As we enter 2023, prevalence of dementias like Alzheimer’s Disease is on the rise. According to the Alzheimer’s Association, more than 50 million seniors are living with Alzheimer’s and other dementias. The impact on those affected by the disease is so staggering that more than 4300 clinical trials are underway for novel treatments. Several new treatments have entered the market in the last year, and early detection methods are becoming more widely available. Here are three things that will impact Alzheimer’s and related dementia care in the coming year.
Breakthrough drug development
After decades of research and clinical trials, new drugs show the promise of slowing and arresting the progression of Alzheimer’s and other dementias. Lecanemab is one of the drugs that was submitted for fast-track FDA approval. Another drug, Aduhelm, has received FDA approval, yet lacks Medicare reimbursement approval outside clinical trials.
Aduhelm and Lecanemab, along with others in the research pipeline, are infusion drugs which require a conclusive diagnosis, often relying on costly imaging or CSF testing. The actual treatment may require ongoing imaging as well. These costs, along with the high-cost of the medication itself, make these drugs inaccessible for most patients who, in lieu of insurance coverage of these treatments would have to pay out of pocket.
Regardless of Lecanemab’s trial outcome, which to date include two reported patient deaths, we benefit from research and key learnings that help move the industry forward. It is early days for dementia research. There are dozens more drugs in various stages of clinical trials, and frontline experts predict this is ripe territory for production.
New and existing drugs are undergoing extensive research as reported in an NIH paper detailing efforts and promising early results. Some of the findings include leveraging existing drugs, such as Ritalin which has shown a reduction of apathy. Providers can also look towards new oral drugs entering the market, which will likely be far more accessible than the recent infusion-based drugs.
Expect to see continued traction in the commercialization of Alzheimer’s drugs. With each new drug, providers will need to conduct a risk/benefit analysis with patients. Considerations will include potential dementia improvement, side effects, access, price, and efficacy.
Novel approaches to diagnostics
New non-invasive testing methods are currently entering the market with more on the horizon. These include retinal scanning, neck nerve biopsy for Lewy-body dementia as well as peripheral blood testing for the most common form of dementia, Alzheimer’s Disease. In a new study, research confirmed the success of a non-invasive peripheral blood test to detect the presence of Alzehimer’s disease-associated proteins in the brain. The success of the test represents major progress in identifying alternatives to traditional diagnostics including the aforementioned brain scans and spinal-tap based tests which are costly. Another blood test developed by Washington University of Medicine in St. Louis, provided a robust measure for detecting amyloid plaques associated with Alzheimers even among young patients not yet experiencing cognitive decline. This test may be helpful for identifying individuals at risk for future dementia, affording them the opportunity to participate in clinical trials when early intervention has the highest potential impact.
Looking forward, we can expect to see an uptick in clinical adoption of non-invasive blood testing as a means of detecting Alzheimer’s, which will be critical in removing several institutional barriers, including cost, time, and access to specialists. Early identification and diagnosis of dementia is a critical step in providing care, enabling more options for treatments that extend independence, access to social support, and more time to plan for the future with their family.
Digitally enabled care is the future of telehealth
“Telehealth” has become an industry norm since the start of the pandemic and used as a catch-all term for everything from virtual doctor’s appointments to at-home testing kits. What’s most important and impactful about telehealth is the technology’s ability to enable care in new ways and improve accessibility. For cognitive health, specifically, digital assessment tools have made access to cognitive health monitoring more widely available without removing healthcare providers from the care model, a common point of criticism in response to the “DIY health economy”.
In the year ahead, we can expect to see continued developments in digitally enabled care as healthcare organizations design workflows that incorporate innovative technologies that expand where and how care can be delivered. Technologies that enable clinicians to provide more personalized care, without adding large time burdens or friction into their in-clinic workflows will truly move the needle. Within cognitive health care, Digitally Enabled Care (DEC) makes early screening for dementia and other cognitive impairment more accessible and convenient for patients. This will lead to more testing for those who need it, and a better characterization of patient populations.
Currently 60% of individuals living with dementia are not formally diagnosed. Patients are typically referred to specialists for diagnostic workup—a process that can delay care by months, often leaving patients disappointed and undertreated. Digital cognitive assessment and clinical decision support tools enable primary care doctors to participate in the diagnostic process effectively, with confidence, and without adding friction to their existing workflows. As a result, expect to see routine cognitive health assessment becoming the new standard of cognitive care at the point of care. In 2023, primary care providers will continue to build comfortable and supportive workflows, incorporating technology and new testing to diagnose and treat dementia.
By 2050 the cost of dementia in the US alone could rise to $1.1 trillion per year. Now more than ever it is critical to address the needs of individuals and families living with dementia. Fortunately, new diagnostic and treatment discoveries are paving the way for significant advancements.
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