As we continue to search for a cure for Alzheimer’s disease, researchers are finding new ways to treat and manage the condition. Sometimes, that research moves us forward, and sometimes that research moves us in uncertain directions.

A recent systematic review and meta-analysis of MRI data, published in Neurology, found that anti-amyloid therapies for Alzheimer’s disease could accelerate brain atrophy. Just to be clear atrophy, or shrinkage, is not a good thing.  This research is particularly important for individuals who may have a family history of Alzheimer’s disease and are concerned about their own long-term brain health.

Editors Note: What’s about to follow here is a bit “scientific.”  That’s okay, we’ll get through this together.” 😊

The review focused mainly on two types of anti-amyloid drugs: secretase inhibitors and monoclonal antibodies. The study found each type had it’s own “type” of effect. Secretase inhibitors had a prominent effect on volume changes in the hippocampus and whole brain, while monoclonal antibodies led to accelerated ventricle enlargement, this was especially true of those antibodies that caused amyloid-related imaging abnormalities (ARIA). The frequency of ARIA was strongly correlated with the degree of ventricular enlargement, which is a classic marker of neurodegeneration.

To cover a few terms that we just tossed out…

Ventricles are hollow spaces inside the brain.  We all have them. We just don’t want them to grow.

Hippocampus is a complex brain structure located deep in the temporal lobes of our brains.  It plays a key role in learning and memory formation.  Stimulating environments cause the hippocampus to grow.

To many researchers and providers, brain shrinkage—whether through a loss in brain volume or an increase in ventricle size—is typically associated with Alzheimer’s progression. Why it occurs after treatment with anti-amyloid drugs isn’t known.

These findings raise questions about clinical trial data on brain volume and ARIA that concern us. Researchers are unsure whether people who developed ARIA had greater volume changes, which brain regions are most affected, the clinical characteristics of those at risk, and whether these changes are related to cognitive and non-cognitive clinical outcomes.

We’ll leave you with this, because we know this for certain.  Individuals who are concerned about their long-term brain health, particularly those with a family history of Alzheimer’s disease, should be aware of the potential risks and benefits of anti-amyloid therapies. While these therapies have shown promise in treating Alzheimer’s disease, they may also have unintended consequences, such as accelerated brain atrophy. It is important to consult with a healthcare professional to determine the best course of treatment for your specific needs and circumstances.