There’s no doubt that we have entered an era when important opportunities will exist to delay or diminish the symptoms of dementia. As we’ve been covering in agebuzz, there is now a new drug (Leqembi) available to delay impairment and decline in patients with mild cognitive impairment or the early stages of Alzheimer’s and a possibly even better drug (donanemab) is on the way for gaining FDA approval by the end of this year. These drugs herald a new world of therapeutic interventions for dementia patients that can be administered before extensive brain damage has occurred. The challenge is to ensure that patients are diagnosed early enough- possibly even before symptoms begin- in order to gain full benefit and minimize permanent damage to their brains.

Currently, diagnosis of Alzheimer’s- necessary for access to these new medications- is challenging, as patients usually need to undergo physical exams, possibly genetic testing, cognitive testing, blood work, and imaging before a diagnosis can be made (previously Alzheimer’s could only be diagnosed upon an autopsy post-death). As we’ve previously mentioned, this diagnostic testing is sometimes difficult to access because of a shortage of experts and infrastructure, and limited Medicare reimbursement for PET scans to better diagnose the presence of dementia. Medicare has now, however, reconsidered its limited payment and proposed a new policy of no longer restricting payment for PET scans to diagnose and monitor patients taking new drugs.

However, screening people for potential early symptoms of dementia and then diagnosing and getting them into more sophisticated treatment settings is not an easy process. While Medicare in theory pays for a “cognitive assessment” for each year’s “wellness” visit, the reality appears to be that many older adults are not offered, and do not receive, these regular tests to pick up possible signs of dementia. A recent survey conducted by The University of Michigan’s National Poll on Healthy Aging found that 80% of those polled (between the ages of 65-80) did not receive a cognitive test to pick up Alzheimer’s within the past year and 59% had never had such a test. The overwhelming majority of those polled (80%) understand the benefits of such testing and the majority believe providers should offer them, yet that does not appear to be happening. At the same time, 60% of respondents said they would feel distressed if a cognitive screening test picked up signs of dementia. This is not surprising as fear of dementia, and what it means for the future, is common and sometimes leads patients not to discuss cognitive problems with their providers. In fact, a recent study out of Australia found that dementia was the most feared medical condition among patients 65 and older (among younger patients, cancer was first and dementia was second).

This is, however, an exciting time when it comes to diagnosing patients earlier than was previously possible. At the recent Alzheimer’s Association International Conference in Amsterdam, several new reports and interventions highlighted the quick pace of advances. New guidelines were proposed to use blood biomarkers to diagnose Alzheimer’s, paving the way for easier-to-use blood tests to reach more patients, in more accessible settings. Blood tests are a relatively inexpensive method of determining risk and diagnosis and could become available in primary care settings. In fact, a report from the latest international Alzheimer’s conference described research now being done in Spain to test the accuracy of a single blood prick that patients could administer by themselves in their own homes using blood biomarkers to detect and diagnose Alzheimer’s. It’s expected that such a test may be approved for use in the US by the FDA within 1-2 years. For more on the opportunities and challenges posed by diagnostic blood tests for Alzheimer’s, read here.

The international conference also brought word of a new “Fastball” EEG test which could cut down on the time and invasiveness it currently takes to diagnose Alzheimer’s. This new test measures brain waves while a person is watching images on a screen and will detect subtle changes in the brain when a person develops dementia and Alzheimer’s. In fact, with this test, it’s thought that dementia could be diagnosed up to five years earlier than current tests are able to do, yielding just the kind of opportunity needed to treat with new drugs before significant brain damage appears. So, it seems that it’s buckle-your-seatbelts time when it comes to new innovations in the arena of diagnosing and treating Alzheimer’s disease.