What’s the next breakthrough with Alzheimer’s disease?

In the U.S., someone develops Alzheimer’s every 65 seconds. By mid-century, that rate will double to every 33 seconds.

Increasing age is the biggest risk factor when it comes to dementia and Alzheimer’s disease, and more than a million South Carolinians will be 65 or older by 2030.

While a cure remains elusive, recent advancements in early diagnosis and treatment offer hope. We asked three MUSC experts on Alzheimer’s to share their research and what’s being done to prepare for the “silver tsunami” of an aging baby boomer generation.

Collaboration drives Alzheimer's research breakthroughs in South Carolina

Steven Carroll, M.D., Ph.D., director, South Carolina Alzheimer’s Disease Research Center

Carroll has researched dementias – including Alzheimer’s – for more than 30 years, the last 10 at MUSC. He knows firsthand the devastation the disease brings to patients and their families because his mother has advanced dementia.

A. A major advance in Alzheimer’s research in South Carolina is how it’s taking place: through coordinated, collaborative investigation.

In 2023, the state announced a groundbreaking venture between MUSC, Clemson University and the University of South Carolina. Our priority is to advance comprehensive Alzheimer’s research, medical discoveries and education. In June, we submitted our application to the National Institute on Aging to be recognized as the 36th national Alzheimer’s Disease Research Center. When approved, the ADRC will qualify for additional federal research funding, data sharing on a national scale, greater access to clinical trials and advances in patient care.

In South Carolina, several demographic groups, including those 65 and older, veterans and African Americans, are at higher risk for Alzheimer’s. Our exceptional resources include the nation’s most comprehensive Alzheimer’s Disease Registry in the country, the MUSC brain bank, a statewide DNA registry and coordination with the Veterans Affairs Health Care System. These demographic cohorts and existing knowledge hubs will benefit from investment by federal, state and philanthropic sources.

I believe biomarker research including brain imaging, magnetic resonance imaging, blood tests, and others show great promise. In addition, genetic testing and brain bank research help us gather data on dementia risk variants to reach a better understanding of the role certain genes may play in causing dementia. These capabilities and others may help us discover who gets Alzheimer’s and why.

New drugs can slow Alzheimer’s progression when diagnosed early. In the future, I see biomarker research possibly leading to prophylactics for the highest risk populations. That would be a tremendous breakthrough.

New Alzheimer’s drugs offer early hope for patients

Nicholas Milano, M.D., director, South Carolina Alzheimer’s Network

Milano's fascination with the brain's role in shaping our humanity ignited when his grandfather was diagnosed with Alzheimer’s. A dementia expert, he wears many hats: researcher, teacher, residency director, and now, the driving force behind the South Carolina Alzheimer’s Network. His work includes clinical trial testing of the first FDA-approved Alzheimer’s drug in more than 20 years.

A. The new kids on the block in Alzheimer’s drugs are the 2023 FDA-approved lecanemab (Leqembi) and the July 2024 FDA-approved donanemab (Kisunla). Clinical trials found that these drugs can slow, and in some cases stall for a period, the progression of Alzheimer’s in patients in the early stages of the disease. Typically, as new drugs arrive on the scene, they are more effective and less expensive than their predecessors.

The culprit that brings on Alzheimer’s is amyloid plaque development in the brain. These drugs are monoclonal antibodies. An antibody is something that your immune system makes to go after infections or other diseases. The term monoclonal just refers to the fact that the lab-created antibodies are clones. When administered, the antibody attaches to the amyloid and clears out the abnormal plaque protein.

MUSC can offer advanced treatments like Leqembi – and soon Kisunla – because we are part of the only comprehensive academic health system in South Carolina. These drug manufacturers require patients to be part of a registry so that we can learn more about the disease as well as the drug’s long-term benefits and possible side effects. MUSC has the neurology expertise, support staff and systems in place to meet these rigorous requirements.

Today’s infusion drugs can buy patients time to live a mostly normal life and buy researchers time to pursue better treatments. I think soon it may be possible to identify those people without symptoms who will one day develop Alzheimer’s. That’s a game changer because we know early treatment is the key to improved outcomes.

Tackling early-stage Alzheimer’s with brain stimulation research

Andreana Benitez, Ph.D.

Benitez is a clinical neuropsychologist who has dedicated her career to Alzheimer’s research. Her lab researches the changes that happen in the brain in the earliest stages of Alzheimer's disease. She also mentors the next generation of researchers and scientists through MUSC’s research training program.

A. My team and I are on a mission to pinpoint the fine line between normal brain aging and the earliest signs of Alzheimer’s. Understanding this subtle difference is crucial – it allows us to zero in on treatments that can address Alzheimer’s right from the start. Normal cognitive aging does not need to be treated – after all, that’s where wisdom lives, sometimes along with a little forgetfulness. An Alzheimer’s diagnosis and outcome is completely different.

Right now, we're conducting clinical trials using TMS, a non-invasive brain stimulation treatment approved by the FDA, aimed at improving symptoms in those with mild cognitive impairment – the pre-dementia stage of Alzheimer’s. Our initial trial results were promising: Participants showed better cognitive test performance and enhanced brain connectivity, as seen through functional MRI. We’re now in the second phase, fine-tuning the TMS dosage to achieve lasting effects. If this works, our next step will be to confirm its effectiveness in treating mild cognitive impairment, potentially adding a powerful tool to our Alzheimer’s treatment arsenal.

It’s a thrilling era in Alzheimer’s research. While new drug treatments are emerging – albeit with some risks –fresh ideas about how Alzheimer’s develops are broadening our treatment options.

I’m excited because our work in non-invasive brain stimulation is part of this promising effort.

Philanthropy makes high-risk, high-reward research possible. To discover how you can help advance Alzheimer’s research, contact Heather Parrish, Director of Development | 843-792-4342 | parrishh@musc.edu