Clinical Conference 2022: Sitting on the cusp of a new era in dementia diagnosis and treatment
“A disease-modifying treatment is within reach. Now is the time to discuss with colleagues how we do things differently. This is a huge opportunity.”
Dr Vanessa Raymont’s remarks during Alzheimer’s Research UK’s Clinical Conference neatly summed up the optimistic tone of this year’s event, which came just two weeks after the historic announcement that a new Alzheimer’s drug, lecanemab, showed small but clear benefits in a rigorous phase III trial.
But while the Conference confirmed the huge strides being made in dementia research, there was an acknowledgment that there remains work to do. Health systems must be readied to accurately diagnose and deliver new treatments when they become available.
Opening the conference, Dr Mani Santhana Krishnan reminded us of the urgency that lies behind this: “People are ageing and ageing quickly. This is an emergency and we need to tackle this”.
But how? Here are our biggest reflections from the day:
Big developments in technology could revolutionise clinical practice – but there are practical barriers to overcome
Developments in biomarkers, brain scanning and machine learning could revolutionise how dementia is currently diagnosed. But while the technology exists, it’s far from straightforward to implement in clinical settings across the NHS.
Noting that fewer than 20% of NHS patients get an MRI scan, Professor Nick Fox acknowledged the “postcode lottery” that blights access across the country. While advances in technology can reduce scan time, and therefore costs, there needs to be a more standardised approach to scanning. This means making sure that clinicians are able to see the scans they request and that the readout is clear enough for them to understand.
Developments in blood-based biomarkers offer hope for ensuring earlier and more accurate dementia diagnoses. But Dr Ross Paterson believes they may be more useful in the medium term as a tool for measuring the rate of cognitive decline, as opposed to being able to make a specific diagnosis of one of the underlying diseases that cause dementia.
While the technology is emerging, improvements to the way dementia is diagnosed will be worth little without good quality data
We need more and better data to support improvements in research and clinical practice. As Dr Krishnan summed up – “if you feed in rubbish, you’re going to get rubbish out!”.
Rapidly evolving techniques, such as machine learning, will be of little value if the data is poor or reinforces factors such as education, culture and personal wealth that Dr Ross Dunne pointed to already contributing to inequalities in diagnosis up and down the country.
We need to see more data from ethnic minorities and people from deprived socio-economic backgrounds too. Without it, how will we ever understand why dementia prevalence is higher in these groups?
“Unrepresentative research is holding back our understanding of dementia,” said Dr Charles Marshall. He added: “Inequalities in society are more than just a political problem, they are a public health problem and a brain health problem. We have a duty to advocate for a more equal society.”
Involvement in research must be a key part of NHS culture
Embedding research in clinical settings will not just improve and support research studies, it will also enhance the quality of dementia care.
Doing so is not easy, but Prof Roy Jones outlined how this can be achieved with a multi-faceted approach.
He described how using the same doctors, nurses and psychiatrists in both clinical and research settings can help foster a strong research culture through continuity and a sense of common purpose.
Alzheimer’s Research UK’s brilliant supporter Carli Pirie, explained why this might be the case – “Being involved in research brings a great sense of empowerment,” she said. “It lets you know you’ve done everything you can. I can look my daughter in the eye and say I helped as much I could.”
When it comes to improving diagnosis, supporting research and preparing for new treatments, the UK is a beacon of innovation
Reflecting on her experience leading the Oxford Brain Health Clinic – one of 14 located across the UK – Prof Clare Mackay outlined how clinicians, researchers and patients had all experienced tangible benefits.
These included reduced appointment times at memory clinics, better quality MRI reports, and more targeted recruitment for research studies and clinical trials – potentially providing access to experimental new treatments that are only available through trials.
So, what’s next?
There is no doubt that the news of lecanemab has infused the dementia landscape with renewed hope, as well as being a wake-up call for dramatic improvements in diagnosis and access to treatments.
However, Dr John Baker rightly made the important point that not everyone will benefit from new medicines like lecanemab.
“It’s likely that lecanemab won’t be the answer that we’re all looking for, for everybody,” he said.
“We’ll have to continue to focus on different pathways to treating people with Alzheimer’s disease in much the same way we do with oncology, for example.”
Coming away from the conference, you couldn’t help but feel positive about the future. Enormous challenges lie ahead, but the development of new technology, and the way services are finding new innovative ways of working, is certainly something to be excited about.
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