Toronto Memory Program is heading up promising drug trials for Alzheimer’s disease.
Twenty-five years ago, Dr. Sharon Cohen founded Toronto Memory Program with an ambitious goal: create a medical facility for people with Alzheimer’s disease and other forms of dementia, one where they could get a timely diagnosis, treatment, support services and access to drug trials, all under one roof.
“I really wanted to help people navigate a very challenging disease. Back in 1996, therapy options were fairly limited, and people were struggling to get taken seriously if they had memory complaints,” says Cohen, a Canadian-trained behavioural therapist and an assistant professor in the University of Toronto’s Division of Neurology and Graduate Department of Speech Language Pathology.
Dr. Sharon Cohen
Cohen decided that working independently in the community, rather than within a university or hospital — the usual settings for memory clinic — was the best way forward. “I could develop a team of skilled staff, and we could create policies and procedures we thought worked, and move the field forward again without layers of bureaucracy and funding problems,” she says.
Today, at a sprawling 13,000-square-foot facility in north Toronto, Cohen’s program provides three branches of clinical care: a state-of-the-art, multidisciplinary memory clinic that sees 1,500 new patients annually; Alzheimer’s education for the community, medical students and other stakeholders; and Canada’s largest drug trials program for Alzheimer’s and related conditions.
Toronto Memory Program has contributed to over 100 national and international clinical trials. Currently, it has 30 trials underway, spanning several drug classes, all phases of drug development (1, 2 and 3), and the full spectrum of disease severity, from pre-symptomatic to the latest stages.
Most of the trials focus on two classes of drugs: those targeting amyloid (the protein fragments that form plaques in the brain), and those targeting tau (the protein that forms tangles inside neurons, impairing function). Additional trials study drugs that combat neuro-inflammation, which is believed to play a role in the development of Alzheimer’s disease, and still others focus on symptom treatment or diagnostic methods.
“We’re pleased to offer this full range. We don’t know, in the end, what will be the prevailing success story, and it’s quite possible in a complicated disease like Alzheimer’s that we’ll need combination therapy,” Cohen says.
We know much more about how the disease evolves and who’s at risk, and we have much more to offer through the clinical trials program.
– Dr. Sharon Cohen
Clinical trials don’t require a physician’s referral, and there’s no cost to participate. The program also provides transportation and accommodations for people who live outside the Greater Toronto Area. “We don’t have a restricted catchment area the way most hospital clinics would,” says Cohen. “Sometimes we have people from out of province, and certainly from all over Ontario.”
Study participants receive detailed assessments, including special tests that provide greater clarity regarding their diagnosis, such as biomarker testing and positron emission topography (PET) scans, which detect amyloid plaques.
Participants also have access to the program’s team of experts, as well as cutting-edge clinical interventions.
“The science has advanced substantially over the last decade, and even the last year or two, despite COVID. We know much more about how the disease evolves and who’s at risk, and we have much more to offer through the clinical trials program,” says Cohen.
“It’s an optimistic time in Alzheimer’s disease. We’re much more hopeful than we’ve ever been.”
Get involved! Below are some of Toronto Memory Program’s actively enrolling trials
Studies targeting amyloid
AHEAD – Phase 3: This prevention study is assessing how well lecanumab, an anti-amyloid antibody, slows the progression of normal cognition into mild cognitive impairment or dementia in people at risk. “It’s the first time we see a trial for people with lower levels of amyloid in the brain than we previously thought were necessary to cause Alzheimer’s disease,” notes Cohen.
Trailblazer-ALZ 2 – Phase 3: The compound donanemab, being developed by Eli Lilly, has shown success in removing amyloid, slowing disease progression in people with mild cognitive impairment and mild dementia.
Study targeting tau
Autonomy – Phase 2: This study assesses the ability of an anti-tau antibody, developed by Janssen, to slow disease progression in early-stage Alzheimer’s.
Studies targeting neuro-inflammation or the immune system
Green Memory – Phase 3: This international study assesses how well GV-971, a plant-based extract, reduces brain inflammation by altering the gut microbiome. In 2019, GV-971 was approved in China for treatment of mild-to-moderate Alzheimer’s disease; the Green Memory study aims to replicate the positive results seen there.
INVOKE-2 – Phase 2: This study assesses the ability of a monoclonal antibody, AL002, to activate the brain’s immune cells to slow the progression of Alzheimer’s disease.
RetiSpec: This study assesses the use of retinal scans for early diagnosis of Alzheimer’s disease. It compares how well eye scans detect amyloid in the back of the eye, compared to a PET scan or spinal fluid analysis.
Vielight: This study assesses the ability of Neuro RX Gamma, a headset that emits near-infrared energy, to improve symptoms in moderate-to-severe Alzheimer’s disease.