UW doctor shares latest on Alzheimer’s diagnosis and treatments in Spokane talk

In the next two years, biomarker blood tests are expected to emerge as a diagnostic tool to catch Alzheimer’s disease earlier – perhaps when people are 55 to 60 years old and the disease is not yet noticeable.

Dr. Thomas Grabowski, director of the University of Washington’s Alzheimer’s Disease Research Center , said it’s better to battle the disease at the beginning of cognitive symptoms, or if possible, a decade or two before they happen.

“People’s ideas about Alzheimer’s need a bigger frame,” he said. “Most people, when they think of Alzheimer’s, they think about dementia and the worst case that can happen. In fact, the dementia’s phase is like the last eight or 10 years in something that is really a 30-year process.

“Making a diagnosis much earlier is what the goal is in medicine.”

These insights and the latest in Alzheimer’s research will be part of the “Next Generation Medicine Lecture” at Gonzaga University’s Cataldo Hall. It takes place from 6 to 8 p.m. Wednesday and is open to the public and led by Grabowski, who is also medical director of the UW Memory and Brain Wellness Center.

Dr. Silvia Russo, a Spokane-based Providence Medical Group cognitive and behavioral neurologist , is scheduled to join in a question-and-answer discussion.

Today, patients with suspected Alzheimer’s issues typically get either a spinal fluid biomarker test or a brain scan known as positron emission tomography to see if there is more amyloid plaque in the brain than normal – a hallmark of the disease. In 2020, as many as 5.8 million Americans were living with Alzheimer’s disease, according to the federal Centers for Disease Control and Prevention.

Grabowski said blood testing for biomarkers related to Alzheimer’s is already being used in research and starting to become commercially available. While Grabowski added that such blood tests aren’t quite ready to help doctors make treatment decisions, that’s expected to change soon.

“I think they’re getting better really fast, and you’ll see them roll out,” he said.

“I think if you fast-forward the clock to 2030, what will be the case is people will probably get a biomarker test most likely on blood when they turn 55 or 60 and see whether they already have a pre-clinical process happening and intervene then. That’s what the future is, so the biomarkers really can test on spinal fluid or blood and predict what’s going to happen.”

Grabowski said detecting Alzheimer’s early helps patients in many ways and ties into emerging medications. One is the newly approved infusion drug Leqembi – the first to affect the underlying biology of the disease that shows promise in slowing decline – but only for early-stage Alzheimer’s or mild cognitive impairment.

He also plans to talk about the risks and benefits of Leqembi, which the UW center is setting up to offer to qualified patients by mid-November.

Amyloid-beta protein accumulates in the form of plaques in the brains of people with Alzheimer’s. This accumulation is thought to contribute to the cognitive decline. Medicare doesn’t currently pay for a PET scan, although the agency is reviewing that policy, he said.

“Right now, the best practice is to make a diagnosis when people have mild cognitive impairment, when there are symptoms suggestive of memory trouble. Then for these new medicines, what we would do is a biomarker test on spinal fluid or with a brain scan – and then not this year but literally in the next year or two – with a blood test to prove it’s Alzheimer’s.”

Lecanemab, or brand name Leqembi, was granted full Food and Drug Administration approval in July, as the first disease-slowing drug.

Leqembi is an antibody that specifically binds to amyloid beta and allows a person’s immune system to remove the plaques from the brain. Studies consistently showed a marked reduction in the amount of amyloid accumulation, but it’s only been studied in people with early Alzheimer’s and mild cognitive impairment due to Alzheimer’s.

A similar drug, donanemab, is expected to receive FDA approval by year’s end, he said. With these medications, doctors have to review whether patients are in early stages and aren’t on blood-thinning medications, can tolerate MRI scans and are willing to do infusion treatment intravenously every two weeks for 18 months.

The new medications include risks, so people need to go over those with their doctors.

“They run the risk of some small blood vessel trouble in the brain, so if you’re someone with mild cognitive impairment and don’t have Alzheimer’s, and there is no amyloid to remove, then we’re only exposing you to risk and not the benefit of the medicine,” he said. “That’s the practical reason why you would want to know with biomarker certainty.”

“These are medicines, not cures,” Grabowski added. “There are factors to know about, and there are expectations to set about what these new medicines can do, but we’re excited about them as an important step forward.”

He expects some of his talk will be in reframing people’s understanding of Alzheimer’s disease, such as the differences between it and other forms of dementia.

Doctors typically determine issues with memory based on the continuum of normal cognition, mild cognitive impairment or dementia, he said. Then, a diagnosis considers what’s causing the issues in a brain, “which might be Alzheimer’s or vascular brain injury … or something else.”

Other earlier interventions exist that aren’t pharmacological, such as cognitive training.

“It is possible to compensate for some memory impairment by taking advantage of the parts of the brain that are spared by Alzheimer’s. It’s a lot more effective if you do it early.”

The University of Washington School of Medicine and Gonzaga University support a regional, community-based medical education program called WWAMI for Washington, Wyoming, Alaska, Montana and Idaho. It includes sites in Seattle and Spokane for medical school training.