Why are there no good drugs to treat Alzheimer’s? More than 20 years after scientists discovered that mutations in three genes can cause the devastating disease, and that the apoE gene increases people’s risk for it, there are only four FDA-approved drugs to treat Alzheimer’s. And they do little but slow symptoms (if that).

Over the last decade, more than 99 percent of the new compounds tested against Alzheimer’s have failed in clinical trials, costing their developers billions of dollars and crushing the hopes of the 5.5 million (and counting) Americans with the disease.

Readers joined STAT reporters Sharon Begley and Damian Garde on Monday as they moderated a chat with Alzheimer’s expert Dr. Reisa Sperling of Brigham and Women’s Hospital. We aimed to cover a lot of ground: What drugs are in the pipeline, the therapeutic approaches, and which diet and lifestyle habits might prove protective. Sperling, who has relationships with several biopharma companies, also talked about her “A4 Study,” which is testing a new therapy in patients who are at high risk for Alzheimer’s, but as yet have no symptoms.

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Here’s a transcript of the conversation.

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  • Could you discuss the difficulties in recruiting people to participate in clinical trials, how the lack of volunteers impacts your research, and how you screen volunteers to develop a cohort of currently normal, but likely to develop AD?

  • The brain responds to insult with protein accumulation (PD, AD, ALS) –different ratios. We should be looking beyond the response to the triggering pathway.

  • Hello Dr. Sperling, Sharon and Damion. Thanks for taking your time with us. The microglia approach sounds very interesting. What do you think of the MIT research with the light frequency getting microglia to clean up amyloid beta?

  • It is my understanding that some of the drug pipeline failures have been due to not finding the right patients. Please comment on the role of diagnostics in identifying patients that may benefit most from treatment.

  • Are you excited by any non-amyloid targeting therapies? You have said in the past that it will probably be a combination of therapies that ultimately tamed Alzheimer’s, do you still think that is the case?

  • Where do volunteers go looking to participate in a trial looking to prevent memory loss associated with Alzheimer’s Disease?

  • The complexity of AD shares metabolic derangement pathways with chronic disease–a monotherapeutic solution seems very “small molecule” when AD does not fit that model. What does the latest data show outside of plaques and tangles?

  • I have knowledge (and rights to) an “off the western radar” treatment for Alzheimer’s with Russian roots in SECRET clinical trials in Kazakhstan. Scientist is Dr. Igor Pomytkin. Details are in my “Bannana books”, available on Amazon.

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