Almost seven million Europeans are living with Alzheimer’s, and every memory is precious to them. Unfortunately, Alzheimer’s has all but faded into obscurity as a public health priority.
Still, there is reason for hope: in May, G7 leaders pledged to boost action and resources to care for people with dementia and welcomed the development of potential disease-modifying therapies (DMTs).
A communiqué from health ministers reaffirmed the commitment to improve early detection, diagnosis and intervention through the development of standardized and efficient care pathways and capacity building among healthcare providers.
As encouraging as these signs are, the structural issues preventing these improvements are deeply rooted in our healthcare systems, which must evolve in preparation for an aging population.
The Burden and Challenge of Alzheimer’s
Across Europe, it is estimated that more than one in five people over the age of 50 suffer from some form of Alzheimer’s. Worryingly, many are not diagnosed until it’s too late — according to one study, it takes about two years to diagnose.
Additionally, caring for them is expensive – an estimated €392 billion in Europe in 2019, largely due to the burden of informal, unpaid care and lost economic productivity.
Research shows that in England alone the number of people leaving the labor force due to dementia will rise to almost 53,000 by 2040 and the value of lost skills and experience is likely to exceed €2.3 billion.
The economic burden of Alzheimer’s is clear, but the solutions to alleviate it are not, as it is difficult to diagnose people early and accurately enough. Simple clinical assessments often lead to inaccurate diagnoses because doctors are unfamiliar with the signs of Alzheimer’s disease that transcend normal aging.
The problem is exacerbated by capacity constraints and reimbursement issues, leaving clinicians dependent on instruments that measure cognitive and functional decline only after the disease has progressed.
The benefits of timely and accurate diagnosis
While there is currently no treatment for Alzheimer’s, there is an opportunity to delay the disease’s onset with disease-modifying therapies (DMTs). But only through timely and accurate diagnosis can we identify the patients who may benefit most from DMTs.
Recent diagnostic advances, such as amyloid PET scans and CSF testing, allow clinicians to detect Alzheimer’s earlier and more accurately.
In addition, biomarker tests can be helpful in diagnosing people with Alzheimer’s symptoms, as they help doctors rule out false negative diagnoses and track disease progression.
Such advances can improve patients’ quality of life, give them a better chance of benefiting from treatments when they are most effective (earlier in the disease course), and enable long-term cost savings for healthcare systems by avoiding wasted time and potential misdiagnosis . The industry is open to dialogue with healthcare decision-makers to address current challenges and find solutions that are both life-saving and cost-saving.
“We cannot allow patients to wait until their symptoms have progressed too far before taking action. Then the situation is hopeless, because Alzheimer’s disease is often too far advanced for new treatments such as DMTs to have any real effect,” says Susan Mitchell, Head of Prevention, Screening and Diagnosis at Alzheimer’s Research UK.
Act before it’s too late
Advances in diagnostics and treatment will not be effective if they are not available to physicians in good time. Currently, clinical practice guidelines and healthcare pathways are not designed to take advantage of these advances, leading to delays in diagnosis, putting patients at risk and increasing healthcare system costs.
Healthcare systems need to adapt to prioritize timely diagnosis and allow full use of approved treatments. We can achieve this by:
- Invest appropriately to fill gaps in care pathways and improve patient outcomes, with a particular focus on recruiting more specialist physicians and providing clinicians with more diagnostic resources.
- Equip clinicians with access to advanced diagnostic tools and guidance on how and when to use them to enable timely and more accurate diagnosis.
We must take action now that meets the needs of aging populations, patients and their carers – not through lengthy legislative proposals that will take years to implement.
In this way, payers and policy makers can be reminded that they can stop the devastating socioeconomic impact of Alzheimer’s disease on our society. As Timo Grimmer, head of the Center for Cognitive Disorders at the Technical University of Munich, points out: “We have to act before it’s too late.”
Credentials:
- European Brain Council (EBC) Rethinking Alzheimer’s Disease Detection and Diagnosis White Paper Last accessed June 2023
- The White House: G7 Hiroshima Leaders’ Communiqué Statement Published May 2023
- The G7 2023 Hiroshima Summit: G7 Nagasaki Health Ministers’ Communiqué Report Published May 2023
- Gustavsson, A, Norton, N, Fast, T, et al. Global estimates on the number of persons across the Alzheimer’s disease continuum. Alzheimer’s dementia. 2023; 19:658-670.
- Alzheimer’s Europe: European Carers’ Report 2018
- The Lancet Regional Health – Europe 2022;20: 100472 Published online 25 July 2022
- Tahami Monfared AA, Byrnes MJ, White LA et al. The Humanistic and Economic Burden of Alzheimer’s Disease. Neurol Ther 11, 525-551 (2022).
- Alzheimer’s Society: The Economic Cost of Dementia to English Businesses Published September 2019
- Porsteinsson AP, Isaacson RS, Knox S et al. Diagnosis of Early Alzheimer’s Disease: Clinical Practice in 2021. J Prev Alzheimers Dis 8, 371-386 (2021).
- EFPIA: Alzheimer’s Disease Health System Readiness – The Time to Act is Now Published September 2020
- Lee, SAW, Sposato, LA, Hachinski, V et al. Cost-effectiveness of cerebrospinal biomarkers for the diagnosis of Alzheimer’s disease. Alz Res Therapy 9, 18 (2017).
- Horgan D, Nobili F, Teunissen C, Grimmer T, Mitrecic D, Ris L, Pirtosek Z, Bernini C, Federico A, Blackburn D, Logroscino, G., & Scarmeas, N. (2020). Biomarker Testing: Piercing the Fog of Alzheimer’s and Related Dementia. Biomedicine hub, 5(3), 19-40.
- Bradford A, Kunik ME, Schulz P, Williams SP, & Singh H (2009). Missed and delayed diagnosis of dementia in primary care: prevalence and contributing factors. Alzheimer’s disease and associated disorders, 23(4), 306-314.