More than 55 million people worldwide are living with dementia, the most common form of which is Alzheimer’s disease. This figure is set to rise to 139 million by 2050. So developing new drugs to slow its progress is critical; and the focus of decades of research.
The announcement this week – that a new drug, lecanemab, could give patients living with Alzheimer’s more time – has the potential to change millions of lives. But only if we can radically reduce the time to diagnosis first.
In a landmark trial involving 1,795 patients, published in the New England Journal of Medicine, lecanemab (an antibody) was found to affect the speed of cognitive decline in persons with early stage Alzheimer’s disease whilst reducing the levels of beta amyloid protein build-up in their brains.
The link between Alzheimer’s disease progression and beta amyloid has been the subject of controversy recently, however this trial appears to show a significant relationship between the two. More importantly, whilst the drug does not appear to stop the disease from progressing entirely, it could slow cognitive decline by around a quarter over the course of 18 months. But only if the disease is diagnosed early.
There’s no doubt that this is an incredibly significant and promising development, opening the door for many more such discoveries. But early intervention is crucial in order to slow the disease’s progress, and unfortunately, early identification of Alzheimer’s is rare.
According to research from the Royal College of Psychiatrists, the average time from referral to diagnosis for dementia is 17.7 weeks, with some patients waiting up to two years to be diagnosed. There was also a decrease in early-stage drug prescriptions in 2021, meaning more people are being diagnosed at a later stage and missing out on early access to life-changing palliative care.
There are a number of reasons why diagnosing dementia is slow and difficult. A key problem is a lack of understanding about the disease in society at large; meaning progressive cognitive decline and changes in behaviour are often misassociated with normal ageing, depression or other mental illnesses.
And even once medical intervention is sought, a quick diagnosis is not guaranteed. Factors such as confusion around which healthcare professional to consult, a shortage of specialist healthcare experts and a lack of effective diagnostic tools create additional roadblocks which critically delay the time to diagnosis.
Even when a specialist clinician does see a patient in the early stage of Alzheimer’s, the disease can be misdiagnosed as depression for years due to the lack of accessible and affordable diagnostic tools for both conditions. These are problems we must urgently fix.
Early intervention has always been important for Alzheimer’s. It gives patients and their families more time to come to terms with diagnoses and prepare for the future; and means therapies can be administered sooner to manage patients’ symptoms. But until now, early intervention has not enabled us to change the course of the disease. With this changing, early diagnosis becomes an even bigger priority.
Reassuringly, new technologies are already being developed with the potential to drastically improve how (and how quickly) we can diagnose Alzheimer’s and other forms of dementia. At UCL, scientists have developed a VR game helping doctors assess dementia by analysing spatial awareness. As players move through different environments, the game captures data enabling doctors to assess a patient’s spatial navigation capabilities, and use this information to identify dementia sooner.
I have also been working with clinics and universities, including King’s College London, to build and test video game-inspired tools that can help doctors assess dementia before it would otherwise be detected.
Our platform, thymia, uses AI-powered games to assess millions of biomarkers in people’s voices, facial expressions and movements to identify symptoms of dementia and distinguish it from similarly presenting mental health conditions – such as depression. It’s still early days, but our aim is to help doctors detect dementia sooner and differentiate between Alzheimer’s and other forms of dementia, such as Vascular or Lewy Body Dementia.
These technologies – and others like them – could be transformative in the early diagnosis, and thereby treatment and management of Alzheimer’s. By adding more diagnostic technologies to their existing arsenal, clinicians will have better tools to spot cognitive decline sooner and administer treatment faster than ever before. With the number of people living with dementia only on the rise, the time to make this vision a reality is now.
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Lecanemab could be an amazing treatment, but there are still a number of things that need to happen before it can be rolled out. It’s currently being assessed by regulators in the US, with the approval process planned for other countries from next year.
Once approved, existing treatment pathways must change if the drug is to get to patients: patients must undergo “amyloid tests” to determine whether they’re eligible to take it. Currently, only 1 to 2 per cent of people with dementia have such tests. The high levels of adverse side effects found in this trial must also be reduced to make the drug safer to use.
But while we may not have a perfect solution yet, we are certainly heading the right way and are the closest we’ve ever been to slowing the progress of Alzheimer’s.
That means now is the time for change – at a practical, cultural and institutional level – to make early diagnosis possible and ensure drugs like lecanemab can quickly reach the hands of the patients who need them. It’s up to scientists and healthcare decision-makers to keep their feet firmly on the pedal – and only lift it when the job is done.
Dr Emilia Molimpakis is a neuroscientist and CEO and co-founder at mental health technoloy startup thymia