Predictive Medicine, Neurobiology and New Pharmacological Strategies in the Transformation of Memory Research
Abstract: The Alzheimer’s disease represents one of the major health and social challenges of contemporary societies. The most recent scientific evidence indicates that the neurodegenerative process associated with the disease may begin many years before the appearance of the first cognitive symptoms. The progressive accumulation of the beta-amyloid protein, together with synaptic dysfunction and neuronal degeneration, constitutes one of the principal biological mechanisms underlying the pathology. This shift in perspective has encouraged the development of new therapeutic strategies aimed not only at treatment but also at early biological prevention. This contribution examines the evolution of scientific knowledge regarding the role of brain biomarkers, the outcomes of anti-amyloid therapies such as lecanemab, and the emerging prospects associated with the use of drugs such as levetiracetam, which may potentially act on the synaptic mechanisms involved in the production of beta-amyloid.From this perspective, Alzheimer’s research is increasingly situated within the field of predictive medicine, in which early diagnosis, biomarkers, and anticipatory pharmacological interventions may significantly modify the natural history of the disease.
Keywords: #Alzheimer #Neuroscience #PredictiveMedicine #BetaAmyloid #Neurodegeneration #Lecanemab #Levetiracetam #BiomedicalResearch #PublicHealth #EthicaSocietas #ScientificJournal #SocialSciences #KatiusciaVella #EthicaSocietas #ScientificJournal #EthicaSocietasJournal #HumanSciences #SocialSciences #ethicasocietasupli
The Biological Dimension of the Disease
For a long time, Alzheimer’s disease was described as the moment when a person begins to progressively lose memory. More recent research, however, reveals a far more complex biological reality. The disease does not appear suddenly with the onset of symptoms but develops gradually over time, often years or even decades before the first clinical manifestations.
Within the brain, a protein known as beta-amyloid progressively accumulates, tending to deposit between neurons and form plaques. At the same time, synapses—the communication points between nerve cells—begin to lose efficiency. This process alters the transmission of neuronal signals and contributes to the progressive degeneration of the neural networks involved in cognitive functions.
By the time the first memory disturbances appear, a significant portion of neurological damage has often already occurred. It is precisely this early phase, invisible from a clinical perspective, that today represents one of the main areas of interest for scientific research.
From Treatment to Biological Prevention
Current therapies show limited clinical benefits because they intervene when the neurodegenerative process is already advanced. In recent years, however, a new interpretative perspective has gradually emerged: Alzheimer’s disease as a long-term biological process, potentially modifiable before the onset of symptoms.
This shift represents a genuine scientific paradigm change. A useful parallel can be drawn with preventive cardiology, where intervention does not wait for the occurrence of a heart attack but instead addresses risk factors such as cholesterol and blood pressure beforehand.
The central question therefore becomes whether it is possible to protect the brain before cognitive decline begins, by intervening in the early biological mechanisms of the disease.
Current Scientific Evidence
Alzheimer’s disease is currently the leading cause of dementia worldwide (World Health Organization, 2023). The pathology is characterized by the accumulation of beta-amyloid and progressive neuronal degeneration.
Among the most studied therapies in recent years is lecanemab, a monoclonal antibody designed to bind to beta-amyloid and facilitate its removal. In the clinical trial published in the New England Journal of Medicine, the drug demonstrated a significant reduction in amyloid plaques and a statistically significant—although clinically moderate—slowing of cognitive decline in patients at the early stages of the disease (van Dyck et al., 2023).
However, the clinical effectiveness of anti-amyloid therapies remains the subject of scientific debate. Some researchers have highlighted that reducing amyloid does not always translate into a substantial improvement in patients’ daily lives (Digma et al., 2023).
Preventing Instead of Removing: The Levetiracetam Perspective
An emerging line of research involves levetiracetam, an antiepileptic drug that has been used in clinical practice for many years. Experimental studies suggest that this molecule may interfere with intracellular mechanisms of synaptic vesicles, reducing the production of beta-amyloid 42, the form considered most neurotoxic.
Within this perspective, the therapeutic paradigm changes radically: rather than removing plaques that have already formed, the aim is to prevent their accumulation.
If these results are confirmed in clinical studies involving humans, this strategy could open the way to extremely early interventions, potentially many years before the appearance of cognitive symptoms.
The Epidemiological Situation in Italy
In Italy, approximately 600,000 people are estimated to be living with dementia, more than half of whom have Alzheimer’s disease (Istituto Superiore di Sanità, 2023). Each year, around 80,000 new cases are recorded.
The high average age of the Italian population makes dementia a particularly relevant issue from both a health and social perspective. The National Dementia Plan has strengthened the territorial care network in recent years; however, significant regional differences persist in access to early diagnosis, biomarkers, and innovative therapies.
The European Dimension of the Challenge
Across Europe, more than seven million people are estimated to be living with dementia, with projections indicating significant growth by 2050 (Alzheimer Europe, 2022). In Northern European countries, access to specialized centers and clinical trials appears more uniform, whereas in Southern European countries—Italy included—the organization of services remains more fragmented.
The challenge of Alzheimer’s disease therefore concerns not only scientific research but also the capacity of healthcare systems to organize diagnosis and care effectively and uniformly.
Limits of the Scientific Evidence
Despite advances in research, it is essential to maintain a rigorous and cautious approach. The preventive effect of levetiracetam has not yet been demonstrated in humans, and the available evidence derives mainly from experimental models. At the same time, the clinical benefits observed with anti-amyloid antibodies remain moderate.
At present, no preventive therapy has been approved for healthy individuals. Nevertheless, the shift in scientific perspective represents a fundamental step forward in neurological research.
An Open Future
For many years, Alzheimer’s disease was regarded as an inevitable consequence of aging. New scientific knowledge now suggests that the brain undergoes biological changes long before symptoms become evident.
Understanding that the disease begins years before clinical manifestations highlights the importance of early diagnosis, the development of reliable biomarkers, and continued investment in pharmacological research.
The central question is no longer only how to treat Alzheimer’s disease, but how early we can intervene to protect the brain. Within this perspective lies a significant part of the future of neurology and preventive medicine.
ESSENTIAL BIBLIOGRAPHY
Alzheimer Europe. (2022). Dementia in Europe Yearbook.
Digma, L. A., Winer, J. R., & Greicius, M. D. (2023). Substantial doubt remains about the efficacy of anti-amyloid antibodies. arXiv preprint.
Istituto Superiore di Sanità. (2023). Epidemiology of dementia in Italy.
Northwestern University. (2026). Preventing amyloid formation via synaptic vesicle mechanisms.
van Dyck, C. H., Swanson, C. J., Aisen, P., Bateman, R. J., Chen, C., Gee, M., … Iwatsubo, T. (2023). Lecanemab in early Alzheimer’s disease. New England Journal of Medicine, 388(1), 9–21. https://doi.org/10.1056/NEJMoa2212948
World Health Organization. (2023). Global status report on the public health response to dementia.
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