Alzheimer’s disease (AD) is a major unmet medical need that requires innovation to be aligned with public health needs. It represents between 60% and 70% of the dementia cases. It is still diagnosed too late when the symptoms become evident as the disease progresses. 

AD is now portrayed as continuum consisting of 3 stages: an asymptomatic preclinical phase, a mild cognitive impairment (MCI) phase and dementia.  To match this continuum, current research is focussing on the early stages of the disease (MCI stage) when it is believed that a therapeutic intervention would slow or prevent disease progression.  

The European Brain Council (EBC) is leading the ‘RETHINKING Alzheimer’s disease project’, in collaboration with the European Federation of Pharmaceutical Industries and Associations (EFPIA).  The project aims at identifying the roadblocks to early detection and diagnosis of AD and will propose a new clinical pathway building bridges between all stakeholders to improve the current situation. This is what the Symposium speakers discussed with the audience during the 32nd Alzheimer Europe Conference which took place from 17-19 October 2022 in Bucharest (Romania) and online. 

There are different types of dementia that are treated differently and getting a proper diagnosis leads to proper treatment, thus avoiding overmedication and drug misuse. Kevin illustrated this saying that the diagnosis allowed him to reduce the 19 different medications he was taking to 4. 

The disease modifying treatments (DMTs) that are currently developed will target the huge number of people with mild dementia and MCI. A molecular diagnosis will then be relevant in the short term to identify people at risk. Some studies will need to be carried out though to determine if lifestyle interventions and if DMTs will bend the disease curve.  

It will be important to raise awareness among primary care practitioners about the factors that influence brain health, the different types of dementia and understand how the brain functions. 'Checking-up from the neck up' needs to be included in clinical practice. For the other types of dementia that are not recognised, the memory clinics have the facilities for such diagnosis.  

The event was moderated by Lydia Lanman (Roche) on behalf of EFPIA's Alzheimer's Disease Platform (Roche, Eisai, Eli Lilly, Novo Nordisk and Biogen). The discussion with the audience raised the importance of involving the family in the diagnosis. Family's and patient's history must be put in parallel with the tests. Families are well-placed to identify red flags. 

To the question about diagnosis leading to depression, Kevin answered that in his case depression existed before the diagnosis because of not knowing what was happening with him. The diagnosis helped him overcome his depression.  As a matter of fact, not understanding what was happening with him led him to have suicidal thoughts.  

Regarding blood-based biomarkers, it was specified that they will give information about neurodegeneration in the brain. The diagnosis will be made by a specialist. They could be used routinely to see if something goes wrong in the brain. 

The Symposium ended with a lot of optimism: all the progress that has been made cannot be taken for granted and the current research developments look promising. It is crucial to build on the major achievements that are being made in the detection and diagnosis of AD and continue research to end-up with solutions. This calls for finding a new detection and diagnosis pathway building bridges between all stakeholders (patients, health professionals, researchers and policy makers to ensure the healthcare system is read to uptake the new developments). The time is ripe.