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BWH neurologist Reisa Sperling, MD, is convinced that Alzheimer’s disease is preventable. The director of the Center for Alzheimer’s Research and Treatment at BWH, Sperling has devoted her career to proving this. She hopes to change the approach to Alzheimer’s as we know it through a study called the A4 trial.
“I imagine looking at Alzheimer’s in the same way we look at heart disease,” said Sperling, project director of the trial. “Similar to how we can proactively lower cholesterol over time, can we prevent amyloid plaque buildup—the hallmark of Alzheimer’s—over time and decrease memory loss?”
In the U.S. alone, about five million people suffer from Alzheimer’s. One of the earliest brain changes in the disease is the buildup of amyloid protein, which forms plaque deposits in the brain. Some researchers believe that these plaque deposits begin forming decades before a person experiences symptoms of the disease, such as memory loss, personality changes and disorientation.
The A4 trial, which stands for Anti-Amyloid Treatment in Asymptomatic Alzheimer’s, will test a specific investigational drug—designed to help the brain clear amyloid protein—against a placebo. One unique aspect of the trial is that it is targeting people ages 65 to 85 who are at risk of developing Alzheimer’s but who are not yet experiencing symptoms. Risk will be determined by the buildup of amyloid from brain scans during the screening process.
Sixty sites across the U.S., Canada and Australia, including BWH, are working to screen 10,000 participants in order to find 1,000 participants who meet the criteria for the three-year trial. The $140 million study is a public-private partnership funded by the National Institute on Aging, Eli Lilly and Company, and several philanthropic organizations, and is coordinated by the Alzheimer’s Disease Cooperative Study at the University of California, San Diego.
“We know that brain changes begin more than a decade before people develop memory loss,” said Sperling. “We want to try to lower amyloid burden much earlier to see if it will change the outcome. It’s about targeting the right people at the right time, and the stakes are extremely high.”
Another unique feature of the trial is its focus on participant diversity. African-Americans and Latinos are at a higher risk of developing Alzheimer’s, but the reason for this is unknown. In order to learn more the role of race in Alzheimer’s, A4 is requiring that one out of every five participants comes from an underrepresented minority.
Sperling’s motivation to end Alzheimer’s is personal. She was just starting medical school at Harvard when her grandfather began losing his memory. He passed away of Alzheimer’s during her first year as a neurology resident. Her father was diagnosed with Alzheimer’s last year.
“I was already interested in the disease from a neuroscience perspective but watching the progression of the disease in a family member is really devastating,” said Sperling. “But I think the A4 trial offers a new sense of hope that if we intervene early enough, we can change the course of the disease at a time when we can still save the brain.”
Learn more about the A4 trial at a4study.org.