Alzheimer’s treatments in development could launch a new era in dementia care (Guest blog)
For 30 years, the Alzheimer’s Europe Conference has been an annual opportunity to review the state of play and look ahead to advances that might shape the future of dementia care. This year’s event was a little different – not just because, like all major conferences, it was held remotely.
The key difference in 2020 is the sense that we are on the cusp of a shift in how we view Alzheimer’s disease (AD). The reason is the potential arrival of new therapies that might help target earlier stages of Alzheimer’s and preserve people’s independence longer.
At a live session of the Conference, supported by EFPIA, a diverse group of contributors agreed that next year could be a watershed in the history of dementia. Their optimism was tinged with caution: anyone active in Alzheimer’s disease research, care and advocacy can recall moments where hopes were raised only to be dashed.
Nonetheless, there is reason to hope. While there is much work to do to prepare our health systems for this new era, the first AD treatments could get the green light from regulators soon.
‘We are at a turning point,’ as Professor of cognitive neurology Philip Scheltens of VU University Medical Centre put it. The availability of an Alzheimer’s therapy would change attitudes to dementia, showing the world that this is a disease that we can diagnose and treat early. ‘It would get rid of the idea that dementia is just a normal part of ageing.’
This was echoed by Charles Scerri, Professor of Dementia, University of Malta, who called for a paradigm shift in how Alzheimer’s disease is viewed. ‘It doesn’t make sense that AD is not given as much attention as cancer or cardiovascular disease,’ he said. ‘Ageism and stigma remain a barrier to serious discussions on AD. New therapies will help, along with investment in infrastructure and research.’
Despite the positivity brewing in the field of dementia care, Europe still has a lot of work to do to get the most out of new Alzheimer’s disease medicines. For Sarah Garner of the World Health Organisation, significant investment will be needed in health systems, along with detailed conversations among stakeholders on access to innovative medicines.
‘As the number of people with dementia continues to grow, the market for effective treatments is potentially larger,’ she said. ‘We need to come together as a community to talk about the roles of private and public sector on access, financing and innovation.’
Barriers to success
There is a growing realisation that Europe’s health systems are not ready for the kinds of disease-modifying therapies that are in development. If a new medicine can successfully slow the damage done by this progressive disease, early detection, timely diagnosis, and prompt treatment will be essential. Here, the lack of medical imaging and diagnostics are limiting factors – as well as shortage of suitably trained clinicians.
Emerging blood-based biomarkers offer opportunities for screening patients before performing lumbar puncture tests to check for amyloid proteins in cerebrospinal fluid. The availability and reimbursement of blood tests, and the use of lumbar puncture tests, varies across Europe. Sharing best practice, and scaling up capacity where needed, will be essential to catching the early signs of mild cognitive impairment (MCI).
The panel also discussed the need for more clinicians trained in diagnosing early stage dementia. While some countries, notably France or The Netherlands, have rolled out specialist memory clinics as part of a national plan, other countries rely on family doctors to detect early signs of Alzheimer’s disease.
There are further gaps that could limit access to therapies for patients. Infusion capacities to provide treatments in hospitals need to be expanded urgently, while capacity in primary care settings and via home infusion services must also be strengthened.
Time for action
At a policy level, dementia plans are essential. While the WHO has published a seven-point Global Action Plan on the Public Health Response to Dementia, some governments have yet to develop a national plan; some to implement them fully and others need to update theirs. These plans should have resources attached to them and include a focus on health system-readiness for the entry of disease-modifying therapies in the market.
There is more that the EU can do. It should set out an ambitious strategy to beat AD – just as we have seen for cancer. AD and dementia must become a priority in European politics with dedicated funding, building on the work of the Innovative Medicines Initiative (IMI) and the Joint Programme on Neurodegenerative Diseases research (JPND). Responding to stakeholders’ calls for closer collaboration, the European Commission should harness the EU4Health programme to support sharing of best practice and evidence-based guidelines on detection and care.
Inaction is not an option – the demographic trends demand a response. More than 10 million people in Europe are living with Alzheimer’s disease and other forms of dementia. By 2030, 14 million of us will be affected, costing the European economy more than €250bn.
As we prepare for a new dawn in AD care, we should seize this moment to inject momentum into how we manage dementia. Let’s turn our shared optimism into action.
EFPIA member companies have joined forces to launch the EFPIA Alzheimer’s disease Platform. Our call for action is outlined in a detailed position paper “Alzheimer’s Disease Health System Readiness: The Time to Act is Now”.