Alzheimer’s & Brain Awareness Month raises awareness for Alzheimer’s disease (AD) and other brain disorders, reminds the public about the challenges facing more than 6 million Americans currently living with AD and mixed dementias and their caregivers and emphasizes the importance of access to early, accurate diagnoses.
This is an opportunity to support these efforts, advance understanding of the disease and address issues surrounding the need for accurate diagnosis.
Understanding AD
AD is a progressive brain disease and the most common cause of dementia, a general term for memory loss and other cognitive abilities serious enough to interfere with daily life. AD accounts for 60%-80% of dementia cases and is the most common cause of cognitive impairment or dementia in individuals age 65+.
The first symptoms of AD tend to be memory, language and thinking problems.
Indications that AD could be the cause of different behaviors include:
- Memory loss significant enough to disrupt day-to-day activities
- Poor judgment
- Loss of initiative/spontaneity
- Losing track of dates
- Forgetting current location
- Wandering/getting lost
- Misplacing items in strange places
- Difficulty completing daily tasks like bathing.
However, age is only one risk factor, and many people live into their 90s and beyond without ever developing dementia.
Prevention Strategies
Two-thirds of people think dementia is a normal aspect of aging, however, it is important to challenge this belief and share that up to 40% of dementia cases can be prevented.
Many lifestyle changes encourage a healthy mental state as one ages. Activities include:
- Adopting an overall healthy lifestyle by maintaining normal blood pressure and blood sugar, being physically active and maintaining a healthy weight, avoiding drinking and smoking, caring for hearing loss and getting proper sleep.
- Maintaining a healthy diet that supports cognitive function.
- Cultivating strong social connections and maintaining a sense of community.
- Participating in light or moderate exercise.
- Avoiding head trauma.
The EXERT study found that regular exercise can help adults at risk for AD slow cognitive decline. Similarly, the Systematic Multi-Domain Alzheimer’s Risk Reduction Trial (SMARRT) study found that reducing risk factors such as physical inactivity, smoking, depression, mid-life hypertension, mid-life obesity and diabetes, can also reduce the prevalence of AD in the U.S.
Patients should also ensure they receive their Annual Wellness visits and cognitive assessments for physicians to check for any cognitive impairment and address modifiable risk factors.
Although those experiencing these symptoms may feel worried about the future, treatments are becoming increasingly available that may slow the progression of AD.
Need for Accurate Diagnostic Testing, Appropriate Treatment
People experiencing symptoms of AD such as forgetfulness, bad judgment, forgetting the date or where they are, difficulty doing everyday tasks or experiencing mood and personality changes should visit their doctor to discuss appropriate options.
One suggestion physicians might have is getting tested for AD. Important considerations to look for in an AD test include:
- Demonstration of high specificity and sensitivity with both early and late-stage AD and diagnosing AD for people experiencing mixed dementia.
- Easily accessible and administered by general practitioners in the community setting.
- Paid for by Medicare.
- Accuracy in identifying AD, even in people recently diagnosed with dementia.
- Autopsy-validated in prospective clinical trials.
- Assesses multiple crucial factors that directly relate to AD and that regulate memory, as well as the presence of operating synaptic connections among neurons and the level of amyloid plaques and the level of neurofibrillary tangles in the brain.
In a recent survey, a majority of clinicians were dissatisfied with the current diagnostic pathway, citing it’s highly subjective nature. This sentiment is reinforced by recent data from the Alzheimer’s Association noting that more than half of symptomatic patients are misdiagnosed due to the lack of diagnostic tools in primary care where most dementia patients are managed. Testing options such as positron emission tomography (PET) and cerebrospinal fluid (CSF) are limited as they are not globally available, have high costs and are believed to be invasive procedures.
Testing for AD should be cost-effective, easily accessible and convenient for patients. Fortunately, there is an option currently available, even for people recently diagnosed with dementia that does not require burdensome or expensive testing and is autopsy-validated versus the NIH Gold Standard definition of AD. The test can be ordered through the patient’s provider. Once ordered, the provider will take a small skin sample and ship it to a lab. The sample will then be cultured and evaluated. When a conclusion is reached, the healthcare provider will be contacted and will review it at a follow-up appointment. It is 95% accurate in diagnosing AD and informs a clinician’s definitive diagnosis, assessment and treatment plans. In the survey noted above, clinicians indicated that they were four times more likely to prescribe disease modifying drugs with a positive AD diagnosis with this test than without it. This procedure is much faster and more affordable than CSF and PET tests and can be done with dementia patients to receive a quick diagnosis, even in early disease.
New Drugs to Treat AD
Leqembi (lecanemab) has shown to slow AD by 27% and donanemab, a newer drug for which Eli Lilly plans to apply for FDA approval for in summer 2023, has shown to slow the disease by 36%. However, it is important that only patients who truly have AD are prescribed these drugs as they may have significant safety considerations. These anti-amyloid therapies have exorbitant price tags with Leqembi priced at $26,500 per year. It is estimated these therapies will add $10B by 2030 in direct drug costs and $.5B for monitoring with advanced imaging.
With a focus on prevention, deeper understanding and early, accurate diagnoses of AD, providers, payers, patients and their families can have definitive answers about AD and patients can have a better care experience.
Frank Amato
Frank Amato is President and CEO, SYNAPS Dx.
