Professor James Burrell, who joined Macquarie this month as a specialist clinical neurologist and Professor of Cognitive Neurology, says the advent of ‘disease-modifying’ drugs marks an exciting new phase in dementia management.
In Alzheimer’s disease, the most common form of dementia, plaques containing the protein amyloid form around nerve cells (neurones) in the brain and disrupt communication at the synapses where neurones connect with one another.
The drugs donanemab and lecanemab, both of which have been approved in Australia this year for the treatment of mild cognitive impairment and mild dementia, are antibodies that attach to amyloid and activate the brain’s immune system to remove it.
“Each of these therapies has been proven to clear amyloid from the brain and to significantly slow the cognitive decline of patients with early or mild Alzheimer's disease,” says Professor Burrell.
“Lecanemab and donanemab are regarded as the first genuinely disease-modifying treatments for Alzheimer’s treatments because we have clear clinical evidence that they can slow progression of early-stage disease.”
However, providing these potentially valuable treatments in a public hospital setting is difficult for several reasons, says Professor Burrell.
Firstly, to be eligible for either drug, patients must have evidence of amyloid plaques in the brain, as shown by a specialised PET brain scan using a tracer that binds to the unwanted protein.
Both drugs must be given by intravenous infusion, either fortnightly (in the case of lecanamab) or monthly (donanemab), and patients need to be monitored carefully via regular MRI scans to check for any untoward effects on the brain.
Professor James Burrell
The University-owned clinical and research setting at Macquarie is ideal for the kind of co-ordinated care needed to administer and monitor these new treatments, Professor Burrell says.
“Macquarie has very deep expertise in neurology and neurodegeneration, together with state-of-the-art facilities, including our on-site brain imaging.
“This is going to be critical for selecting patients, starting treatment and monitoring safety, so we're very well-placed – we've got everything we need in the one place.”
Before coming to Macquarie, Professor Burrell was Head of the Neurology Department at Concord Hospital in Sydney where, in addition to establishing a specialised Young Onset Dementia clinic, he treated patients with a wide range of neurological conditions.
He is looking forward to opportunities to leverage Macquarie’s leading treatment and research expertise and experience in neurodegenerative diseases, including dementias, motor neurone disease and Parkinson’s disease.
“I’m keen to see what we can learn from each other in terms of what these diseases have in common and what we may be able to do to further our understandings and develop diagnostic and prognostic tools and treatments across the spectrum.”