“The statistics are terrifying: dementia is the UK’s biggest killer. It has been the leading cause of death in women since 2011,” says Hilary Evans, CEO of the company Alzheimer’s disease research in the UK and co-chairman British Dementia Mission. “One in two people will develop dementia while caring for someone with the condition or developing it themselves.”
There is reason for optimism, however, as Alzheimer’s disease researchers achieve remarkable breakthroughs in treating the disease. In May 2023, drugmaker Lilly announced that its novel Alzheimer’s drug, donanemab, slows cognitive decline by 35 percent; in 2022, another drug – lekanemab – achieved similarly promising results. “For a long time, dementia research has been an expensive, even hopeless, affair,” says Evans. “But now we are at a real turning point of change with the arrival of the first-ever Alzheimer’s drugs that address the root cause of the disease, not just its symptoms.” Donanemab and lekanemab act as antibodies, removing amyloid plaques that form in the brains of Alzheimer’s patients.
“However, as with many first-generation therapies, the benefits are modest and are associated with serious side effects,” Evans says. “We need to look back at how we began developing the first generation of treatments for diseases like HIV, which often had limited effectiveness and difficult side effects, but paved the way for combination medicines that revolutionized treatment outcomes for the next generation of people with HIV. condition: disease.
Evans has reasons to be optimistic. They currently exist over 140 Clinical trials are underway for a variety of potential treatments for Alzheimer’s disease, ranging from compounds that can remove toxic proteins to drugs that can restore the function of damaged brain cells. “I’m in my mid-40s and I really think our generation will benefit from the progress we’re seeing now,” says Evans. “Developing safer and more effective medicines is really a matter of when, not if.”
However, Evans is concerned that these novel treatments will remain out of reach for patients if they do not receive a timely and true diagnosis. The latest research published in the New England Journal of Medicine also showed that Alzheimer’s disease can be in its early stages as early as 20 years before detectable symptoms appear. “New treatments will rely on diagnosing people at an earlier stage of the disease,” says Evans. Moreover, diagnosis of this disease in the population remains woefully inadequate. “It hasn’t changed in over two decades,” Evans says. Paper-based cognitive tests remain the most common diagnostic method; only 2 percent of patients pass the gold standard test— lumbar puncture and PET brain scans.
Even though the UK Government has set a national target for dementia diagnosis of: 67 percent of patients, in many parts of the country this goal is not achieved. Patients who actually received a diagnosis had to wait an average of two years; for patients under 65, the waiting time increases to four years. “One in three people with dementia in England are not diagnosed at all,” says Evans. “It’s not something we would accept for any other health condition.”
This could be changed, for example, by introducing true digital cognitive tests that would enable real-time assessment of patients and faster access to care. Scientists at Moorfields Eye Hospital are doing this too developing AI algorithms that 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 studied noninvasively during routine eye exams,” says Evans.
Alzheimer’s UK also supports research to find biomarkers of the disease in the blood. “Research has shown that a blood test can be as effective as a standard lumbar puncture and brain scan and can be used as an initial triage tool,” he says. “People are naturally much more willing to undergo a blood test than a very invasive test. This could revolutionize the way we diagnose dementia.”
The article was published in the July-August 2024 issue WIRED Magazine UK.