Dementia is a significant public health issue in the UK. In 2022, it was the leading cause of death in England and Wales, accounting for almost 66,000 (11.4%) deaths[1].

Alzheimer’s disease is the most predominant pathology leading to Dementia. Global pharmaceutical companies have invested billions in the development of medicines that can modify the progress of Alzheimer’s disease and slow cognitive and functional decline. 

As of January 1, 2023, there were 187 trials assessing 141 unique treatments for Alzheimer’s disease2. Phase 3 included 36 agents in 55 trials; Phase 2 had 87 agents in 99 trials and Phase 1 had 31 agents in 33 trials2. Disease-modifying therapies were the most common comprising 79% of drugs in trials. 28% of candidate therapies are repurposed agents[2].

The number of trials has increased from 172 to 187 over the past 12 months[2], which reflects an increasing interest in this therapy area and a greater need for governments to ensure that health systems are ready for emerging treatments.

In a paper published in The Journal of prevention of Alzheimer’s disease entitled “Estimated Investment Need to Increase England’s Capacity to Diagnose Eligibility for an Alzheimer’s Treatment to G7 Average Capacity Levels” the authors concluded that the English health system was the least prepared to adopt Disease modifying therapies among the G7 countries once they become available. Also, within their conclusion they said without substantial investment (£14 billion over 10 years to bring England to G7 average), Alzheimer’s disease patients in England would experience substantial wait times and avoidable disease progression[3].

The first disease modifying therapy could be available in the UK by 2025, this is a truly exciting prospect and although the outcomes for the first few medicines may be modest, they signal a paradigm shift in optimism for people who may be at risk of developing Dementia through Alzheimer’s disease.

The people who will benefit most from these disease modifying treatments will be people early in the course of their disease, for example, people with mild cognitive impairment (MCI) because of Alzheimer’s pathology would be potential candidates for these treatments.

One of the issues this presents for health systems is that the identification of suitable candidates for these new treatments requires a much more sophisticated detection and diagnostic pathway than currently exists.

The people who will be suitable candidates are most likely to present in primary care with mild symptoms that could be attributed to a range of conditions outside of Alzheimer’s disease. The primary care physician will need to skilfully discern which people they need to refer to undergo a series of tests and scans to confirm the presence of pathology that would confirm Alzheimer’s disease. These steps alone require significant investment in education, resource, and tools to benefit those candidates suitable for disease modifying treatments.

In summary, the therapeutic landscape for Alzheimer’s disease is positive and likely to get better given the significant investment in research and development from research bodies, charities, and industry. A key challenge rests with governments and health bodies to ensure the systems are ready to identify and treat people eligible for these breakthrough treatments.

Mednet is working to support the Dementia Industry Group in facilitating discussions with key stakeholders to support the optimisation of the health system for people at risk of developing Dementia.

1. Death registration summary statistics, England and Wales 2022 (Office for National  Statistics) 

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/death s/articles/deathregistrationsummarystatisticsenglandandwales/2022

2.Alzheimer's disease drug development pipeline: 2022. Jeffrey Cummings, Garam Lee, Pouyan Nahed, Mina Esmail Zadeh Nojoo Kambar, Kate Zhong, Jorge Fonseca, Kazem Taghva.  https://doi.org/10.1002/trc2.12295

3. Estimated Investment Need to Increase England’s Capacity to Diagnose Eligibility for an Alzheimer’s Treatment to G7 Average Capacity Levels. J Prev Alz Dis 2024; Published online February 7, 2024, http://dx.doi.org/10.14283/jpad.2024.24