Dementia Debate: How To Diagnose And Treat Alzheimer’s
Dementia Debate: How To Diagnose And Treat Alzheimer’s
July 31, 2024
If it feels like there’s an onslaught of information these days about how to diagnose and treat Alzheimer’s dementia, your feelings are valid. New developments and research are coming fast and furious, as academic researchers and for-profit companies race to find effective ways to diagnose Alzheimer’s as early as possible (when it can best be treated with current modalities) and companies are competing to get their therapeutics to market to meet the growing numbers of Alzheimer’s patients. As you’re likely well aware, Alzheimer’s diagnoses are predicted to rise sharply in the coming years as the aging population grows and people live longer. According to the CDC, “In 2023, an estimated 6.7 million Americans aged 65 years or older had Alzheimer’s disease. This number is projected to nearly triple to 14 million people by 2060.” For researchers, that’s a large number to try to help with new diagnostic and therapeutic options. For pharmaceutical corporations, there is the potential for millions- perhaps billions- of dollars in new revenue. For society and individual families, the potential responsibility for providing care and comfort to all those who may be affected is an enormous task. It’s no wonder that new advances are coming so quickly.
First, let’s review what’s new when it comes to diagnosing Alzheimer’s. We’ve previously noted that PET scans and lumbar punctures for spinal fluid were the best ways to confirm clinical evaluations that suspected a person had Alzheimer’s. Both of these methods, however, are costly, invasive, and not readily available, especially in a primary care setting. But just a few weeks ago we highlighted the potential of blood tests that might be able to confirm the presence of Alzheimer’s biomarkers, leading to the possibility of a much more accessible (and less expensive) way of confirming a diagnosis. Well, that day has come. According to a study just published in JAMA Network and presented at the Annual Alzheimer’s International Conference, an Alzheimer’s blood test with an accuracy rate of 90% in patients exhibiting symptoms has just been demonstrated. Moreover, the accuracy of this blood test is well above clinical diagnoses made by dementia specialists (who are accurate 73% of the time) and primary care doctors who have an accuracy rate of 61%. While this blood test will not replace a clinical evaluation by physicians, it will be an easy-to-deploy method of verifying a diagnosis and setting up patients and families to better prepare for what may come. According to Axios, there are currently 16 other Alzheimer’s blood tests in development, though perhaps none are yet ready for clinical implementation and none currently have FDA approval. Yet, you can see the future coming and it’s expected that new practice guidelines about using Alzheimer’s blood tests in the clinical setting will be published in early 2025. Developers of these new tests suspect blood tests will be able to replace the PET scans and spinal taps currently employed. For more on this newly reported blood test, stick out your arm and click here.
As for available treatments, we have previously highlighted Leqembi and more recently Kisunla as FDA-approved therapeutics available for early-stage treatment to slow down the progression of the disease (neither of these drugs will stop, reverse, or cure Alzheimer’s). It is important to note that, “the European Medicines Agency declined to approve Leqembi last week because the small clinical effects seen with the drug were “not large enough to outweigh the risks” of brain swelling and bleeds being serious enough in some patients to require hospitalization.” While both of these medications have shown some benefit in slowing the disease progression, whether or not that benefit is actually experienced by patients and their families – or whether it’s just a statistical finding- is another question. There’s no doubt that both of these drugs raise the possibility of serious side effects for those taking them, including brain bleeds and brain swelling. While for most people these side effects are modest, there have been patients on these medications who have experienced seizures, stroke, or even death. There are also some signs that these medications may cause brain shrinkage.
Among neurologists and dementia specialists who treat patients with early signs of Alzheimer’s, there continues to be ongoing debate about the use of these medications, and whether the benefits of these drugs outweigh their harms. Another new study presented at the recent Alzheimer’s conference surveyed neurologists about their prescribing recommendations and use of these drugs, among other issues. There was almost a 50-50 split among the neurologists surveyed about their support for these new drugs. The survey further revealed that where you live, and which doctor you see, may determine what therapeutics you are offered. There is even skepticism among many physicians that clearing away amyloid plaques, as these drugs attempt to do, will directly correlate to better outcomes for people with Alzheimer’s. For more on this survey, read here. And so the debates and research continue, as people with Alzheimer’s and their loved ones try as best as possible to remain hopeful for positive results from currently available treatments, and hopeful for exciting research advances they anticipate in the years to come.