In Focus: World Alzheimer's Day

By Dr Ashton Harper, Head of Medical Affairs

Rising to the challenge

Alzheimer’s disease, and other forms of dementia, are pervasive and it is increasingly rare to find someone whose life has not been touched by dementia in some way. And anyone who has watched a loved one succumb to dementia knows too well the toll it takes.

At Roche, we are deploying our passion for patient-centric science and solutions to find ways to reduce the impact of Alzheimer’s disease on individuals, families and the health and social care systems that support and treat them. 

When it comes to tackling Alzheimer’s disease there are two key messages which, to my mind, cut through the complexity and ambiguity. Firstly, knowledge is power. Secondly, collaboration is key. Together they unlock the combination of prevention, diagnosis, treatment and care which could give those affected more quality time with the people they love. 

As it stands in the UK today, 1 in 3 people will be diagnosed with dementia in their lifetime and, with prevalence predicted to rise, it is expected that 1.4 million people will be living with dementia by 2040. These statistics are a stark reminder of the huge impact dementia is having now and will continue to have in the future and one of the reasons why we need to work in partnership to support patients to live independently for longer.

On top of the emotional cost to families across the UK, the annual cost of dementia in the UK is predicted to more than double to £90 billion by 2040. New research commissioned by the Alzheimer's Society shows that 1 in 6 hospital beds are currently occupied by someone with dementia, with these numbers also expected to increase to 1 in 4 by 2040.  Of course, many of these people need the treatment and care that can only be provided in an acute hospital setting. But there are many for whom earlier diagnosis and more timely treatment and support could help to both improve quality of life and possibly reduce the risk of hospital admission.

Diagnosis is the first step to disease management

An early and accurate diagnosis gives people with Alzheimer’s - and their loved ones - the knowledge to navigate the health system, to make advanced decisions about the right care, and to make lifestyle choices, which in some cases, might slow the onset of symptoms. The additional benefit of this could be to help reduce the long-term costs on our health and social care services. 

Currently, the diagnosis of Alzheimer’s disease is largely based on clinical symptoms, including non-specific cognitive testing, with a significant number of patients diagnosed when their disease has already advanced. Despite the importance of diagnosis, NHS figures show that 1 in 3 people living with dementia in England never receive a formal diagnosis.

Cerebrospinal fluid (CSF) testing (involving the identification of biomarkers found in the fluid surrounding the spinal cord and brain), in combination with clinical assessment, is an important way to facilitate an early, definitive diagnosis of Alzheimer’s. It can be used to help determine disease in people with very mild cognitive impairment (an early pre-dementia phase) and, potentially, even before symptoms arise. 

We already have this key diagnostic tool but only a tiny handful of patients are currently able to access it. National adoption and implementation could be a key pillar of a wider strategy to make early, accurate diagnosis more accessible for patients across the UK and relieve pressure on other, more expensive, diagnostic modalities such as PET CT scanners.

We also need to ensure that the infrastructure is ready for when blood tests for Alzheimer’s disease are given the green light. In January 2024, Roche’s first blood-based biomarker test for Alzheimer’s disease was accepted onto the MHRA's Innovative Diseases Access Pathway (IDAP) pilot programme. Getting this test onto the IDAP pilot programme is an important step to ensuring it can reach patients as soon as possible, provided regulatory approval is quickly followed by rapid adoption across the NHS to ensure equitable access to everyone who could benefit from them. 

As new Alzheimer’s treatments are being approved, reliable, clinically validated diagnostic tests will be critical in ensuring the right patients are identified early at a stage where they can benefit from them.

Without widely available treatment, why does diagnosis matter?

A question we often hear is ‘With no widely available treatments for Alzheimer's, is there any point to being tested and diagnosed?’

It’s no surprise that for most people the answer is yes. 

Earlier this year, we partnered with The Patients Association on a survey of over 1,000 people to understand the public’s attitude to diagnostic testing. Respondents were asked for their thoughts on tests that can predict the probability of developing a condition, such as Alzheimer's, despite effective treatments not yet being available.

Interestingly, nearly three-quarters (72%) of respondents said they would be likely to take such a test if it was made available to them; and if these tests revealed that they were likely to develop Alzheimer’s, nearly 9 in 10 (89%) said they would make lifestyle changes that might delay the onset of symptoms.  

Whilst the availability of treatments will undoubtedly be a significant milestone in the management of Alzheimer’s, these figures highlight the need to look additionally to lifestyle changes, cognitive training, and holistic care models. These are consistently gaining recognition for their potential to both delay the onset of symptoms and help manage and improve the quality of life for individuals with this disease.

Knowledge is power and collaboration is key

In May this year, I attended the Alzheimer's Society Annual Conference and heard the resounding message of hope for the future of Alzheimer's. However, significant work still lies ahead, which is why we need to work together, now, to ensure more patients have access to and benefit from an early diagnosis. 

With greater partnerships and true collaboration between patients, carers, patient advocacy groups, healthcare professionals, researchers, the life sciences industry and our healthcare systems – I’m confident that we can create a more hopeful future for those affected by this devastating disease.