Groundbreaking drugs herald a ‘new era’ in the fight against dementia, experts predict

Pills that prevent Alzheimer’s disease or blunt its effects are on the horizon as the fight against dementia enters a “new era”, experts say.

Scientific advances were about to produce drugs that could be used even in the most remote and underutilized parts of the world, “democratizing” healthcare, says Jeff Cummings, a professor of brain sciences and health at the University of Nevada.

An estimated 50 million people worldwide live with dementia, more than two-thirds of these in low- and middle-income countries.

In 2024, the first drugs that can change the course of Alzheimer’s disease came onto the market. Eisai and Biogen’s lecanemab and Eli Lilly’s donanemab have been approved by drug watchdogs in many Western countries. including Great Britain and USA

“I’m so excited about this,” Cummings said. “We are really in a new era. We have opened the door to understanding and manipulating the biology of Alzheimer’s disease for the benefit of our patients.”

Cummings admitted that high prices, complicated administration techniques and requirements for advanced technology to monitor patients meant that these newly approved drugs “would not be made widely available in the world”.

Neither is yet available on the NHS in Britain due to the high cost – around £20,000 to £25,000 per year for each patient. They require additional tests and scans that would likely double that figure.

But Cummings said they have provided evidence for tackling dementia and “this knowledge will open the door to new therapies of many types, and those medicines can be exported around the world”. There are currently 127 drugs under investigation for Alzheimer’s disease.

Lecanemab and donanemab – which prompt the body to clear amyloid plaques in the brain – slow the decline by about 30%, says Cummings, who works with a number of pharmaceutical companies on research and drug development.

Before treatment, patients need a diagnosis confirmed by a high-tech PET scan or a lumbar puncture. Brain scans are required for follow-up monitoring. The necessary equipment and expertise are scarce in many countries and the drugs are administered intravenously – a further limitation.

However, Cummings highlighted recent decisions by the US regulator, the Food and Drug Administration, which have allowed the diagnosis of Alzheimer’s based on a blood test as an eligibility criterion for trials of anti-dementia drugs.

That could pave the way for blood tests, which look for ‘biomarkers’ for dementia, which could be used for diagnosis in clinics instead of expensive scans.

In the meantime, test results suggest that the new drugs could instead be administered by injection under the skin, opening the door to home administration by a nurse or caregiver.

“Ultimately we want oral medications, some pills that can be taken once a day,” said Cummings, joined by Paola Barbarino, CEO of Alzheimer’s Disease International (ADI), after the organization’s year-end forecast.

Tablet forms of semaglutide – better known as Ozempic, an injectable weight loss drug – are already being tested for Alzheimer’s disease, with results expected in late 2025. Cummings, who chaired these trials, said there were plausible reasons to think the drug would be effective by reducing inflammation, which was “a fundamental part of the disease”.

He called for greater involvement of low- and middle-income countries in clinical trials, to increase knowledge about how the drugs work among different populations and to increase scientific capacity and knowledge about dementia in those places.

Is there a cure for Alzheimer’s disease? That was “tough,” Cummings said. But, he added.

“We know enough about manipulating biology and how it starts that, I think, within my lifetime – maybe a little longer, because I’m not young – we can control the processes that cause the disease, and therefore it is simply would not develop in the brain.”

Experts believe 40% of Alzheimer’s cases can already be prevented by tackling key risk factors such as smoking, alcohol consumption and air pollution.

Prices should drop so that low- and middle-income countries can “even think” about offering drugs that could change the course of Alzheimer’s disease, Barbarino said.

Attitudes should also change, she said, adding: “When I speak to health ministries in some poorer countries, they tell me that they don’t have dementia in their countries, which of course is not true.”