Reports that new Alzheimer’s drug slows disease by a third. Early reflections and contemplations from Dr Chris Russell.
In the last few days an announcement has been made about the potential to treat Alzheimer’s disease, which hails possible (very) positive consequences. This is about donanemab, the name given to a pharmacological response (i.e. medication) to that illness. Those responsible for its development report treatment using donanemab can slow the rate at which symptoms might be expected to progress by up to a third. Unsurprisingly this has generated excitement, underpinned by the fact that donanemab works by tackling the apparent underlying causes of Alzheimer’s disease (aiming at the removal of amyloid, the plaques that damage the brain), and because this is the second drug targeting amyloid where such progress has been announced (the other being lecanemab).
This is good news. Many of the people I know who are personally affected by dementia have reflected to me at one time or another that finding a cure for their dementia is a prized priority. This medication is not a cure as such, but it looks like things are moving in the right direction. There is momentum building. It appears we have reached a seminal moment in the history of dementia and responses to it. Now is an opportunity to look ahead and consider what might come next and what this could mean.
Firstly, trials of donanemab and lecanemab continue. The recent reports indicated side effects associated with donanemab (some of them serious). Mode of delivery of the medication is via regular infusion rather than any oral method. So, more needs to be known about the pharmacology of these interventions and their application.
More significant though is the fact that both donanemab and lecanemab focus upon Alzheimer’s disease. Nothing about them targets the underlying causes of other dementias. So, this medication will not offer the same hope to people living with vascular dementia or dementia with Lewy bodies, for example. This matters for many reasons, not least because people living with other forms of dementia must not be forgotten or have their future circumstances neglected.
In conversation with my colleague Emeritus Professor Dawn Brooker yesterday, Dawn reflected that there was a decline in care research funding and a general decrease in interest after Aricept (donepezil) was released in the late 1990s. It could be that we see a similar downturn after these new drugs get licenced. Many people live with dementia and will continue to do so. Emphasis upon understanding what works well in enabling people to live lives of quality must not be discounted at this moment.
For people living with Alzheimer’s disease, early diagnosis will be more important than ever. Successful outcomes with donanemab are possible when damage to the brain is not advanced. Treatment will have to begin at a very early stage. At present diagnosis rates are poor. These must improve. Services will have to be better supported to achieve this. Stigma can hold people back from seeking diagnosis too. Means will have to be taken to address this.
As more people are diagnosed earlier with dementia, they are likely to be younger and physically fitter than in recent times. An outcome may be that advocacy and campaigning by people living with dementia will be boosted. This has happened in the past, as people in better health are diagnosed. A consequence has been increasing challenge by advocates with lived experience of dementia to the status quo and what is acceptable, in terms of acknowledgement of individual rights and how support and care is offered. This is positive. If more of this transpires as a result of advances in pharmacology it will be wonderful.
At the Association for Dementia Studies, we are already considering what the impact will be once these drugs become widely available. For example, thinking about how pharmacological developments will work hand in hand with good psychosocial support to adjust to the changes that diagnosis brings. Several areas of our work spring to mind, not least the Meeting Centres programme – which has adjustment to change at its heart. Enabling environments is another context where we can contribute to building knowledge and best practice. Leisure too, as greater numbers of people are diagnosed at an earlier stage they are, quite rightly, going to want to continue to pursue and develop hobbies and interests. Additionally, the courses we offer, including the Postgraduate Certificate in Person-Centred Dementia Studies, will similarly incorporate new developments, and strengthen the synergy between advances in pharmacological practice alongside psychosocial support in learning and teaching. Work on stigma and how we support professionals to talk with people about dementia will be crucial, for example. Everyone we teach needs to be happy talking to people about their dementia and its implications.
So, at this most important of moments, there is much to look forward to and much to do to ensure the best outcomes are achieved for all.