The NHS spending watchdog says a drug which has showed signs of slowing the progression of Alzheimer’s disease should not be rolled out on the UK’s public health service.

According to National Institute for Health and Care Excellence (NICE), clinical trials showed that lecanemab can slow cognitive decline by four to six months, but the watchdog is concerned about the lack of evidence about its long-term effects – and say they can’t justify the cost.

This decision goes against the Medicines and Healthcare products Regulatory Agency’s (MHRA) standpoint which claims that the drug, developed by pharmaceutical company Eisai and sold under the brand name Leqembi, is safe and effective.

Commenting on the announcement, Hilary Evans-Newton, chief executive at Alzheimer’s Research UK, said: “Today’s news is bittersweet for people affected by Alzheimer’s disease.

“It’s a remarkable achievement that science is now delivering licensed treatments that can slow down the devastating effects of Alzheimer’s, rather than just alleviating its symptoms. However, it’s clear our health system isn’t ready to embrace this new wave of Alzheimer’s drugs.”But what is Alzheimer’s and what other treatments are available?

What is Alzheimer’s?

“Alzheimer’s disease is a progressive neurodegenerative disorder that primarily affects memory, thinking, and behaviour,” explains Dr Ahmad Khundakar, senior lecturer in biomedical sciences at Teesside University. “It is the most common cause of dementia, affecting one in 14 people over the age of 65 and one in six people over the age of 80.”

Khundakar’s research primarily involves investigating the molecular and pathological mechanisms underlying neurodegenerative illnesses, such as Alzheimer’s.

“Pathologically, Alzheimer’s disease is characterised by the build-up of abnormal protein deposits in the brain, known as amyloid plaques and tau tangles, that lead to the death of brain cells,” adds Khundakar. “As these proteins spread through different brain regions, they impair function, manifesting in the cognitive and behavioural symptoms characteristic of dementia.”

A common misconception is that Alzheimer’s and dementia are the same thing.

“In reality, dementia is an umbrella term for a range of conditions that affect cognitive function,” clarifies Khundakar. “Alzheimer’s disease is just one of these conditions.”

What are the symptoms?

“Early symptoms often involve mild cognitive impairment, such as difficulty remembering recent conversations or events,” says Khundakar.

However, as the disease progresses, affected individuals begin to struggle with everyday tasks.

“Tasks like managing finances, cooking and self-care become increasingly difficult,” explains Khundakar. “The disease also affects personal relationships, as individuals may experience depression, agitation, or significant personality changes.”

In latter stages, psychological symptoms such as confusion become more pronounced, adds the lecturer.

Who is most at risk?

Age is widely regarded as the most significant risk factor.

“Most cases occur in people aged 65 and older, and the risk nearly doubling every five years after age 65,” says Khundakar.

Your genetics and family history can also play a significant part.

“Genetics can play a role, particularly if there is a family history of Alzheimer’s disease or if it develops early in life,” explains Khundakar. “Cardiovascular health is another important factor, with conditions like diabetes, hypertension, and high cholesterol increasing the risk.”

How is it diagnosed?

Alzheimer’s disease is diagnosed through a combination of clinical assessments, medical history and cognitive tests.

“Neuroimaging techniques like MRI and PET scans can reveal brain changes typical of Alzheimer’s disease, such as shrinkage in specific areas like the hippocampus, which is crucial for memory,” notes the lecturer.

More recently, blood tests and cerebrospinal fluid analysis have shown promise in detecting the disease early by identifying biomarkers associated with Alzheimer’s disease, he adds.

What is this new lecanemab drug?

“Lecanemab is one of the first treatments which targets the underlying pathology of Alzheimer’s disease, specifically the amyloid plaques in the brain,” explains Khundakar. “It is a monoclonal antibody designed to bind to amyloid-beta plaques, helping to clear them from the brain and slow the progression of cognitive decline.”

However, the lecturer recognises its limitations.

“The drug’s efficacy was less evident in women and those with a particular genetic variant known as APOE4,” notes Khundakar.

In addition, it is very expensive to produce.

“The production of monoclonal antibodies is costly, and repeated treatments may be required,” he says. 

What other treatments are available?

Most treatments available on the NHS focus on managing symptoms.

“Medications such as acetylcholinesterase inhibitors and memantine can help alleviate cognitive symptoms,” says Khundakar. “Recent advancements include the development of disease-modifying drugs that target the underlying pathology of Alzheimer’s disease, specifically the amyloid plaques and tau tangles in the brain.”

Where can friends and family get support?

There are lots of great charities and helplines in the UK which offer valuable support and resources about Alzheimer’s.

If your family is looking for some advice about a loved one, contact organisations like Alzheimer’s Society, Alzheimer’s Research UK and Age UK Advice Line.