Short Wave - COVID And Aduhelm On The Agenda At Denver Alzheimer's Meeting

Episode Date: August 4, 2021

The Alzheimer's Association International Conference took place in Denver this year. Today on the show, NPR science correspondent Jon Hamilton talks to Maddie Sofia about what he learned at the conference, the latest on the controversial new drug Aduhelm, and the potential links between COVID and Alzheimer's. You can follow more of Jon's reporting by clicking this link.Email the show at [e-mail] pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. Hey there, Maddie Safai here today with NPR's brain guy, John Hamilton. He's here to talk to us about the annual Alzheimer's Association International Conference, which was in Denver this year. Hey, Maddie. So, John, fascinating times to have an Alzheimer's meeting, I suppose. Yeah, let's just say COVID-19 was a big presence this year. Partly that was because of the Delta variant that is spreading so fast. was sitting in one session when someone walked up to the podium and announced that we all had to

mask up. This was when the CDC had just changed its mask guidance. And while there wasn't a huge surge in Denver, this meeting draws people from all over the world. So we all started wearing masks. Right. I mean, last year, it was virtual. We were about six months into the pandemic.

So I imagine a lot of research has happened since then, both related to COVID and more generally, because Alzheimer's is such a huge area of study. That's right. And I'd like to talk about a couple of things. First and foremost, there was some new research on whether there's a link between COVID and Alzheimer's. Second, I was on shortwave a few weeks ago talking about the new drug that the FDA approved for Alzheimer's. There have been some developments with that, and it was another big topic at the meeting in Denver. All right.

So today on the show, John brings us the latest on Aga Helm, the controversial drug that the FDA approved a few weeks ago. And we look at the latest on the links between. COVID and its relationship with Alzheimer's. You're listening to Shortwave, the Daily Science Podcast from NPR. Okay, John, tell me a bit about the relationship between COVID and the brain. Well, it's become clear that COVID can cause lasting damage to the brain. So just before I went to the Alzheimer's meeting, I talked to a woman in San Antonio, Texas, named Cassandra Hernandez.

She told me that before she got COVID-19, she was in great shape, physically and mentally. I'm a nurse, and I would work three times. 12-hour shifts back to back, and I would walk six to seven miles a day at work. I work with surgeons, and my memory was sharp. I was on it. I had to be on it. You know, my patient's life depended on it. And now I'm slow at times. Mind you, Hernandez is only 38, but she was working at this large hospital, and in June last year, she and several other people in her unit came down with COVID. Went home after working a 12-hour shift and sat down to eat a pint of ice cream with my husband because that was our favorite thing to do after a 12-hour shift and couldn't taste it.

But thought, you know, hey, maybe I'm just tired. Went to sleep and woke up that next morning at 6 in the morning and couldn't get out of bed. She told me she spent two weeks in the hospital and then months at home and in rehabilitation. She had symptoms including tremors, extreme fatigue. She was temporarily paralyzed on one side. But the worst of it was her problems with memory and thinking. I would literally fall asleep if I was having a conversation or doing anything that involves my brain. So researchers at UT Health in San Antonio, they've been studying the brains of patients like Hernandez.

And they presented some of their findings at the Alzheimer's meeting in Denver. I talked to Dr. Gabriel de Arrowskian while he was still in San Antonio. He says scientists are beginning to see, I guess you'd call it. some patterns. For example, the greatest risk of brain problems seems to be in people like Hernandez. Remember how she talked about not being able to taste her ice cream? Yeah, yeah, and that's worrisome, right? Because loss of taste and smell can be a sign that COVID is affecting the brain. Yes, the area involved in sensing odors. Deirauskin told me that's probably because the disease has affected a brain area called the olfactory bulb. Persistent lack of smell, it's associated with

brain changes. Brain changes, not just in the olfactor evolved, but those places are connected one way or another to the smell sense. Which is bad because those include areas involved in memory, thinking, planning, and mood. De Eraskin told me COVID's effect on the brain also seems to vary with age. In older people, people over 60, the foremost manifestations forgetfulness. These folks tend to forget where they place things, they tend to forget names, they tend to forget phone numbers. They also have trouble with language. They begin for getting words. And those symptoms are a lot like early Alzheimer's. But isn't Alzheimer's like sort of a forever thing, John? That's how I think of it. I mean, how long do these COVID symptoms persist?

No one knows yet. But Deira Askin says many of these patients are still impaired months after an infection. Those people look really bad right now. And the expectation is that it may behave as Alzheimer's behaves in a progressive fashion. But the true answer is we don't know. So at the Alzheimer's meeting, there were several big sessions about whether COVID-19 can increase a person's risk of developing Alzheimer's. Another doctor from San Antonio who spoke there was Suda Seshadri. She told me the idea that COVID might increase the risk of Alzheimer's is alarming. Even if the effect is small, it's something we're going to have to factor in because the population at risk is quite large. Yeah. I mean, in the U.S. alone,

millions of people have developed persistent cognitive problems after getting COVID, right? Exactly. And Sashadri says it may take a decade to know whether these people are really more likely to develop Alzheimer's. In the meantime, that nurse I spoke to, you know, Cassandra Hernandez, she's been going to the COVID recovery clinic at UT Health San Antonio. I spoke to her doctor there, Monica Verdusco Gutierrez, and she told me Hernandez is doing pretty well. She's made so much improvement. I would love for her. to go back to nursing. But again, we don't know what happens with this disease. Fortunately, there is an international consortium that's trying to answer that question. They've got a study underway.

It's going to follow patients with cognitive problems for three years after an infection to see if they get better. Okay, John, you know, reason 1,000 to try and stay away from this Delta variant, you know, mask up, get vaccinated. Yeah, exactly. So to the treatment end, can we turn to Aegehelm here? doctors can now prescribe this controversial new drug to their patients with Alzheimer's disease. But even medical experts are still trying to figure out if it should be used at all, which patients should get the drug and how to use it safely. Yeah, that's right, Maddie. Adjuhlm received this conditional approval from the Food and Drug Administration back in June. That approval came despite conflicting evidence on whether the drug actually slows the progression of Alzheimer's. And since then, some experts have said they won't prescribe adieuelm at all.

But, you know, it's complicated. While I was at the Alzheimer's meeting, I talked to Dr. Alireza Atri of the Banner Sun Health Research Institute in Arizona. He told me that just refusing to prescribe adieuhelm would be unfair to patients in their families. This is an incurable condition and it's progressive. And I think we need to figure out a way to present that option to them in a way that, that's safe. And of course it turns out that the safety issue is complicated too. Usually, you know, doctors look to a drug's label and instructions for guidance on how to use the product appropriately and safely. But Atri, you know, who has worked as a consultant to the drugs maker,

Biogen, says that's not enough when it comes to Adjahom. The label left a lot of gaps. So it is important to have very quickly some preliminary recommendations regarding how to use this because people are using it already. Also, John, doesn't Agilhelm have to be infused directly into the bloodstream? And doesn't it have, like, a lot of possible and pretty harmful side effects? Yes, it can cause swelling and bleeding in the brain, usually not severe, but it can be. So at the Alzheimer's conference, Atri and this panel of scientists offered a set of detailed recommendations. And before you dig into this, John, we should say that the doctor that we just heard from and others on this panel have worked

as consultants for the drug maker at one time or another, right? That is correct. They made a point of disclosing all of this at the meeting and the Alzheimer's Association, which is running the conference, backed the approval of Adjuhelm, and also disclosed that it had received some funding from biogen. So obviously, you know, it's problematic when scientists have a financial relationship with the drugs maker, but these are also often the scientists who know the most about a new drug, you know, precisely because they were involved in its development. So for better or worse, this is kind of business as usual when it comes to drug development. Okay, got it. It's also worth noting that the association and the panel members

say that the company, Biogen, did not have any involvement in writing these recommendations. Okay, so are these guidelines, like legit, John? Yes, in the sense that they are based on the studies the FDA used to approve the drug. So one of the panel's recommendations is to make sure that the drug is given only to patients who are still in the early stages of Alzheimer's. I talked to Dr. Eric McDade. He's a neurologist at Washington University in St. Louis. He was not involved in developing these recommendations. And he says doctors should say no to patients who appear to be significantly impaired already. They're probably not safe to be driving. They've given up most of their complex hobbies and social activities outside of the home.

This is a patient, for instance, I would say, really, there's no evidence whatsoever that this is going to benefit you. It also told me that he agrees with the recommendation that doctors obtain a brain scan or a test of spinal fluid before they give this drug. Right, and that's to confirm the presence of the sticky amyloid plaques in the brain that Adjahelm is designed to remove. Exactly. So it's a complicated drug, and people at the Alzheimer's Association say the recommendations are really for specialists, not general practitioners, because most primary care doctors lack the training or the facilities to offer it. One thing that struck me at the Alzheimer's conference was how many senior research. scientists there said they still have questions about using Adjahelm. So, for instance, studies have found that patients with a genetic variant called APOE4 are twice as likely to experience dangerous side

effects from the drug. But at the meeting, scientists were saying that APOE4 seems to work differently in black and Hispanic patients, who were largely left out of those studies. Here's Maria Carrillo, the chief science officer at the Alzheimer's Association. Unfortunately, we don't know enough about the impact of APOE4 on underrepresented populations, in particular on African-American or Latinx backgrounds. That means doctors are going to be in a tough spot when it comes to prescribing Adjahelm to Black and Hispanic or Latinx people. Either they prescribe it to patients without knowing a lot about how they will respond, or they tell these patients they can't get the drug. So at the conference, there were several scientists who called for a new study that would focus just on people in these

groups. Okay, John Hamilton. As always, thank you for coming on the show, and I really look forward to finding out how this is all developing. Anytime. This story was produced by Thomas Liu and Giselle Grayson, who also edited. Indy Kara checked the facts. The audio engineer for this episode was Alex Drewenzkus. I'm Maddie Safaya. Thanks for listening to Shortwave from NPR.