"The Fight Against Alzheimer's Reaches a Moment of Ecstasy. The First Drug Could Arrive in Spain Next Year"

Dr Mercè Boada Rovira has joined the prestigious list of recipients of the Balmis Award this year, granted by the Rotary Club of Alicante, recognising the work of doctors and researchers in the field of health.

The Barcelona-based researcher and neurologist earned the award thanks to her work focused on neurodegenerative diseases, with a special emphasis on Alzheimer's disease. Read more

In 1991, alongside her husband, psychologist Lluís Tárraga, she founded the Alzheimer Centre Educacional (ACE), the first therapeutic-educational centre for people with dementia in Barcelona. This project led to the creation of the Fundació ACE, Institut Català de Neurociències Aplicades, now known as Ace Alzheimer Center Barcelona.

Among other contributions, the institution has implemented artificial intelligence technologies and big data analysis to develop pioneering digital diagnostic tools, improving the quality and accessibility of medical care.

The medical discovery of Alzheimer's disease dates back to 1906, but it wasn't until 90 years later that we began to have the first treatments. These allowed, for the first time, the inhibition of enzymes that destroy neural connections and ultimately cause the disease.

Generically named, these treatments are donepezil, galantamine, rivastigmine, and later, a more complex formulation dedicated to maintaining glutamate in the neuronal membrane, called memantine. The latter appeared in 2003.

Without these relatively recent treatments, the significant advances we are currently achieving would be inconceivable. Two proteins have guided Alzheimer's research over the past 30 years: tau protein and beta-amyloid. Research has focused on how to eliminate or prevent these proteins from accumulating and affecting neural networks.

Most drugs have failed, as while they managed to stop this cycle, they did not improve cognition, so clinically there was no progress. This has changed with the emergence of three drugs: aducanumab, lecanemab, and donanemab, registered and accepted at different rates by the US FDA and the European Union's EMA.

Today, the world has two drugs to treat the possible or one of the causes leading to Alzheimer's-type dementia, known by their commercial names as Kinsulo and Leqembi, the latter already approved in Europe, while the former is pending, so we will soon have them in our country. With these advances, we can say we are at the best moment in the fight against Alzheimer's since the first treatments appeared 30 years ago.

These drugs can be considered a form of passive immunisation, but we also have an active type, represented by vaccines. At this point, we must mention the design of a vaccine against the disease, led by Dr Manuel Sarasa, with whom I have had the opportunity to work from the Fundació ACE.

This vaccine is in phase II of its clinical trial, and we are awaiting the start of a phase III study, which will allow for much broader and longer-term research to verify and replicate the results obtained so far. It could be approved in three years. We have never come this far; we are in a moment of true ecstasy.

As it is already approved in Europe, everything depends on administrative procedures. The pharmaceutical industry must present it to the Spanish Medicines Agency, prices will be negotiated, and with any luck, it could arrive in our country by next summer. This will not be a drug administered from community pharmacies, but only in hospitals.

It should also be noted that this medication does not cure the disease. What it does is reduce the slope of its progression, which implies a slower advance and allows the patient to remain stable for longer.

There is room for this treatment to evolve. Currently, it is administered intravenously every 15 days; however, in the future, it could be applied subcutaneously, making its administration easier. There is even the possibility of administering it intrathecally—directly into the cerebrospinal fluid—which would allow the treatment to be completed in just three doses.

A reference report is the 2024 Lancet Commission, which tells us that to reduce the onset of dementias by 40%, we must start from childhood and adolescence with good nutrition and a commitment to schooling. This will allow the brain to grow healthily and develop the functions it is designed for.

Upon reaching the age of 30, it is also important to avoid exposure to toxic agents, including environmental ones like pollution. This aspect does not depend solely on the individual but requires the implementation of state plans to reduce pollutant emissions. We must also not forget the importance of regular physical exercise and eliminating harmful habits such as smoking, alcoholism, and drug use in general.

Mental disorders, such as depression, schizophrenia, and anxiety, are also risk factors, as is social isolation. We must cultivate our social life, which involves relating to like-minded people, having hobbies, sharing joys and sorrows... In short, we are talking about civic education.

Now we are fortunate that science advances at a speed that was unthinkable when I started working. The amount of data we can analyse and share thanks to artificial intelligence is immense. At the Fundació ACE, we have a biobank with more than 32,000 samples from individuals, representing millions of data whose analysis, a few years ago, would have been extremely costly.

With today's technology, we can input that data into a platform, develop an algorithm that allows us to understand how language changes as the disease progresses, or even make predictions about the disease's development by analysing language. Artificial intelligence will change our world in a span of 4 to 5 years.