World-leading Alzheimer's disease experts, including UCL scientists, are calling for rapid reform in healthcare systems, public policy, and societal attitudes, in order to fully realise the potential of groundbreaking new medications.
In The Lancet Series on Alzheimer's disease, 40 leading Alzheimer's disease experts write about how the approval of new antibody medications for Alzheimer's disease - lecanemab and donanemab - and diagnostic tests in the blood mark the beginning of a new era in Alzheimer's disease diagnosis and treatment.
Professor Nick Fox, director of the UCL Dementia Research Centre in the UCL Queen Square Institute of Neurology, was first author on one of the papers, which offers practical advice to clinicians on how to integrate the much-anticipated new monoclonal antibody drugs into their treatment plans when available.
Professor Fox commented: "We really are entering a new era in Alzheimer's disease treatment, which comes with huge opportunities, huge challenges, and plenty of hope.
"Finally having disease-modifying therapies for Alzheimer's presents an opportunity to improve the pathways of diagnosis, care and support. These medications are not a panacea, and will need to be offered as part of a holistic approach to care, alongside support for behavioural and psychological symptoms. Additionally, these drugs are only useful when given early on in the disease course, so healthcare systems will need to reduce delays to enable people to benefit, and prioritise early and accurate diagnosis.
"This is an exciting time in Alzheimer's research, and the advent of these new drugs - just the first of many more advances to come - may represent the beginning of the end of the nihilism that has all too often been associated with dementia."
Alzheimer's disease accounts for about 70% of all dementia cases and is a leading cause of disability, resulting in high societal and economic costs.
In a novel comparison, the Series highlights that the new monoclonal antibody treatments (such as lecanemab and donanemab) can slow Alzheimer's disease progression to a level comparable to the efficacy of medicines for cancer, rheumatoid arthritis and multiple sclerosis. However, the authors say that differences in age, patient outcomes, and side effects mean such comparisons should be treated cautiously.
Despite the similarity in treatment effectiveness for other diseases, high costs of medication, complex testing requirements, suboptimal care for behavioural symptoms, and under-resourcing risk leaving Alzheimer's patients behind.
Encouragingly, improvements in the prevention of Alzheimer's disease are also on the horizon, with emerging Brain Health Services identifying people at a high risk for developing the disease and providing them with personalised treatment programs. Yet most cases of Alzheimer's disease occur in people with low or normal risk, making population-wide measures which decrease risk - such as healthier urban design and restrictions on alcohol and sugary drinks - essential.
The authors call for coordinated global action so that the rapid pace of science advancement in the field of Alzheimer's disease is matched by reforms at the level of healthcare providers, policy and society.
Lead author of the Series, Professor Giovanni Frisoni, University of Geneva (Switzerland), says: "Blood tests, biological drugs for Alzheimer's disease, and prevention interventions are propelling care into entirely new and exciting territory. However, the old needs of patients will not disappear. On the contrary, more general practitioners and dementia specialists will need to master the less glamorous but steady advances made in the past few decades in the care and treatment of behavioural disorders, the use of sophisticated diagnostic imaging and laboratory tools, and psychosocial care. A concerted societal effort in this direction will enable our current and future patients to benefit fully from the potential of scientific and technological advances."
