Steve Smith’s children were home for the holidays in 2023 when his daughter noticed that something seemed a little off. “She said, ‘Dad, you’re kind of missing some things. It’s like you’re having trouble finishing your thoughts,’” recalled Smith, who retired in 2016 after a long career in leadership, first as brigadier general in the U.S. Army and then as director of human resources for Duke University Hospital and Duke University Health System.
His primary care doctor ran some cognitive assessments and referred Smith to a specialist. Further tests produced a result no one ever wants to hear: Alzheimer’s disease.
For Smith, the diagnosis was doubly devastating. His wife, Luci, has pulmonary fibrosis, and Smith is her primary caretaker; he likes to tell people his career path has led from Army officer to HR director to Candy Striper.
“Next thing I know, I was told I had Alzheimer’s, and I was in an absolute panic,” he said. “All I could think was, ‘How am I going to take care of my wife?’”
Smith happened to have a regular breakfast meeting scheduled with William Fulkerson, MD, former executive vice president of Duke University Health System. Fulkerson took one look at him and asked whether he was OK.
“I said, ‘No, I’m panicky,’ and told him what was happening,” Smith recalled. “He said, ‘OK, don’t panic. There is hope here,’” Smith recalled. “And then he told me about this new medication.”
A Breakthrough
Lecanemab, the first drug targeting the underlying processes of Alzheimer’s disease that has shown a clinical benefit, was approved by the U.S. Food and Drug Administration in early 2023 for the treatment of early Alzheimer’s. Delivered by regular infusions every two weeks, the drug reduces beta-amyloid plaques that form in the brain, one of the defining features of the disease.
In clinical trials, lecanemab substantially reduced beta-amyloid and slowed the progression of cognitive symptoms by some 27% over 18 months.
“That’s significant,” said Kim G. Johnson, MD, assistant professor of psychiatry and behavioral sciences and division chief of Memory Disorders in the Department of Neurology. “It’s an exciting treatment, because this is the first drug to receive traditional FDA approval for Alzheimer’s in about 20 years. It’s not a cure, but trials indicate that it affects the disease.”
After extensive internal discussions, Duke became the first institution in North Carolina to offer lecanemab in the spring of 2023.
This article was published in Magnify, the Duke University School of Medicine's online magazine.