SIX MONTHS INTO the Covid-19 pandemic, Florida resident Francisco, known as Pako, now 48, found himself acting oddly. A vegan, he was suddenly binging on ice cream and splurging on soccer paraphernalia, despite being more of a baseball fan.
At first, Pako’s wife chalked up his uncharacteristic behavior to depression. Like many people, he’d been cooped up at home during the lockdown and adjusting to his new routine. But there was one symptom that didn’t quite fit that diagnosis: episodes of forgetfulness that kept getting worse. “I’d go into a room and try to look for something, and forget what I was looking for,” says Pako.
Eventually, he could no longer ignore it. As he stood by the refrigerator one day, trying to remember what he was searching for, he turned to his wife and said, “I think there’s something seriously wrong with my memory.”
When Confusion and Memory Loss Can Signal a Problem
ALMOST EVERYONE HAS struggled to recall a person’s name or blanked on the right word to use in a conversation. Stress, anxiety, and depression can all cause some forgetfulness or trouble concentrating, and some memory problems are a normal part of aging. In other cases, this confusion, trouble focusing, or difficulty remembering things—sometimes referred to as “brain fog”—can be caused by low blood-sugar levels or conditions like chronic fatigue syndrome.
But whereas brain-fog-related forgetfulness doesn’t tend to interfere with daily life (embarrassment aside), memory loss from Alzheimer’s disease (AD)—the most common form of dementia—tends to worsen with time rather than, say, improve after a good night’s sleep.
“The symptoms of normal aging and Alzheimer’s disease can feel similar, but they are different,” says Ashok Patel, MD, a geriatric psychiatrist based in Toms River, New Jersey. “No matter what, as we age, we all slow down a bit, we forget things, and we repeat ourselves every now and then. With Alzheimer’s disease, however, the slowing is more frequent, the forgetting more intense. For example, people with AD will have a difficult time figuring out words—specifically, the names of things.” Moreover, a person’s short-term memory loss tends to be affected most, whereas their long-term memory can remain stable. “Their distant memories, of their childhood or of a decade ago, remain intact,” says Dr. Patel.
Ron was diagnosed with mild cognitive impairment after word recall became difficult for him.
In 2021, that’s what was happening to Ron, now 79, a patient of Dr. Patel’s and a former adjunct professor at a community college near Philadelphia. “Many times, I found myself saying to a class, ‘Where was I, guys?’” he says. His students didn’t seem to pay much attention to his memory lapses—and when they did, they chalked it up to his age—but Ron could tell something was wrong.
He was 76 years old at the time and experiencing more than just memory loss. He was also having trouble finding the right words during a conversation. When he blanked on a particular word or phrase, he usually came up with a substitution. “It was a little unsettling,” he recalls.
What Alzheimer’s Disease Looks Like in the Brain
PAKO’S MEMORY PROBLEMS remained uninvestigated until the fall of 2021, at an appointment with his eye doctor. During the exam, the ophthalmologist noticed that he was losing his peripheral vision. (Some research suggests that AD can interfere with this.) Concerned, the doctor ordered a magnetic resonance imaging (MRI) test, which revealed a loss of brain mass—one sign of the condition.
Pako was diagnosed with early-onset Alzheimer’s disease after a routine checkup with the eye doctor.
“AD occurs when an abnormal buildup of two different proteins, called amyloid beta and tau, occurs in the brain tissue,” says Dr. Patel. These plaques clump together and disrupt the function of neurons (specialized cells that act like messengers between the brain and the rest of the body).
They can appear throughout the brain, but the buildup tends to cause particular problems in the temporal lobe (the area involved in retrieving memories and understanding language) and the parietal lobe (the area involved in complex movements, such as writing).
“There’s the progressive accumulation of more amyloid plaques and then the secondary damage to the brain caused by tau proteins,” Dr. Patel says. “Both lead to neuronal dysfunction, depending on where the buildups grow. For example, if they’re in areas that control speech and motion, it’ll be difficult to say specific words or tie your shoes. As the buildup takes over more space, the issues will broaden: There will be more difficulty in remembering recent events and past events, and even functional and personality changes.”
AD is a progressive disease, advancing in stages: early, middle, and late. Early AD is also known as mild cognitive impairment (MCI) or mild dementia due to AD. Symptoms of MCI include forgetting names and confusion, which can be very mild and may not interfere with daily activities. Mild dementia due to AD is when symptoms, like trouble managing finances and difficulty with familiar tasks, start to get in the way of daily life.
When Pako was given an initial diagnosis of early-onset AD (which affects people who are younger than 65), he was shocked. He was only 46 years old at the time—too young to get Alzheimer’s disease, he thought. So he traveled to a specialized AD clinic to get a second opinion, and the experts there confirmed the early-stage diagnosis. Pako has a family history of early-onset AD, and with this diagnosis, his worst fears had come true.
Pako has since found hope and a new purpose in his life. He and his wife have become advocates for disease awareness, sharing his story with others who are living with or caring for someone with AD. “If it’s happening to me, there’s a lot of people that it’s happening to,” he says, “If we help even just one person that’s good enough for me.”
A Treatment for Alzheimer’s Disease
AFTER RON RETIRED from his academic position two years ago, he was diagnosed with MCI and started taking a treatment called LEQEMBI® (lecanemab-irmb, 100 mg/mL, injection for intravenous use)—a medication that’s approved by the U.S. Food and Drug Administration under the traditional approval pathway for the treatment of AD. The drug is made by Eisai Inc. in partnership with Biogen. The medication, which is given by infusion, is the first approved anti-amyloid AD treatment shown to slow disease progression and cognitive and functional decline in adults with early AD. Even though it is not possible to stop AD from getting worse, with LEQEMBI, one can take steps to slow how fast it progresses. The treatment was tested in a large 18-month clinical study in patients with MCI and mild dementia due to early AD.
“LEQEMBI is a therapy shown to slow disease progression in a clinically meaningful way,” Dr. Patel says. “It fights the disease in two ways: LEQEMBI removes existing amyloid plaque within the brain and also targets the different types of harmful amyloid proteins that can continue to damage nerve cells even after plaque is removed.”
LEQEMBI can cause serious side effects including amyloid related abnormalities (ARIA), serious allergic reactions and infusion-related reactions. Some people may have small spots of bleeding in or on the surface of the brain, sometimes fatal events with larger areas of bleeding have occurred. Patients who may be eligible for treatment with LEQEMBI should ask their doctor about testing for a genetic risk factor that may cause an increased risk for ARIA. It is important they also tell their doctor about all the medicines they take, including medications to reduce blood clots from forming such as antithrombotic medicines like aspirin. Some medicines can increase the risk for larger areas of bleeding in the brain. Most common side effects included infusion related reactions, swelling in areas of the brain, and headache. These are not all the possible side effects of LEQEMBI. Please see full safety information below.
A prompt diagnosis of AD and early intervention are important. Once AD progresses to middle and late stage, LEQEMBI may no longer be right for you. That is why it’s important to discuss treatment with your doctor as soon as possible.
As for Ron, he has not noticed his disease worsening. Both he and Dr. Patel are happy with the results and continue to monitor his symptoms. “I’m more comfortable knowing I’m able to do something to slow the progression of Alzheimer’s disease,” says Ron. “I’m a happy man.” In the past year, Ron even came out of retirement and got a job working as a tipstaff, the position responsible for maintaining order in a courtroom.
When Ron eventually relayed the news of his new job to Dr. Patel, he was floored. “He said, ‘In the 25 years I’ve been in this business, you’re the first one ever with this particular diagnosis who got a full-time job,’” Ron recalls. “I know I can live with this diagnosis. I feel like I’m doing something about it now, rather than just sitting in a corner and watching. I’m an advocate for positive change, and believe that if you lean into it, right around the corner there is help.”
If you or someone you love may be living with AD, it’s important to speak with your doctor. To learn more about LEQEMBI, visit www.LEQEMBI.com.
Sponsored by Eisai Inc. and Biogen.
WHAT IS LEQEMBI?
LEQEMBI is a prescription medicine used to treat people with Alzheimer’s disease.
If you have serious allergic reactions to any of the ingredients in LEQEMBI, you should not be treated with LEQEMBI.
IMPORTANT SAFETY INFORMATION
What is the most important information I should know about LEQEMBI?
LEQEMBI can cause serious side effects, including:
- ARIA (amyloid-related imaging abnormalities). There are usually no signs of ARIA. In rare cases, it can lead to serious complications
- ARIA can show up as swelling in parts of the brain or small spots of bleeding
- Larger areas of bleeding in the brain may occur, but this is uncommon
- ARIA usually goes away over time
- Most people with ARIA don’t have any symptoms. However, some people may notice:
— headache
— confusion that gets worse
— dizziness
— vision problems
— nausea
— problems walking
— seizures - Some people have a gene called ApoE4 that may increase the risk of ARIA. Talk to your healthcare provider about testing to see if you have this gene
- Some medicines can increase the risk of larger areas of bleeding in the brain for people taking LEQEMBI. Talk to your healthcare provider to see if any of the medicines you’re taking increase this risk
- Your healthcare provider will check for ARIA with MRI (magnetic resonance imaging) scans before you start LEQEMBI and during treatment
Call your healthcare provider or go to the nearest hospital emergency room right away if you have any of the symptoms listed above.
Before receiving LEQEMBI, tell your healthcare provider about all your medical conditions, including if you:
- are pregnant or plan to become pregnant. It is not known if LEQEMBI will harm your unborn baby. Tell your healthcare provider if you become pregnant during your treatment with LEQEMBI
- are breastfeeding or plan to breastfeed. It is not known if any of the ingredients in LEQEMBI pass into your breast milk. Talk to your healthcare provider about the best way to feed your baby while receiving LEQEMBI
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
Especially tell your healthcare provider if you take medicines to reduce blood clots from forming (including aspirin). Ask your healthcare provider for a list of these medicines if you are not sure.
Keep a list of the medicines you take. Show it to your healthcare provider and pharmacist when you get a new medicine.
What are the possible side effects of LEQEMBI?
LEQEMBI can cause serious side effects, including:
- ARIA (amyloid-related imaging abnormalities) (see above)
- Serious allergic reactions may happen during a LEQEMBI infusion. Tell your healthcare provider if you notice any of these symptoms during or after a LEQEMBI infusion:
— swelling of the face, lips, mouth, or tongue
— itchy bumps on the skin, also known as hives
— difficulty breathing - Infusion-related reactions are common and can sometimes be serious. Tell your healthcare provider right away if you notice any of these symptoms during an infusion:
— fever
— flu-like symptoms (chills, joint and body aches, feeling shaky)
— nausea and/or vomiting
— dizziness or lightheadedness
— fast or slow heart rate, or feeling like your chest is pounding
— difficulty breathing or shortness of breath
Your healthcare provider may give you medicines before your next infusion to lower the chance of having a reaction.
The most common side effects of LEQEMBI include:
- infusion-related reactions
- swelling in areas of the brain, with or without small spots of bleeding in or on the surface of the brain (ARIA)
- headache
These are not all the possible side effects of LEQEMBI. Call your doctor for more information and medical advice about side effects. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Please read the accompanying full Prescribing Information including Boxed WARNING, and Medication Guide for LEQEMBI.
Dr. Patel was compensated by Eisai Inc. for his participation in this story.
LEQE-US3410 © Eisai Inc. July 2024
