abstract metrics like percent changes in cognitive decline.”

For individuals facing Alzheimer’s, the choice to pursue these therapies is complicated. While neither treatment promises to improve cognitive function or halt the condition’s progression, they could potentially delay the decline. However, patients must also consider the high financial costs, the requirement for regular infusions, and the risks associated with the treatment, which may include mild yet potentially serious side effects, such as brain swelling and bleeding.

Despite these limitations, the potential benefits are still considered significant by both patients and their families. “My patients often ask, ‘How long can I continue to drive? How much longer will I be able to manage my personal care? What additional time might I gain from this treatment?’” explained co-author Suzanne Schindler, MD, PhD, an associate neurology professor at WashU Medicine. “Choosing the right treatment is nuanced and should reflect not just medical considerations but also the patient’s personal priorities and comfort with risk.”

Defining Independence in Alzheimer’s Care

Two pivotal moments mark the transition from independence to reliance in individuals affected by Alzheimer’s. The first occurs when a person can no longer independently manage daily activities like cooking, driving, or keeping track of bills and appointments. The second critical point arises when basic self-care tasks such as bathing and dressing require assistance.

To assess the potential benefits of treatment, Hartz and her team first projected when patients would lose these forms of independence without intervention. Their analysis included data from 282 individuals enrolled in studies at WashU Medicine’s Charles F. and Joanne Knight Alzheimer Disease Research Center. All participants qualified for treatment with lecanemab or donanemab but had not yet received either drug. The team also evaluated how quickly symptoms typically advance without treatment.

After compiling this data on independence and disease progression, along with the known effects of the new drugs, the researchers estimated how long patients at various stages could sustain self-care independently with treatment compared to those who remained untreated.

A typical individual showing very mild symptoms could expect to maintain independent living for 29 months without treatment; this duration increases to 39 months with lecanemab and 37 months with donanemab. For those with mild symptoms, who often lacked the ability to live independently at the outset, the analysis found they could expect an additional 26 months of self-care with lecanemab and 19 months with donanemab.

This clearer perspective on the effect of these treatments may enable patients and their families to make more informed healthcare decisions. “The objective of this study is not to promote or criticize these medications,” Hartz remarked. “Instead, we aim to contextualize their effects in ways that empower individuals to determine the best course of action for themselves and their loved ones.”

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