MW We may be able to detect Alzheimer's years in advance. What that means for funding and the future.
By Brett Arends
Alzheimer's tests raise a lot of questions
Our ability to diagnose and predict Alzheimer's - and other forms of dementia - is running way ahead of any ability to treat it. And if that doesn't seem like a problem, it soon will be.
Scientists in Sweden have just unveiled a blood test that they say can tell with about 90% accuracy whether someone who has cognitive impairment has early-stage Alzheimer's. That's much more accurate than previous methods. As cognitive impairment can take years to develop into full-blown Alzheimer's, this is a significant step forward. But it's not in isolation. We recently wrote about scientists who believe they can predict who will get Alzheimer's nine years or more in advance, with more than 80% accuracy. And scientists in Germany have been developing another blood test that may be able to predict Alzheimer's as much as 17 years in advance.
Read: Is there a blood test for Alzheimer's? Yes, but it isn't at your doctor's office yet.
The tests mostly rely on finding the protein biomarkers, known as amyloid plaques and tau tangles, that appear in the brain and are associated with Alzheimer's disease.
As for actual treatments? We are years behind. The two main commercial drugs on the market, Biogen $(BIIB)$ and Eisai's (ESAIY) lecanemab, marketed as Leqembi, and Eli Lilly's $(LLY)$ donanemab, marketed as Kisunla, have only recently been approved. Both can slow the disease in its early stages. But there is still debate about how much they help, and about the risks. The European Union's equivalent of the Food and Drug Administration just refused to approve lecanemab, arguing the risks outweigh the benefits.
It is not news that dementia is a crippling and devastating death sentence. The disease is progressive and always fatal. What may be news to many is that the people who finally get diagnosed with dementia may have been secretly incubating the disease in their brains for as much as 20 years before they show any symptoms.
Consider this in concrete terms. Scientists forecast that, by 2040, more than 11 million Americans will be diagnosed with Alzheimer's or another form of dementia. Most or all of them are walking around right now, incubating the illness. They have no idea.
An even grimmer statistic is that nearly 50 million Americans may be living today with some form of preclinical Alzheimer's.
This raises all sorts of questions for which there aren't easy answers.
Should people be tested if we don't have a cure?
There are strong arguments in favor. The earlier we catch the illness, the better the chances of doing something that might help. That includes all the lifestyle changes that are thought to lower your risk of dementia, may help prevent the disease, or even just slow it. (These center around exercise, healthy eating, social involvement and mental exercises.)
Finding out about the disease early also lets you live your best life while you still can - and make the needed preparations.
People who know they are incubating the disease are probably going to be more likely to volunteer for experimental treatments to help us find a cure.
The arguments against are pretty obvious: We don't know how much those things can help, especially once your brain is starting to build up the telltale protein clumps associated with dementia. Meanwhile, anyone given a positive diagnosis has to walk around knowing that their brain is dying. Not everyone wants to know.
This sort of knowledge may also drastically change the political dynamic toward biotech and the pharmaceutical industries.
Typically it's been very easy to demagogue against them as big, greedy Bond villains, who charge seemingly outrageous prices for lifesaving drugs that "we" ought to get for free.
But what happens when tens of millions are living with a death sentence, and their only possible hope can come from a massive flood of capital and human energy into drug discovery?
We saw one possible answer just a few years ago, during the COVID-19 crisis.
For a brief period - it lasted less than a year - drug companies were suddenly being treated as heroes. It was a topsy-turvy moment, when even liberal late-night talk hosts were occasionally defending pharmaceutical companies - from conspiracy theorists on the right, of all things.
During the panic over COVID, the federal government found about $4.5 trillion to spend dealing with the crisis. Covid ended up killing 1.2 million Americans, nearly all of them over 65.
Alzheimer's is currently killing 6 million. Nearly all of those are over 65 too. And the figures are rising dramatically. Total federal spending? This year: $3.8 billion, or 0.08% as much.
Here's a prediction: If tens of millions find out that they are incubating the disease, that's going to change. Big time.
-Brett Arends
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(END) Dow Jones Newswires
July 30, 2024 14:13 ET (18:13 GMT)
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