Dementia or brain damage and injury as a mental health and neurology medical symbol with a thinking human organ made of crumpled paper torn in pieces as a creative concept for alzheimer disease.

Dementia or brain damage and injury as a medical symbol for mental health and neurology with a thinking human organ made of crumpled paper torn into pieces as a creative concept for Alzheimer's disease.

As we enter 2023, the prevalence of dementias such as Alzheimer’s is on the rise. According to Alzheimer’s Association, more than 50 million older adults are living with Alzheimer’s and other dementias. The impact on those affected by the disease is so staggering that more than 4300 clinical trials are underway for new treatments. Several new treatments have entered the market in the past year, and early detection methods are becoming more widely available. Here are three things that will impact Alzheimer’s and related dementia care in the coming year.

Revolutionary drug development

After decades of research and clinical trials, new drugs show promise in slowing and halting the progression of Alzheimer’s and other dementias. Lecanemab is one of the drugs that was submitted for fast-track approval by the FDA. Another drug, Aduhelm, has received FDA approval but does not yet have approval for Medicare reimbursement outside of clinical trials.

Aduhelm and Lecanemab, along with others in the study, are infusion drugs that require a conclusive diagnosis, often relying on expensive imaging or CSF testing. Actual treatment may also require ongoing imaging. These costs, along with the high cost of the drug itself, make these drugs unaffordable for most patients, who instead of insurance coverage for these treatments will have to pay out of pocket.

Regardless of the results of the Lecanemab trial, which to date include two reported patient deaths, we benefit from the research and key lessons that help move the industry forward. It’s too early for dementia research. There are dozens more drugs in various stages of clinical trials, and front-line experts predict this is ripe territory for manufacturing.

New and existing drugs undergo extensive research such as reports in an NIH paper detailing efforts and promising early results. Some of the findings include using existing medications, such as Ritalin, which have shown a reduction in apathy. Providers may also be looking at new oral drugs entering the market that are likely to be much more affordable than recent infusion-based drugs.

Expect to see continued traction in the commercialization of Alzheimer’s drugs. With any new drug, providers will need to conduct a risk/benefit analysis with patients. Considerations will include potential improvement in dementia, side effects, access, cost and efficacy.

New approaches in diagnostics

New non-invasive testing methods are currently entering the market, with more on the horizon. These include a retinal scan, a cervical nerve biopsy for dementia with Lewy bodies, and a peripheral blood test for the most common form of dementia, Alzheimer’s disease. In new study, research confirmed the success of a non-invasive peripheral blood test to detect the presence of Alzheimer’s disease-related proteins in the brain. The test’s success represents a major advance in identifying alternatives to traditional diagnostics, including the aforementioned brain scans and spinal tap-based tests, which are expensive. Another blood test developed by Washington University of Medicine in St. Louis, provided a robust measure for detecting Alzheimer’s-related amyloid plaques, even among young patients not yet experiencing cognitive decline. This test may be useful in identifying individuals at risk of future dementia, allowing them to participate in clinical trials when early intervention has the greatest potential effect.

In the future, we can expect to see an increase in the clinical acceptance of non-invasive blood tests as a means of detecting Alzheimer’s, which will be critical in removing several institutional barriers, including cost, time and access to specialists. Early identification and diagnosis of dementia is a critical step in providing care, allowing more treatment options that increase independence, access to social support and more time to plan for the future with family.

Digitally enabled care is the future of telehealth

“Telehealth” has become an industry norm since the start of the pandemic, and is used as an umbrella term for everything from virtual doctor’s appointments to at-home testing kits. What is most important and impactful about telehealth is the technology’s ability to activate caring in new ways and improving accessibility. Specifically for cognitive health, digital assessment tools have made access to cognitive health monitoring more widely available without removing health care providers from the model of care, a common point of criticism in response to the DIY health economy.

In the coming year, we can expect to see continued development of digitally enabled care as healthcare organizations design workflows that incorporate innovative technologies that expand where and how care can be delivered. Technologies that enable clinicians to provide more personalized care without adding large time burdens or friction to their clinic workflows will truly move the needle. Within cognitive healthcare, Digitally Enabled Care (DEC) makes early screening for dementia and other cognitive impairments more accessible and convenient for patients. This will lead to more tests for those who need them and better characterization of patient populations.

Currently, 60% of people living with dementia have not been formally diagnosed. Patients are typically referred to specialists for diagnostic workup, a process that can delay care for months, often leaving patients frustrated and undertreated. Digital cognitive assessment and clinical decision support tools enable primary care physicians to engage in the diagnostic process efficiently, confidently, and without adding friction to their existing workflows. As a result, expect routine cognitive health assessment to become the new standard of care for cognitive care at the point of care. In 2023, primary care providers will continue to build convenient and supportive workflows, incorporating technology and new tests to diagnose and treat dementia.

By 2050, the cost of dementia in the US alone could rise to $1.1 trillion annually. Now more than ever, it is critical to meet the needs of people and families living with dementia. Fortunately, new diagnostic and treatment discoveries are paving the way for significant progress.

Photo: wildpixel, Getty Images

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