Early Alzheimer’s opportunity demands system readiness

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Barriers to the detection and diagnosis of early Alzheimer’s disease need to be addressed if Australia is to realise the potential of medicines that work to counter cognitive decline. 

While there is no silver bullet for Alzheimer’s disease, medical research is for the first time showing real promise. Medication that targets amyloid plaque in the brain is starting to be used overseas to slow disease progression in people with early Alzheimer’s disease (mild cognitive impairment and confirmed presence of the amyloid protein in the brain).

Australia will also have the opportunity to tackle this devastating disease and realise the potential of medical innovations. The problem is that our healthcare system is not equipped for this brave new world, despite Alzheimer’s disease affecting up to one in 10 Australians aged over 65 years.

As a company that has worked to pioneer therapeutic and diagnostic innovation in Alzheimer’s disease for the past 30 years, Eli Lilly is acutely aware of the effort required to prepare Australia’s health system for “the early Alzheimer’s opportunity”. 

We have complicated clinical pathways, non-standardised diagnostic mechanisms, and inadequate resourcing that significantly curtail early intervention. This is important, because diagnosing and treating Alzheimer’s disease at the earliest opportunity is key to preventing or delaying cognitive decline.

Yet, access to advanced diagnostic tools remains limited in Australia. Experts point to research that shows that globally up to three-quarters of all cases of dementia may remain undiagnosed.

Our conversations with Alzheimer’s disease experts make it clear that Australian doctors need access to brain imaging scans that can detect Alzheimer’s-related biomarkers and confirm diagnosis. 

At the same time, Australia needs to ensure there is equitable access to the diagnostic imaging and disease modifying treatments that will underpin care models of the future.

Beyond improved detection and diagnosis, it is critical to address barriers to care at a national level, with the need to upskill and upsize our health workforce to cater for an anticipated increase in patient demand.

In preparation for a new treatment era for early Alzheimer’s disease, there is a call for government, industry and health and aged care bodies to work together to:

Improve community understanding of Alzheimer’s disease and its early symptoms

A lack of awareness and understanding of dementia often lead to stigmatisation and barriers to diagnosis and care.

Alzheimer’s disease advocates have shared countless stories of individuals and families that lacked the information and confidence to seek medical support when symptoms first presented.

Like other stakeholders, Eli Lilly would welcome a national community education and awareness campaign to reduce the stigma of Alzheimer’s disease and encourage early identification.

Standardise screening and diagnostic tools

Beyond public awareness and understanding, there are major barriers to the identification and adequate assessment of mild cognitive impairment in general practice.

This is why Alzheimer’s disease experts support efforts to normalise ‘brain health checks’, encourage cognitive health discussions in primary care, and arm clinicians with advanced diagnostic tools to support timely and more accurate diagnosis.

It is critical that GPs have the tools to guide assessment for early Alzheimer’s disease, as well as clear diagnostic and referral pathways. This must be standardised and reflect advances in diagnostic technology.

These reforms require a formal review of the various diagnostic tools to inform guidelines for assessing and diagnosing early Alzheimer’s disease.

Train more healthcare providers and enhance telehealth services

In Australia we have gaps in clinician knowledge, along with capacity challenges, which limit the use of the advanced diagnostics required to identify the hallmarks of Alzheimer’s disease.

When it comes to diagnosing and treating early Alzheimer’s disease, it is acknowledged that we simply don’t have enough specialists, and certainly not outside capital cities.

Australia would benefit from a national framework for the management of cognitive impairment and Alzheimer’s disease. This should include mechanisms that link primary and secondary care for diagnosis and ongoing management; establishment of multidisciplinary teams to coordinate and optimise care; and investment to upskill workers and expand the capacity of services, including telehealth.

Utilise all options for infusion therapy, including the home setting

Amyloid targeting therapy for early Alzheimer’s is administered via infusion, which is likely to be a challenge given the number of Australians who may be eligible for treatment.

Alzheimer’s disease experts support calls to upskill general practitioners, practice nurses and pathology centres to administer infused therapies, as well as investigate opportunities for the delivery of infused medication in the home setting.

Ensure appropriate reimbursement of services, tests and treatments

Last, but certainly not least, cost should not be a barrier to equitable care. Governments will need to evaluate and assign funding to a range of services, tests and treatments. This cost will be incremental, but entirely necessary to counter the ever-increasing burden of Alzheimer’s disease.

Australia will need to consider the direct and indirect costs of Alzheimer’s disease, including its social and financial impacts on carers, when determining the cost-effectiveness of new tests and treatments.

It is anticipated that many of these reforms will be addressed in the Federal Government’s National Dementia Action Plan due to be released later this year. The 10-year policy is being developed to improve the experiences of people living with dementia and their carers, with five immediate priorities:

• Timeliness of diagnosis
• Coordination of care following diagnosis
• Dementia capability of the workforce
• Support for carers
• Data collection, intelligence and monitoring systems.

The National Dementia Action Plan Consultation Paper estimates that 400,000-500,000 Australians are currently living with dementia. This number is expected to reach 900,000 in the next 25 years, with Alzheimer’s accounting for approximately two-thirds of dementia cases. 

Additionally, it is estimated that more than 1.6 million Australians are involved in the care of someone living with dementia. 

There is significant cost and burden for carers, something the Australian government does not currently consider when determining the cost-effectiveness of innovative medicines and medical technologies. Australia should look to overseas experience where the impact on carers is being considered in the valuation of new tests, treatments and care models for Alzheimer’s disease.

With new treatment options on the horizon, there is a window of opportunity to prepare the sector and ensure advanced diagnostics, models of care, infrastructure and the workforce can meet the needs of Australia’s ever-increasing Alzheimer’s population.

Changing the course of Alzheimer’s disease in its early stages can limit damage and reduce the impact on individuals, loved ones and health services. Let’s not miss out on the early Alzheimer’s opportunity.

Dr Vinay Prusty is executive director, medical neuroscience at Eli Lilly in Australia. He obtained his medical qualifications from Utkal (MBBS) and Manipal (MD) universities in India, has additionally qualified in clinical research from Harvard Medical School, Boston and has undertaken postgraduate studies in diabetes and metabolism from Leicester University in the UK. Dr Prusty has extensive experience with clinical trial strategy and managing clinical, medical and regulatory functions.

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