Jacqueline Kretschmann, 57, has always lived life at a quick pace. “I always do everything pretty quickly,” the Berliner says. Initially, she and her husband, Steffen Schostok, weren’t overly concerned by small memory lapses—forgetting what she’d gone to another room for, or misplacing things around the house. They had no idea a devastating change was underway.
Four years later, the couple sat in a room at the Berlin Charité. The forgetfulness now had a name: Alzheimer’s disease. Kretschmann was receiving an infusion offering a glimmer of hope—a chance to slow the disease’s progression. The drug, donanemab (trade name Kisunla), was administered for the first time on a cold January day. “Let’s see if that helps,” Kretschmann said, just before the infusion began.
Medicine Doesn’t Promise a Cure
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Donanemab became available in Germany in November. “The therapy does not represent a cure, but studies with donanemab have clearly shown a slowing of disease progression,” explained neurologist Jörg Schulz. A gain of four to six months is possible within an 18-month treatment period. Unlike previous Alzheimer’s drugs, this antibody targets the underlying disease processes, not just the symptoms.
Around 50 patients at the Charité are currently being treated with donanemab or lecanemab—the first approved Alzheimer’s drug of its type, available in Germany since September. Maria Buthut, a neurologist at the University Hospital, co-leads the memory consultation for Alzheimer’s patients with Harald Prüß. She has been treating Jacqueline Kretschmann for three years. “People have very high hopes for this therapy,” Buthut said, noting she is also a member of the German Center for Neurodegenerative Diseases.
Who is Eligible for Treatment?
Nearly all of Buthut’s Alzheimer’s patients have expressed interest in the new medications. However, she often tempers expectations. “The demand is much higher than the number of patients to whom we recommend treatment.”
Treatment is limited to those in the very early stages of Alzheimer’s, and who possess a specific risk gene. Donanemab is administered via infusion every four weeks, while lecanemab requires infusions every two weeks.
Familiar Activities Take Longer
Buthut assesses Kretschmann as being in the range of mild dementia. At 57, she remains relatively fit, able to manage 90 to 95 percent of daily tasks independently, according to her 68-year-old husband. However, shopping is becoming increasingly difficult, orientation is a challenge, and everyday activities take longer. Memory gaps are frequent. When writing the date on a letter, she needs her husband’s help: What day? What month? What year?
© dpa/Jens Kalaene
She recently forgot her last vacation on New Year’s Eve, and after considerable thought, could only vaguely recall the year of her wedding. When telling stories, she sometimes pauses, searching for the right words. Her husband patiently allows her time, occasionally teasing her gently when she struggles to remember.
The couple receives support from the Alzheimer Society in Berlin, which offers psychosocial counseling, family support groups, training, and volunteer placement.
Medication Not Without Risks
Kretschmann underwent numerous tests and examinations to confirm her eligibility for donanemab therapy. Both medications carry risks, including brain changes like edema or microbleeds, with donanemab posing a higher risk. Previous analyses also suggest the drug may be less effective in women than in men, according to Peter Berlit, Secretary General of the German Society for Neurology.
“Fearless and Optimistic”
To monitor for changes, Kretschmann will undergo regular MRIs during treatment. Despite her slight frame, she appears remarkably resilient—happy, often laughing, and full of life. “My wife does everything possible. Always fearless and optimistic,” her husband says.
Whether the medication will work remains to be seen, Kretschmann admits. “I have no other choice,” she says in a distinct Berlin dialect, accepting her situation with stoicism. When asked if she fears the future, she responds firmly, “No!” She strives to remain positive. “Whatever comes, comes.”
But moments of vulnerability surface. When discussing her Alzheimer’s diagnosis four years ago, Kretschmann initially responds defiantly: “Oh, we accepted it, that’s easy.”
Her husband interjects: “Well, it was devastating. You cried.” His wife’s eyes immediately fill with tears, and she falls silent, overcome with sadness. Even discussing how many years she might have left brings her close to tears.
The Couple Sticks Together
How is her husband coping with her illness? “Badly,” he replies, admitting to trouble sleeping and worrying about his own potential future health challenges and ability to provide care. “We can manage everything else.”
Kretschmann has no other health conditions, a good education, a strong social network, and is not depressed—all factors that could positively influence the disease’s course, Buthut notes. However, she is relatively young for an Alzheimer’s patient. “The younger you are, the faster the disease progresses.” Buthut describes Kretschmann as optimistic, forward-looking, and determined. Alzheimer’s, however, is an incurable disease leading to increasing dependence on others.
Buthut hopes the medication will slow her patient’s cognitive decline in the coming years. But predicting the outcome is impossible. If no side effects occur, Kretschmann will receive donanemab infusions every four weeks for the next 18 months—”in the hope that we will give her time.”
Both Kretschmann and her husband are retired and enjoy traveling. They visited the Caribbean last year, and she hopes to return to Brazil. She wants the medication to work and slow the progression of her Alzheimer’s. “And to make the best of it, right?” she says. “There’s nothing else.”
