The diagnosis and medical treatment of Alzheimer's disease, a condition that according to leading researchers in the field should be treated, has now advanced significantly. A series of articles in The Lancet provides both a comprehensive and thorough review of current research.
"This is a clear statement, and a wake-up call for Sweden. We have reached a stage where Alzheimer's disease is no longer something you can do little about. We must now implement the new diagnostic methods and the new medicines, and change the healthcare system," says Henrik Zetterberg, professor of neurochemistry at the University of Gothenburg.
The articles published early Tuesday constitute of "The Lancet Series on Alzheimer's disease" and summarize the current state of Alzheimer's research worldwide. Henrik Zetterberg is co-author of two of the three articles.
Strong international consensus
The series describes the history of research, the major discoveries, controversies along the way, and the current consensus among the majority of scientists in the world that the pathology of the disease, with high levels of amyloid and tau proteins in the brain, is initiating the condition.
Similarly, there is a consensus that people undergoing memory assessments should be offered a finger prick so that their blood can be analyzed for biomarkers of Alzheimer's disease, preferably at an early stage when memory and mental abilities still only reveal mild symptoms.
"The debate is whether the new clinical tests are adequate, and whether the new medicines have a clinically meaningful effect. The answer to these questions is yes, the tests are adequate, and the medicines are useful and should be used, as long as the risk of side effects, such as cardiovascular disease, is properly managed," says Henrik Zetterberg.
More and more tests in Sweden
The EU has approved the medicinal products lecanemab and donanemab, which slow the progression of mild dementia in Alzheimer's disease by removing amyloid plaques in the brain. Since the approval, different countries in the EU have progressed to different degrees. Swedish healthcare is waiting for regulatory approval before the medicines can start being used.
Meanwhile, more and more blood samples for Alzheimer's testing are being taken during basic memory assessments in Swedish primary care, as a complement to cognitive tests and assessments of physical and mental health, including interventions to rule out, for example, stress, depression or brain tumor.
In Henrik Zetterberg's research and laboratory environment at Sahlgrenska University Hospital Mölndal, the influx of Alzheimer's blood tests for analysis has increased in number in recent months alone:
"Every week we run perhaps 40-50 samples, primarily from Sweden and from different parts of the country, and I expect that to increase significantly this fall," he says.
This does not concern screening, Zetterberg emphasizes, but routine care for patients who seek help because they sense that their memory and mental abilities are failing. One of his Lancet articles describes the development within Alzheimer's diagnosis as a revolution.
"It is great that we have it implemented in Sweden; we are at the clinical cutting edge. The fact that we do not yet have the medicines available is annoying and ethically problematic to say the least. The Lancet articles take a stand, stating that we now have something that actually looks good, and we can put the discussion about the benefits behind us," concludes Henrik Zetterberg.
Studies in the series: "New landscape of the diagnosis of Alzheimer's disease", "Treatment for Alzheimer's disease" and "Alzheimer's disease outlook: controversies and future directions", go to the articles.
