A Mother's Love and Daughter's Fight: Facing Alzheimer's Together
Sponsored by and provided by Eisai and Biogen.
Despite caregiver role reversal, an Alzheimer's treatment gives a Mississippi family hope.
Missie and her mother, Patricia, have always had a close bond. For Patricia, this was particularly true after enduring several miscarriages before having Missie. Missie and her mother were inseparable. Missie often attended school functions with her mother and father, who were the Dean of Women and Dean of Men at Jones College in Ellisville, MS.
As an adult, Missie followed in her mother's footsteps, starting a family and becoming a teacher when she moved back home to be closer to her parents. She wanted to help care for them as they entered their golden years. Missie juggled it all, even winning faculty accolades, such as humanitarian of the year.
Unfortunately, as time went on, Missie and her mother would both be surprised to find themselves navigating new waters.
On Christmas Day 2022, Missie forgot to bring presents to a family event at her parents' house, a long standing holiday tradition. The forgotten presents followed a series of missteps and changes in Missie's normal routine. Her family was becoming increasingly concerned, and Patricia decided it was time to take her daughter to their local neurologist.
An appointment with Wendell Helveston, M.D., a neurologist in Hattiesburg, MS, led to a series of diagnostic tests, such as blood work and cognitive exams. A week before Missie's 50th birthday, the heartbreaking diagnosis came back: mild cognitive impairment (MCI) due to early-onset Alzheimer's disease (AD).
The first signs that were almost mistaken for normal aging
Patricia had first become concerned when she noticed some slip ups in Missie's daily routine. Her daughter started misplacing everyday items like car keys and forgetting to take out the trash. These small missteps soon progressed, and Missie was forgetting critical tasks, like picking up her husband from work.
At the same time, Missie's students began noticing that she would often repeat herself, forget to collect assignments and administer the same test more than once. This was particularly difficult to confront as Missie was a well-respected teacher.
"I was nowhere near the old Missie," she recounts of the months before her diagnosis following that landmark Christmas Day.
Though Missie had long expected to be a caregiver to her aging parents, her diagnosis would mean these roles were now reversed.
An early AD treatment brings hope
Patricia was, of course, devastated by her daughter's diagnosis. However, her heartbreak was tempered by the fact that the family had acted quickly to get a diagnosis while the disease was still in its early stages. MCI, Missie's diagnosis, is one of the earliest stages of AD. As AD is a progressive disease that gets worse over time, it is important to catch it early. Dr. Helveston informed the family that although they could not stop the disease from getting worse, they could take steps to slow how fast it progresses.
Missie and Patricia learned that AD is caused by a buildup of amyloid protein in the brain that forms into sticky, harmful plaques. As the amyloid plaques collect between neurons, a cascade is triggered, the affected neurons die off, causing disruption in the brain's electrical signals responsible for memory, cognition and daily function. Once someone loses neurons to AD, they cannot get them back. But the speed of that degeneration may be slowed with treatment that reduces existing amyloid plaques and targets different harmful amyloid proteins that can continue to damage brain nerve cells even after plaque is removed.
Missie's diagnosis came at the same time as a significant advance in the decades-long quest for an early AD treatment option. The U.S. Food and Drug Administration had just approved LEQEMBI® (lecanemab-irmb, 100 mg/mL, injection for intravenous use), making it the first traditionally-approved anti-amyloid AD treatment shown to slow disease progression and cognitive and functional decline in adults with early AD. Missie was able to start treatment shortly after her diagnosis.
LEQEMBI can cause serious side effects including amyloid related abnormalities (ARIA), serious allergic reactions and infusion-related reactions. Some people may have small spots of bleeding in or on the surface of the brain, sometimes fatal events with larger areas of bleeding have occurred. Patients who may be eligible for treatment with LEQEMBI should ask their doctor about testing for a genetic risk factor that may cause an increased risk for ARIA. It is important they also tell their doctor about all the medicines they take, including medications to reduce blood clots from forming such as antithrombotic medicines like aspirin. Some medicines can increase the risk for larger areas of bleeding in the brain. Most common side effects included infusion related reactions, swelling in areas of the brain and headaches. These are not all the possible side effects of LEQEMBI. Please see full safety information below.
Until recently, AD could only be treated with therapies that addressed symptoms but not the underlying disease. In addition to working to remove Missie's amyloid plaques, LEQEMBI targets harmful amyloid proteins that can continue to damage brain nerve cells even after that plaque is removed. Because of this progressive nature of the disease, early diagnosis and continued treatment are important.
Embracing a new path forward with purpose
Since starting LEQEMBI, Patricia has seen that Missie's cognitive abilities have largely been maintained. Missie's doctor is continuing to monitor her while she's on LEQEMBI.
As she did during her childhood, Missie is once again her mother's constant companion. They garden, attend church together and volunteer at several community and civil locations. Surrounding herself with people uplifts Missie's spirit and keeps her active.
"Our time here on Earth is precious, and I'm able to stay optimistic because I've found that there is life after an AD diagnosis," says Missie. "Change is inevitable, but I've found a way to learn, grow and to make the best of it."
Patricia urges other families seeing memory loss and cognitive impairment in loved ones to act - not wait - to see a doctor. She knows Missie's story is an example of how someone can develop AD well before they have reached old age.
"Don't sweep it under the rug," she says. "That's the worst decision you can make. Look for signs and voice your concerns early on. You won't be sorry you did. I'm certainly not."
LEQEMBI is indicated to treat people with early AD, which includes MCI or mild dementia stage of disease, and has been shown to slow disease progression by 27% over 18 months compared to placebo, as measured by the global cognitive and functional scale, the Clinical Dementia Rating Sum of Boxes (or CDR-SB). CDR-SB measured progression by asking people how AD impacted different abilities: remembering, staying active, knowing your way around, completing daily tasks, problem-solving and doing activities independently. LEQEMBI was not proven to individually impact each of these abilities.
If you or someone you love may be living with AD, it's important to speak with your doctor. To learn more about LEQEMBI, visit www.LEQEMBI.com.
WHAT IS LEQEMBI?
LEQEMBI is a prescription medicine used to treat people with early Alzheimer's disease, which includes mild cognitive impairment (MCI) or mild dementia stage of disease.
IMPORTANT SAFETY INFORMATION
What is the most important information I should know about LEQEMBI? LEQEMBI can cause serious side effects, including:
ARIA (Amyloid-Related Imaging Abnormalities). ARIA is a side effect that does not usually cause any symptoms, but serious symptoms can occur. ARIA can be fatal.
ARIA commonly shows up as temporary swelling in areas of the brain that usually goes away over time
Small spots of bleeding in or on the surface of the brain can occur
Less often, larger areas of bleeding in the brain can occur
Most people with ARIA don't have any symptoms. However, some people may notice:
headache
confusion that gets worse
dizziness
vision changes
nausea
difficulty walking
seizures
Some people have a gene called ApoE4 that may increase the risk of ARIA. Talk to your healthcare provider about testing to see if you have this gene
You may be at a higher risk of developing bleeding in the brain if you take medicines to reduce blood clots from forming (antithrombotic medicines) while receiving LEQEMBI. Talk to your healthcare provider to see if any of the medicines you're taking increase this risk
Your healthcare provider will check for ARIA with MRI (magnetic resonance imaging) scans before you start LEQEMBI and during treatment
You should carry information that says you are receiving LEQEMBI, which can cause ARIA, and that ARIA symptoms can look like stroke symptoms
Call your healthcare provider or go to the nearest hospital emergency room right away if you have any of the symptoms listed above.
Serious allergic reactions:
Do not receive LEQEMBI if you have serious allergic reactions to LEQEMBI or any of the ingredients in LEQEMBI.
Tell your healthcare provider if you notice any symptoms during or after a LEQEMBI infusion, including:
swelling of the face, lips, mouth, or tongue
itchy bumps on the skin, also known as hives
difficulty breathing
Infusion-related reactions:
Tell your healthcare provider right away if you notice any of these symptoms during a LEQEMBI infusion:
fever
flu-like symptoms (chills, body aches, feeling shaky, joint pain)
nausea and/or vomiting
dizziness or lightheadedness
fast or slow heart rate, or feeling like your chest is pounding
difficulty breathing or shortness of breath
If you have an infusion-related reaction, your healthcare provider may give you medicines before your next infusion to lower the chance of having a reaction
The most common side effects of LEQEMBI include infusion-related reactions, ARIA, and headaches.
These are not all the possible side effects of LEQEMBI. Call your doctor for more information and medical advice about side effects. You may report side effects to the FDA at www.fda.gov/medwatch or call 1-800-FDA-1088.
Before receiving LEQEMBI, tell your healthcare provider about:
All your medical conditions, including if you are pregnant, breastfeeding, or plan to become pregnant or breastfeed. It is not known if LEQEMBI could harm your unborn or breastfeeding baby
All the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Especially tell your healthcare provider if you take medicines to reduce blood clots from forming (antithrombotic medicines, including aspirin)
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