Paulo Caramelli, MD, PhD, Federal University of Minas Gerais, Belo Horizonte, Brazil, discusses the existing pharmacological approaches to treating Alzheimer’s disease (AD) and comments on the results of recent Phase III clinical trials which investigated anti-amyloid disease modifying therapies. At present, pharmacological management of AD in most countries involves the use of cholinesterase inhibitors and memantine, which can be used from early to advanced stages of dementia. These agents have modest effects on improving clinical symptoms which is helpful to both patients and caregivers. Due to their widespread and long-term use, their safety profile and pharmacological characteristics are well known and understood. A large Swedish study investigating the use of cholinesterase agents in patients over the course of several years also found them to confer a benefit on the time taken to reach the severe dementia stage and on mortality, when compared to patients not taking the drug. Anti-amyloid medications are now approved for use in patients with AD in the United States, having shown a slowing of the rate of cognitive and functional decline observed in patients over the course of 18 months. Although data collected has been primarily positive, safety concerns with these agents must be addressed, as well as the lack of ethnic diversity amongst participants recruited, which ultimately affects the applicability of findings. This interview took place at the World Congress of Neurology (WCN) 2023 in Montreal, Canada.
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