More than 55 million people were living with dementia as of 2021. Alzheimer’s disease, the most common source of dementia, is the seventh leading cause of death in the U.S.
The number is likely to climb as the baby boomer generation ages. According to one estimate, the number of people who are diagnosed with dementia will triple by 2050 without any major breakthroughs in therapeutics.
That’s why in 2020, the World Economic Forum and the Global CEO Initiative convened in Davos, Switzerland to create a public-private partnership aimed at combating Alzheimer’s disease. George Vradenburg, who served in an advisory capacity on Alzheimer’s disease under former U.S. Health and Human Services Secretary Kathleen Sebelius, was chosen as the founding chairman of the partnership, the Davos Alzheimer’s Collaborative.
“Quite simply, the world isn’t ready,” said Vradenburg, who believes the coming wave of people with Alzheimer’s disease is a pandemic equivalent to the size of certain infectious diseases like COVID-19.
Dr. Barak Gaster, dementia expert and professor of medicine at the University of Washington, said the projections on how many people will be diagnosed with dementia are sobering.
“Not only is there a demographic population bubble, but that cohort of people is also more likely to live into their 70s and 80s,” Gaster said. “So, there’s an incredible urgency to evaluate and manage this disease better.”
What’s particularly challenging is available patient data is mostly limited to white people, Vradenburg said. “There are a lot of people around the world who have dementia with different genetic legacies and characteristics and who live in different climates,” he said.
The Davos collaborative seeks to build a diverse database of one million people who have Alzheimer’s disease, extend clinical trials beyond North America where most of them take place and develop innovative solutions to detect and diagnose Alzheimer’s more effectively.
Better diagnosis through tech
In the area of better diagnosis and detection, the collaborative recently released $4.5 million in grant money to healthcare organizations in eight countries across North America, Asia and Africa. The grantees range from organizations using new-age technologies like artificial intelligence-enabled retinal scans to those using something simpler, like a structured cognitive checklist.
Dr. Sharon Cohen, medical director of the Toronto Memory Program, said clinicians often misdiagnose Alzheimer’s disease or wait too long to diagnose it. She said the current gold standard methods of biomarker detection are either too expensive and not readily available, or painful and invasive to patients.
The medical center, which focuses on the diagnosis and treatment of Alzheimer’s disease, developed an AI-enabled retinal scan technology with RetiSpec, a Toronto-based medical imaging company, as an alternative. The eye-scanning technology can be used by ophthalmologists when someone is suspected of having memory impairment. Once the scan is completed, it provides immediate analysis.
“The idea of having a retinal scan, which in a non-invasive way takes a picture of the back of the eye and can detect early changes to the amyloid, is exciting,” Cohen said. “This is scalable. It’s cost efficient. It brings new healthcare professionals into the Alzheimer’s field…and we badly need more dementia practitioners.”
Toronto Memory Clinic, along with the Alzheimer’s Society of Toronto, will use the grant funding to expand the technology’s use and develop a model to involve more clinicians in the diagnosis of the disease.
In preliminary data, the technology compares favorably with the other gold standard methods of biomarker detection, Cohen said. She said the clinic and RetiSpec will continue the trials and hopes to validate the technology for clinical use in the U.S. and Canada.
As more therapies potentially enter the market to treat Alzheimer’s disease, it will be imperative to use new technology to confirm diagnosis, Cohen said. “You wouldn’t give someone chemotherapy unless you confirmed they had cancer,” she said. “Times are changing with Alzheimer’s disease, matching the technology of diagnostics with what’s going on with therapeutics is an ideal pairing.”
Primary care docs
Other grantees have innovations that are less futuristic, but potentially just as impactful. Gaster at the University of Washington has implemented a cognitive and educational toolkit for primary care clinicians. It incorporates two cognitive assessments into practice. It also checks for comorbidities, while providing guidance on follow-up counseling and referrals to community resources.
Gaster developed the toolkit when he saw his fellow primary care clinicians struggling with how to deal with patients who had cognitive concerns.
“Primary care does not have a sense of how to put those pieces together and make an assessment,” he said. “Everyone would like to refer that assessment out to, but there are not enough to specialists to do an evaluation. Patients often don’t want to go to a specialist and would feel more comfortable sticking with their primary care provider, who they have developed a relationship with over time.”
Alice Bonner, senior advisor for aging at the Institute for Healthcare Improvement, agreed and said primary care providers are often not comfortable talking about it with patients because it is a terminal disease. The institute is working with Mass General Brigham in Boston to test various intervention strategies that improve assessment of the disease across eight primary care sites. It will then create a learning network where people from the eight sites can connect.
Bonner said the current methods used to diagnose the disease are failing patients and their families.
“We’re missing an opportunity to get in there in a proactive, preventive way,” Bonner said. “People say it’s a progressive disease and we can’t do anything about it. That is wrong. We can do a lot. We can improve people’s quality of life.”
