Alzheimer's. The treatment that slows the disease is already in Greece - The new drug that slows Alzheimer's by up to 35%

For decades, a diagnosis of Alzheimer’s disease seemed like a verdict with no right of appeal. Today, for the first time, medicine has in its hands a weapon that can slow its progress. And this weapon has already reached Greece.

In the last year, at least 35 patients aged 55 to 88 have been receiving donanemab , a new monoclonal antibody against beta amyloid, in specialized hospitals from Attikon and Evangelismos to Patras and Larissa. Clinical studies show that in selected patients in the early stages it can slow cognitive and functional deterioration by up to 35% , with benefits that appear to be maintained for up to four years .

It is not a miracle, and the doctors themselves are the first to clarify this. The treatment has rules, exclusions and risks that are not negligible. Neurologist and psychiatrist Paraskevi Sakka , president of the Alzheimer Society of Athens and the National Observatory for Dementia and Alzheimer’s disease, spoke about all of this to FM Agency and Tania Mandouvalou . As she emphasizes, this is a promising therapeutic approach , which is worth considering for those who meet the criteria, always after full information.

Ms. Sakka explains when memory impairment should motivate us, where one can turn, what is changing with the 19 new Day Centers coming in the coming months, and why prevention starts much earlier than we think, since beta amyloid begins to accumulate in the brain up to 20 years before the first symptoms .

Nineteen new Day Centers in the coming months – Where to go when memory fades

Q: What are the first signs that should prompt a person or their family to seek medical help? How do we distinguish normal age-related memory loss from mild cognitive impairment and dementia?

A: As we grow older, we all forget a little more than we did at a younger age. Memory loss should mobilize both the person himself and his family when it affects his functionality. Not when he simply forgets some names, general information, or events. Then he should contact a specialist, a memory clinic. There are now 37 specialized public memory clinics in total throughout the country, in university and general hospitals, as well as in Dementia Day Centers, while 3 operate in private hospitals. If there is no specialized memory clinic near him, he can contact the neurologist or the local psychiatrist. Because dementia, with the main form being Alzheimer’s disease, is now so common among the elderly, even family doctors and internists know how to examine a person with memory problems and request the necessary check-up.

Q: Where is the network of dementia structures currently located?

A: The network of dementia facilities is expected to be strengthened with 19 new Integrated Day Care Centers throughout Greece. To date, 33 Day Care Centers are already operating, of which 7 also have mobile units. The assignment of the new centers to beneficiary bodies, mainly non-governmental organizations, has already been completed and, according to estimates, their operation is expected to begin within the next few months, as procedural issues remain.

Q: So what is the path for the person who is worried about their memory?

A: Interested parties can find out about Day Centers through the Alzheimer’s Society website, but also by calling the dementia helpline 1102, at a local rate. There they can find out where the nearest facility is located, in order to avoid unnecessary inconvenience.

Approximately 250,000 people with dementia in Greece – 70-80% of cases concern Alzheimer’s disease

Q: Regarding epidemiological data, what is the current picture of Alzheimer’s disease in Greece?

A: In our country, it is estimated that almost 250,000 people suffer from dementia. Alzheimer’s disease accounts for, depending on the studies, 70% to 80% of cases. It is the emblematic form of memory and cognitive decline, perhaps the fastest and worst. All dementias are difficult conditions, last for years and place a financial and emotional burden on families.

In which hospitals is the new treatment administered?

Q: New drugs, such as lecanemab and donanemab, have been approved in the European Union for selected patients with early Alzheimer’s disease. How do they work and how much can they actually slow the progression of the disease?

A: These are two new drugs, monoclonal antibodies against beta amyloid (the protein that accumulates in the brain and is a key feature of Alzheimer’s disease, which is the most common cause of dementia) which were developed in the last five years and have been approved in Europe. Donanemab is on the European market, and is now also being administered in Greece.

It has received a license from the Hellenic Medical Authority (EOF) and, although it is not reimbursed through the usual procedures, it can be administered through the Electronic Pre-Authorization System (EPS), which concerns expensive drugs and foreign drugs. Already, 35 patients have received this specific treatment in our country in the last year, at the Attikon, Evangelismos, Tzaneio, University Hospital of Patras, University Hospital of Larissa, Gennimatas and Hygeia hospitals.

Interested parties should contact specialized memory clinics, or their treating neurologist, in order to assess whether they meet the criteria for granting.

Eligibility criteria – Who can receive the treatment and who is excluded

Q: What are the basic criteria for granting? What diseases or medications exclude a patient from treatment?

A: First, the new treatments are aimed at patients in the early stages of Alzheimer’s disease. There should be no serious systemic disease, such as advanced cancer, severe heart disease, or serious rheumatological diseases that require long-term treatments with significant side effects.

Patients with a specific history of serious strokes or cerebral hemorrhages, as well as those receiving anticoagulant treatment, are also excluded. Regular follow-up with brain MRI scans is also a necessary condition, while age alone is not an exclusion criterion, as the studies also included people of advanced age.

Less than 6% have serious side effects – Treatment is discontinued in 1.5% of patients

Q: What are the potential risks and side effects of these medications, because we know that close monitoring with MRI scans is required.

A: Donanemab is administered intravenously once a month as a day patient, during which the patient remains in the hospital for approximately three to four hours. Adverse effects include cerebral edema, or bleeding lesions in the brain, which can occur in up to 20%. However, severe or symptomatic cases are less than 6%. Treatment discontinuation due to adverse effects occurs in approximately 1.5% of patients.

Q: These risk figures are not negligible at all. Why would anyone risk it? What is the expected benefit?

A: Alzheimer’s disease is a devastating disease, which lasts an average of 11-12 years and results in complete decline of mental functions and loss of autonomy of the patient. The new monoclonal antibodies target beta amyloid that accumulates in the brain and can significantly slow the progression of the disease.

Q: Could you specify the time frame?

A: According to available data from clinical studies lasting approximately 18 months, donanemab can slow cognitive and functional deterioration by up to 35%. This means that the patient can maintain their mental abilities and functionality for a longer period of time.

Q: How old are the 35 people who take it in our country?

Answer: From 55 to 88

Q: So is an 88-year-old who also has the normal decline of age an indication?

A: Yes, as long as he is in very good physical condition and meets the necessary criteria. After all, today, humans continue to remain functional until very old age.

The benefits of treatment appear to be maintained for up to four years

Q: Given that these are particularly expensive treatments, which require electronic pre-authorization, how easy is access for a patient in Greece? And what does the latest data show about the duration of therapeutic benefit?

A: Our experience shows that patients are afraid of side effects. But they turn to specialist clinics, ask for information, are interested, and if the cost of the drug is covered, they take it. It’s just that this perception has not yet been widely disseminated. In the coming years, other monoclonal antibodies against beta amyloid are expected to be added to the therapeutic quiver.

At the same time, long-term follow-up studies of patients who started the new treatments three or four years ago provide encouraging data. In the case of donanemab, the therapeutic benefits seem to be maintained for up to four years. It is not a panacea or a definitive treatment for Alzheimer’s disease, but a promising therapeutic approach. It is worth considering its administration to patients who meet the necessary criteria and are willing to accept the potential risks, after full information.

Beta amyloid begins to accumulate in the brain up to 20 years before the first symptoms appear

Q: Where does prevention stop and when should it finally begin?

A: Prevention starts very early, as early as middle age. Studies have shown that beta amyloid, this “garbage” that accumulates in the brain and is linked to neuronal damage, can begin to be deposited up to 20 years before the first symptoms appear.

Prevention today is documented and includes simple, everyday things, which depend to an overwhelming extent on the will and lifestyle of each of us. That is, I exercise my body. Physical exercise is very important, mainly aerobic, but also muscle strengthening and balance exercises. I exercise my mind in any way. There are infinite ways of mental exercise and mobilization. I eat healthily, I control my blood pressure, my sugar, my cholesterol, my obesity and my weight. I do not smoke, I drink a little and sensibly, I see well, I hear well, I protect my head from injuries, I am in good spirits and I have a good time with people.