In light of the latest news on donanemab, Richard Oakley, Associate Director of Research and Innovation at Alzheimer's Society, discusses the future of dementia diagnosis.
The full results are out and the science behind them is solid – donanemab is the second drug in just eight months which has been shown to slow down Alzheimer’s disease.
The science shows that, dependent on the memory test used, the drug can slow down Alzheimer’s disease by more than 20% and by as much as 60% if given to people at the earlier stages of the disease.
It also meant participants were able to carry out everyday tasks such as driving and managing finances for longer.
We still need to understand the effects of donanemab and lecanemab (the first drug shown to slow Alzheimer’s disease) when they are taken over a longer period of time.
But, whether or not these drugs are approved in the UK, we need to prepare because disease modifying treatments are coming sooner rather than later and the tragedy is that we are not ready for them.
It is entirely possible that in a few years, following approval from MHRA and NICE, the people who could benefit from potentially life-changing treatments will not receive them.
Early and accurate dementia diagnosis
Clinical trial results for both drugs have shown that the patients most likely to benefit are those in the early stages of the disease.
We need to be able to diagnose people much earlier than we currently do – currently only around 63% of people get a diagnosis and estimates are that most people get a diagnosis at the moderate or severe, rather than mild, stage.
Additionally, we need to know exactly which type of dementia a person has. These treatments are for Alzheimer’s disease only.
The problem is that all too often people are getting a fuzzy diagnosis of ‘dementia’ rather than the specific disease of the brain causing their dementia. A revolution in diagnosis is needed.
Preparing for new dementia treatments
Local healthcare systems need to prepare for the advent of disease modifying treatments now with a focus on diagnosis.
We need to give clinicians better diagnostic tools so they can give an early and accurate diagnosis. Alzheimer’s Society is playing our part in this. We have partnered with Alzheimer’s Research UK and the NIHR to fund research into providing a simple blood test for use within the NHS.
We know blood tests can diagnose Alzheimer’s disease in the lab – now we need to get them tested in a UK clinical setting with the hope of rolling blood tests out within the next 4-5 years.
In addition, we need a high-profile public awareness campaign so that more people come forward for a diagnosis early on.
Clinicians who see members of the public everyday need training so they understand the benefits of a diagnosis for people affected by dementia; feel confident they can recognise the signs and can use diagnostic tools effectively.
There needs to be equitable access to scans for memory assessment services. And we need a bold strategy to improve equity of access to ensure those who are eligible can receive the treatments.
We need a commitment within the Major Conditions Strategy for dementia to be prioritised with a focus on timely and accurate diagnosis, investment in dementia research, an improved pathway for those seeking a diagnosis and better data collection along every stage of this pathway.
Investing in dementia research
The endeavour of dementia researchers since dementia was identified over 100 years ago has been to find a drug which will slow the progression of these devastating diseases.
This is remarkable news and will bring hope to millions of people around the world that a treatment and one day a cure will be available.
Although dementia is expected to affect 1 in 3 people born today, investment in dementia research lags behind other conditions, such as cancer and heart disease.
Now is the time to create the sense of urgency that dementia has lacked. We cannot let people down.