Revolutionary Alzheimer’s treatments may not help patients who haven’t been diagnosed

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“The statistics are terrifying: dementia is the biggest killer in the U.K. It has been the leading cause of death for women since 2011,” says Hilary Evans, CEO of Alzheimer’s Research U.K. and co-chair of the U.K. Dementia Mission. “One in two of us will be affected by dementia, either through caring for someone with the disease or developing it ourselves.”

However, there are reasons for optimism, with Alzheimer’s researchers achieving extraordinary success in treating the disease. In May 2023, drugmaker Lilly announced that its new Alzheimer’s drug, donanemab, slowed cognitive decline by 35 percent; in 2022, another drug, lecanemab, reported similarly promising results. “For a long time, dementia research has been an expensive, even frustrating cause,” says Evans. “But now we’re at this real turning point for change, as the first Alzheimer’s drugs have arrived that tackle the root cause of the disease, rather than just the symptoms.” Donanemab and lecanemab act as antibodies that clear the amyloid plaques that form in the brains of Alzheimer’s patients.

“However, like many first-generation treatments, the benefits are modest and there are serious side effects,” says Evans. “We need to look back at how we introduced first-generation treatments for diseases such as HIV, which often had limited efficacy and difficult side effects, but paved the way for combination drugs that have revolutionised outcomes for the next generation of people suffering from this condition.”

Evans has reasons to be optimistic. Currently, more than 140 clinical trials are underway for potential Alzheimer’s treatments, ranging from compounds capable of removing toxic proteins to drugs that restore the function of damaged brain cells. “I’m in my mid-forties and I really think our generation will benefit from the progress we’re seeing now,” Evans says. “Developing safer and more effective medications is really a matter of when, not if.”

However, Evans worries that these new treatments will remain out of reach if patients cannot receive a timely and accurate diagnosis. Recent research in the New England Journal of Medicine also showed that a person can be in the early stages of Alzheimer’s up to 20 years before they start showing detectable symptoms. “New treatments will depend on diagnosing people at an early stage of the disease,” Evans says. In addition, diagnosis of the disease in the population is still inadequate. “This has not changed in more than two decades,” Evans says. Pen-and-paper cognitive testing remains the most common diagnostic method; only 2 percent of patients undergo the gold standard tests—lumbar puncture and PET brain scan.

Even though the U.K. government has set a national dementia diagnosis target of 67 percent of patients, this target is missed in many parts of the country. Patients who do receive a diagnosis have to wait an average of two years; for patients under age 65, the wait time goes up to four years. “One in three people with dementia in England never receive a diagnosis,” says Evans. “This is not something we would accept in any other health condition.”

This could be changed, for example, by introducing accurate digital cognitive tests, allowing patients to be assessed in real time and receive care faster. Researchers at Moorfields Eye Hospital are also developing AI algorithms that could potentially check for signs of Alzheimer’s disease in the eye. “The retina is a particularly attractive target because it is closely related to brain tissue and could be checked non-invasively during a routine eye check,” says Evans.

Alzheimer’s UK is also supporting research to find blood biomarkers for the disease. “Research has shown that blood tests can be as effective as a standard lumbar puncture and brain scan, and could be used as an initial triaging tool,” she says. “People are naturally very aggressively keen to have blood tests. This could revolutionise the way dementia is diagnosed.”

This article is published in the July/August 2024 issue Wired UK Magazine.

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