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Alzheimer’s Association senior director discusses annual meeting highlights for PCPs

Heather Snyder

The first-ever guidelines for clinical evaluation of dementia in primary care, data that suggests a link between normal BP and cognitive decline, and a potential new therapy for Alzheimer’s disease, were some of the top takeaways from this year’s Alzheimer’s Association International Conference, according to Heather Snyder, PhD, the society’s senior director of scientific and medical relations.

Perhaps the most significant presentation for primary care physicians was the clinical practice guidelines for providing guidance to detecting cognitive impairment at the primary care level, she said. These guidelines recommend that all middle-aged or older individuals who self-report or whose care partner or clinician report cognitive, behavioral or functional changes should undergo a timely evaluation; a patient’s concerns should not be dismissed as “normal aging” without a proper assessment; and that patients, clinicians, and in most cases, care partners, such as family member or confidants, should be part of such evaluations.

“More and more people go to their primary care physicians for memory concerns and care following a dementia-related diagnosis. We wanted to know how to best help PCPs with such patients, and these guidelines, based on 30 years of clinical studies, provide the best opportunity to do that,” Snyder said.

She added there are plans to meet with the American Academy of Family Physicians and the ACP to help those societies’ members implement the guidelines in their practices.

Results from the SPRINT-MIND trial, which found that among people treated to a systolic BP of 120 mm Hg or less, there was a 19% reduction in the rate of mild cognitive impairment and 15% reduction in the rate of combined mild cognitive impairment and dementia, was another important topic discussed at the meeting, according to Snyder.

“Though these people were only followed for a little more than 4 years on average, it is really exciting to see that aggressive lowering of BP is possibly a successful intervention to positively impact brain health,” she said. “We’ve often talked about what is good for your heart is usually good for your brain, and these results demonstrate that and underscore the message of managing blood pressure.

A third item from the meeting that Snyder discussed was the results of a phase 2 study involving BAN2401(Eisai, Biogen), an anti-amyloid beta (A) protofibril antibody.

According to a press release from Eisai and Biogen, 856 patients with mild cognitive impairment due to Alzheimer's disease or mild Alzheimer's dementia with confirmed amyloid pathology in the brain were randomly assigned to receive either 2.5 mg/kg biweekly, 5 mg/kg every month, 5 mg/kg biweekly, 10 mg/kg every month, 10 mg/kg biweekly or placebo during this study.

Among the findings stated in the release: patients receiving BAN2401 had a dose-dependent reduction in amyloid plaques as determined by amyloid positron emission tomography that was statistically significant regardless of BAN2401 dose after 18 months. There was also dose-dependent slowing in cognitive decline from baseline on Alzheimer's Disease Composite Score and Alzheimer's Disease Assessment Scale-cognitive subscale and Clinical Dementia Rating Sum of Boxes observed after 18 months.

“These are intriguing results,” Snyder said. “We look forward to seeing what the company’s next steps are regarding this drug.”

Abstracts that looked at risk factors of Alzheimer’s that are exclusive to women were also an important topic, according to Snyder. Some of the data on this topic presented at the meeting include:

• First-trimesters conferred protection against Alzheimer’s disease, which was more consistent with pregnancy’s persisting immunological effects vs. third trimesters, suggesting that pregnancy affected the risk for Alzheimer’s disease.
• Women with three or more miscarriages had a 47% higher risk for dementia vs. those women who never miscarried.
• Women whose menarche occurred at age 16 years or older had a 22% greater risk for dementia than those whose menarche occurred between the ages of 10 and 13 years.
• The use of postmenopausal hormone replacement therapy for less than 5 years greatly reduced the risk for dementia in Korean women.

“More women with men have Alzheimer’s, but the big question has been why: Is it just that women live longer than men? What it is about reproductive health and Alzheimer’s? We don’t know the answers to these questions yet, so it’s important to look at differences in men and women to determine this,” Snyder said. – by Janel Miller

References:

Baek M, et al. Hormone replacement therapy and risk of dementia in postmenopausal women: A nationwide cohort study.

Fox M, et al. Women's pregnancy history may influence Alzheimer's risk through alterations in immune function.

Paola G, et al. Women's reproductive history and dementia risk.

Disclosure: Snyder is employed by the Alzheimer's Association.