Preparing for disease-modifying therapies in Alzheimer's disease

Generalizability of trial criteria on amyloid-lowering therapy against Alzheimer’s disease to individuals with MCI or early AD in the general population

“…Adequate preparation is imperative, and includes the necessary diagnostics for determining amyloid status, monitoring safety, and estimating the contribution of amyloid – relative to other contributing causes – to cognitive decline within a single patient. 35,36 The current study, along with the representative sample of U.S. citizens, 17 offers guidance as to the group of patients for which there is some evidence of treatment efficacy, and those for which there is none as of yet. Even if treatment labels would strictly follow trial eligibility criteria, the absolute number of patients eligible for treatment will pose a challenge to healthcare systems.…”

What will it take to achieve brain health globally?

“…Key take-away messages from the ADI Global Action Plan report 2023 are that caregivers need to be supported (e.g., allowance for time off work when indicated for caregiver services), public health awareness through education for risk reduction is important, and however small the steps governments need to begin to tackle cognitive impairment to meet the challenges of families, communities, and health systems [ 28 , 29 ]. With the recent breakthroughs in disease-modifying therapy monoclonal antibodies for removal of beta-amyloid plaques from the brain, it has become apparent that national health systems are not well prepared to deliver the drugs to but a fraction of persons who might be eligible [30] . In addition, challenges of equitable access, greater access to necessary diagnostic testing (e.g., serial MRI brain studies, PET scans and other diagnostic tests such as biomarkers), availability of infrastructure and staff at infusion centers, and payment mechanisms for such therapies are just some of the hurdles that remain in play [30] .…”

“…With the recent breakthroughs in disease-modifying therapy monoclonal antibodies for removal of beta-amyloid plaques from the brain, it has become apparent that national health systems are not well prepared to deliver the drugs to but a fraction of persons who might be eligible [30] . In addition, challenges of equitable access, greater access to necessary diagnostic testing (e.g., serial MRI brain studies, PET scans and other diagnostic tests such as biomarkers), availability of infrastructure and staff at infusion centers, and payment mechanisms for such therapies are just some of the hurdles that remain in play [30] . Furthermore, WHO has developed “best buys” which represent 4 key risks (tobacco use, harmful use of alcohol, and unhealthy diet and physical activity) as cost-effective public health interventions to prevent and control non-communicable diseases (e.g., diabetes mellitus, cardiovascular disease, cancer, chronic respiratory disease) [31] .…”

Prescribing anti‐amyloid immunotherapies to treat Alzheimer's disease: Fully informing patient decisions

“…Moreover, formidable resources will need to be integrated, and substantial challenges overcome, to provide access to these drugs (e.g., see refs. [13][14][15]. This is particularly important given the unknown impacts across populations with varying degrees of social and structural determinants of health and health access, including racial and gender minorities as well as urban versus rural populations.…”