New Alzheimer’s Drugs Hold Promise, but Is the System Ready?
New disease-modifying treatments for Alzheimer’s disease will be available in Canada soon, but certain health system challenges need to be addressed first.
Alzheimer’s disease is a progressive neurodegenerative disease with a devastating impact on people living with the condition, their families, and wider society. “Today, there are approximately 300,000 Ontarians living with Alzheimer’s disease or some form of dementia, and that will triple in Ontario within 30 years. In Canada prevalence is expected to slightly less than triple.” says Kyle Fitzgerald, Director of Public Policy and Government Relations at the Alzheimer Society of Ontario. “With this rise and prevalence of the disease, we’re going to see strain in every patient setting — be it primary care, acute care, hospitals, or long-term care.”
A new class of drugs has shown promise in clinical trials as a disease-modifying therapy for patients with early stages of Alzheimer’s disease. Pending regulatory approval, these drugs could help people with Alzheimer’s disease stay independent and functioning for longer, alleviating some of the potential strain on the health care system. But there are some barriers and challenges in getting them to the right patients.
A lack of critical resources
To benefit from the new therapies, patients need to be diagnosed and treated early. One critical barrier to early diagnosis is the lack of awareness of the importance of memory symptoms. “Individuals or their loved ones may not recognize the symptoms or be in denial about them and therefore wouldn’t raise these concerns with their family physician,” says Dr. Andrew Frank, a cognitive neurologist at the Bruyère Memory Program in Ottawa.
Another challenge is that family doctors may lack the time, experience, or resources to assess memory. “Even if they’re able to do initial memory assessments, there aren’t a lot of specialists in this field to do the follow-up memory test needed to make an initial diagnosis of mild cognitive impairment,” says Dr. Frank. As a result, the wait times are often lengthy. “In Ontario right now it can take anywhere from 12 to 18 months to see a dementia specialist,” says Fitzgerald.
Today, there are approximately 300,000 Ontarians living with Alzheimer’s disease or some form of dementia, and that will triple in Ontario within 30 years.
A further barrier is the lack of diagnostic infrastructure to confirm an Alzheimer’s disease diagnosis. “With the arrival of new treatments, we need to be certain that what a patient has is indeed Alzheimer’s disease,” says Fitzgerald. “The only ways to do that right now are through biomarker diagnostics like positron emission tomography (PET) scans or a cerebrospinal fluid (CSF) analysis, and right now we don’t have the capacity to administer either of those at sufficient scale.” On top of that, these tests are not widely available as publicly reimbursed services to most Canadians.
Addressing the challenges head on
Resolving these barriers is a lengthy process with many steps and stakeholders to consider. “Canada needs to examine all these barriers and see what level of government can provide resources and support for each,” says Dr. Frank.
One crucial initiative could be increasing public education about Alzheimer’s disease, the importance of taking memory seriously, and what new treatments are available. “There could also be more physician education programs and additional memory clinics to allow more patients to be assessed earlier,” says Dr. Frank. “There also needs to be more awareness and recognition that Alzheimer’s disease can present at younger ages, so that those patients can get timely diagnoses,” adds Fitzgerald. “Right now, we see resistance in primary care to consider Alzheimer’s disease as a possible cause of patients’ mild cognitive impairment until people are well into their seventies and eighties.”
The need for better access and affordability
Canada its and infrastructure CSF and also biomarker look needs at of to PET covering expand diagnostics scan these systems. by provincial “Right healthcare now, Ontario has an amyloid PET registry pilot project, which allows a small number of individuals access to this test and reimbursement, but more will need to be done to improve access and affordability,” says Dr. Frank. “One thing that has us optimistic is that there’s very promising work on blood tests, which might allow us to replace these two expensive tests with a blood test, and that would be a very helpful development.”
The treatments may require monitoring for effectiveness and side effects through regular MRI scans. “However, again, MRI capacity is limited, so that’s another provincial policy aspect that needs to be looked at,” says Dr. Frank.
The good news is that we have a once-in-a-generation chance to offer people hope while also reducing the economic burden of Alzheimer’s disease at a societal level. But it can’t be done without addressing these system challenges so that patients have access to new treatments.