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Revolutionary Alzheimer’s Treatments Can’t Help Undiagnosed Patients

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Revolutionary Alzheimer's Treatments Can't Help Undiagnosed Patients

“The statistics are terrifying: dementia is the leading cause of death in the UK. It has been the leading cause of death among women since 2011,” says Hilary Evans, CEO of Alzheimer’s research in the UK and co-president of the UK Dementia Mission. “One in two of us will be affected by dementia, whether from caring for someone with the condition or developing it ourselves.”

However, there is reason for optimism: Alzheimer’s researchers have made extraordinary progress in treating the disease. In May 2023, the pharmaceutical company Lilly announced that its new Alzheimer’s drug, donanemab, It delayed cognitive decline by 35 percent.; In 2022, another drug, lecanemab, recorded equally promising results. “For a long time, dementia research has been an expensive and even hopeless cause,” Evans says. “But now we are at this true tipping point for change with the arrival of the first Alzheimer’s drugs that attack the root cause of the disease rather than just the symptoms.” Donanemab and lecanemab act as antibodies and eliminate amyloid plaques that form in the brains of Alzheimer’s patients.

“However, like many first-generation treatments, the benefits are modest and also come with serious side effects,” says Evans. “We need to remember how we pioneered the first generation of treatments for diseases like HIV, which often had limited effectiveness and difficult side effects, but paved the way for combination drugs that have revolutionized outcomes for the next generation of people with the same disease.” . condition.”

Evans has reason for optimism. Currently there more than 140 Clinical trials are underway for a variety of potential treatments for Alzheimer’s, ranging from compounds capable of removing toxic proteins to drugs that can restore the function of damaged brain cells. “I’m in my forties and I truly believe our generation will benefit from the progress we’re seeing now,” Evans says. “Developing safer, more effective drugs is really a question of when, not if.”

Evans, however, is concerned that these new treatments will remain out of reach for patients if they cannot receive a timely and accurate diagnosis. Recent research in the New England Journal of Medicine It also showed that someone can be in the early stages of Alzheimer’s 20 years before the appearance of detectable symptoms. “New treatments will depend on diagnosing people at an earlier stage of the disease,” Evans says. Furthermore, diagnosis of the disease in the population remains woefully inadequate. “It hasn’t changed in over two decades,” Evans says. Paper-and-pencil cognitive testing remains the most common diagnostic method; only 2 percent of patients undergo the gold standard test—lumbar puncture and PET brain scans.

Although the UK government has set a national target for dementia diagnosis in 67 percent of patients, that goal is not achieved in many parts of the country. Patients who get a diagnosis have had to wait an average of two years; for patients under age 65, that wait time increases 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 by introducing accurate digital cognitive testing, for example, which would allow patients to be assessed in real time and access care more quickly. Researchers at Moorfields Eye Hospital are also developing AI algorithms which could potentially detect signs of Alzheimer’s disease in the eye. “The retina is a particularly attractive target because it is closely related to brain tissue and can be examined non-invasively during routine eye checks,” says Evans.

Alzheimer’s UK also supports research to find blood biomarkers of the disease. “Research has shown that a blood test could be as effective as a standard lumbar puncture and brain scan, and could be used as an initial triage tool,” she says. “People are naturally much more interested in having a blood test than something very invasive. “This could revolutionize the way dementia is diagnosed.”

This article appears in the July/August 2024 issue of UK WIRED Magazine.

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