Few people in the United Kingdom with Alzheimer’s disease at an early stage are probably suitable for the latest drugs who want to stop the progress of the condition, but many are likely to be referred for these treatments, says research published online in the Journal of Neurology Neurosurgery & Psychiatry.
The disease -modifying medicines, Lecanemab and Donanemab, slow cognitive decline in people with Alzheimer’s disease at an early stage. And they have received the status of breakthrough therapy in the UK because of their ability to remove beta-amyloid protein in the brain, which is thought to play a key role in the development of the disease.
Alzheimer’s disease in the US already licensed in 2023, the legal approval of these drugs for use in the UK will soon be expected. But to maximize their effectiveness, a series of clinical staff and diagnostic and monitoring tests and scans will be needed to indicate the researchers.
In order to gauge the potential level of health care demand, the researchers with retrospective patients attended 5 community memory services in North and East and a national specialist cognitive disorders between January and June in 2022.
They wanted to know the share of patients that it would probably be referred to for triading the memory services for these new medicines, as well as those of the specialized service that might be suitable for treatment with them.
In total, the anonymized files of 1017 patients were admitted, 517 were seen in community memory services and 500 in specialized clinics.
Just over 40% of the memory service patients were men; Their average age was 79, with only 14% (72) younger than 70 years. After exclusions as a result of incomplete data and factors, such as the severity of the symptoms, vulnerability and other disorders, almost 1 in 3 (163; 31.5%) may have been eligible for treatment with the new medicines.
161 had undergone neuroimaging of this; But liquid biomarker tests were performed in only 2 patients. This corresponds to less than 1% of memory clinic patients who are included in the study, “which makes it an urgent need for service development to make the identification of suitable patients possible,” the researchers emphasize.
Based on these figures, they suggest: “With an average memory clinic Caseload of 815 and 80 nationally accredited memory clinics in England and Noord -Ireland, more than 20,000 people per year may need access to such confirming studies.”
More of the specialized clinic patients were men (53%) and they were usually younger. Their average age was 66, but more than half (58%; 290) were younger than 70 years. Alzheimer’s disease was the most common diagnosis (177; 35.5%), followed by frontotemporal dementia (72; 14.5%).
Most of them (492) had received diagnostic scans: computer tomography or magnetic resonance imaging. And flowing Biomarker tests were performed in nearly two -thirds (62%; 109/177) of people with Alzheimer’s disease.
But after exclusions due to vulnerability and contraindications for treatment, etc., only 40% (70) of patients with Alzheimer’s disease were potentially eligible for treatment with the new medicines, equal to only 14% of all cases discussed on specialist cognitive clinics.
“Systems must be set up to tackle this potential large mismatch between referral and ultimate suitability to prevent overwhelming services,” the researchers emphasize.
They add: “An important problem is that due to the lack of biomarker tests in community memory clinics, the clinical suspicion of [Alzheimer’s disease] is probably incorrect in at least 30% of the cases. “
Accurate diagnosis would reduce the number of patients who ultimately qualify for the new therapies. But that would only be possible with affirming liquid biomarkers or brain scans (PET), which are usually not available for memory services in the UK, they point out.
“Although there are limitations to the accuracy of our estimates, given the current barriers for early clinical presentations and referral, our study offers predicted figures based on cohorts in practice,” they write.
The demand for diagnostic services in people with early cognitive care is only likely to grow as soon as the new medicines have received a permit and have been formally assessed by the National Institute for Health and Care Excellence, “make further demands on overloaded services,” they warn.
“While a significant part of patients attending memory clinics can be referred to for triadaging for [disease modifying drugs for Alzheimer’s disease]Only a minority is probably suitable for these, as shown in patients who are seen in specialized cognitive services. This should be considered when designing paths for delivery [of these drugs]”They conclude.
In a linked editors, Dr. Benjamin Underwood from Fulbourn Hospital, Cambridge, the study limitations. “It is retrospective and there are different ‘strangers’, including how many people would choose to be treated if they are eligible, how much would meet criteria for ‘amyloid positivity’, and whether the arrival of treatment could encourage more people to present,” he writes.
Nevertheless, if these treatments have been approved for use, the work presented here will help plan services. It also offers a memory that only a minority of people will be suitable for receiving these treatments. It is essential that services retain focus on the majority of people who need other forms of treatment and care. “
Dr. Benjamin Underwood, Van Fulbourn Hospital, Cambridge
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Journal Reference:
Dobson, R., et al .. (2024). Being eligible for treatment with antiamyloids: preparation for disease -modifying therapies for Alzheimer’s disease. Journal of Neurology Neurosurgery & Psychiatry. doi.org/10.1136/jnnp-2024-333468.