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Anthea Rowan

If a treatment were available, a significant majority of people would get tested for dementia, says charity Alzheimer’s Disease International (ADI).
ADI, based in London in the UK, works with dementia and Alzheimer’s associations in more than 100 countries. It asked a lot of people the testing question: 40,000 in 166 countries.
Hamid Sohrabi is a professor of psychology and clinical neuroscience at Murdoch University in Australia and director of its Centre for Healthy Ageing; he and his team recently developed the McCusker Subjective Cognitive Impairment Inventory (McSCI-S) – a screening test for dementia risk.
The McSCI-S has been translated and is in its final stage of being released for clinical and research applications in China.

The questionnaire collects information about how a person perceives the changes in their cognitive abilities and whether these changes affect their daily functioning, Sohrabi says.
It asks about gradual changes in memory, language, concentration, and other mental abilities that a patient might have experienced or noticed during the past two years, as compared to five years ago.
A doctor can then use this information within the context of other available information to decide whether a more thorough assessment is required, and whether these changes indicate a higher risk of dementia.
If they do, Sohrabi says, “there are various pathways to intervene, for example identifying the relevant modifiable risk factor(s) for a person or even enrolment in clinical trials aimed at the prevention of dementia”.
Those modifiable risk factors might include high blood pressure, cholesterol and blood sugar levels, body weight and social connections.
A timely diagnosis can unlock a whole raft of information, advice and support, enabling people to adjust, to live well, live at home
Paola Barbarino, Alzheimer’s Disease International’s chief executive officer
Sohrabi envisages this test being used either routinely from a certain age, or if a person becomes anxious about their cognition.
But he urges caution, and encourages the use of the McSCI-S to be decided upon by a doctor and not by individuals themselves.
There are several reasons for this, but the most important “is the fact the information from this measure has to be used in the context of other details that require clinical judgment skills and experience”.

ADI chief executive officer Paola Barbarino says time is the most precious thing for people living with dementia.
“A timely diagnosis can unlock a whole raft of information, advice and support, enabling people to adjust, to live well, live at home and stay engaged in the community, with their family, even remain at work, with a combination of treatment and support.”
She attributes the change in public attitudes about getting tested for dementia to a greater understanding of the condition and its causes, and also the new “disease-modifying treatments being approved around the world and the breakthroughs in diagnostics” – like Sohrabi’s.
Note, however, that these treatments are only disease-modifying; there is no cure for Alzheimer’s.
Treatments for the disease are being developed all the time. In June this year, the United States Federal Drug Adminstration approved donanemab – the third Alzheimer’s targeted drug to be given the green light after lecanemab and the discontinued aducanumab.
These drugs are designed to slow Alzheimer’s symptoms and so extend quality of life and a person’s independence.
Trials indicate that donanemab slows cognitive decline in patients with clinical symptoms of Alzheimer’s by about 35 per cent over 18 months.
Patients treated with donanemab had 40 per cent less decline in daily tasks performance after 18 months and a 39 per cent lower risk of progressing to the next stage of the disease.

Nearly 50 per cent of patients treated experienced no decline on the Clinical Dementia Rating Dementia Staging Instrument – CDR – at one year after the start of the trial.
The CDR is a five-point scale used to define six areas of cognitive and functional performance applicable to dementias:

memory;


orientation;


judgment and problem-solving;


community affairs;


home and hobbies; and


personal care.

Donanemab works a little differently than lecanemab. The latter drug targets the amyloid plaques that are associated with Alzheimer’s as they start to form and clump in the brain. Donanemab binds with the plaques so that the antibodies it contains can destroy the harmful proteins that cause the plaque build-up and the resultant brain damage.
The other way the drugs are different is the way they are administered; lecanemab via intravenous infusions every two weeks, donanemab every four weeks.
While Barbarino welcomes the development of these drugs, she is concerned about their availability; donanemab has been approved for use in some countries but not others.
Another obstacle to access will be cost; in the UK, for example, it will not be available on the National Health Service, only privately. And at a cost in excess of £20,000 (US$26,500) a year, few people will be able to afford it.

The burden of dementia is huge, and while these drugs are not a cure – nor are they perfect – they are a hopeful start; somewhere in the world somebody is diagnosed with dementia every three seconds.
Not all doctors agree, some critics noting that the drugs are too costly to produce and arguing their potential side effects are too great – donanemab’s side effects, for example, include allergic reactions, brain swelling and brain bleeds.
In 2020, the cost of bringing a new drug to market was estimated to be between US$300 million and US$3 billion. To put that in context, in 2019, the annual global societal costs of dementia were estimated at over US$1.3 trillion.
Like what you read? Follow SCMP Lifestyle on Facebook, Twitter and Instagram. You can also sign up for our eNewsletter here.


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Wellness

World Alzheimer’s Day 2024 arrives with encouraging news about treatments for it and other forms of dementia, and trials of a questionnaire to help doctors assess early signs of the disease. Photo: Shutterstock

Hamid Sohrabi is director of Murdoch University’s Centre for Healthy Ageing in Australia. His team has developed a screening test for dementia risk. Photo: Alzheimer’s Research Australia

Paola Barbarino is the chief executive officer of Alzheimer’s Disease International. She says that time is the most precious thing for people living with dementia. Photo: Alzheimer’s Disease International

A brain exploration hologram. A new test can screen for dementia risk. Photo: Jonathan Wong

While there is no cure for Alzheimer’s, treatments for the disease are being developed all the time. Photo: Jonathan Wong

How Alzheimer’s disease could be reversed through lifestyle changes: new research

Diet is a lifestyle factor linked to preventing or even reversing Alzheimer’s disease, according to new research. Photo: Shutterstock

Diet, specifically eating a mostly plant-based one, is a lifestyle factor linked to preventing or even reversing Alzheimer’s disease - the most common type of dementia - according to new research. Photo: Shutterstock

Dr Dean Ornish has four rules for better brain health as we age: eat well, move more, stress less and love more. Photo: Facebook.com/Ornish

Practising yoga for an hour a day was linked to preventing or reversing mild cognitive decline in Ornish’s study. Photo: Shutterstock

Dr Sanjay Gupta has Alzheimer’s disease in his family. Photo: Facebook/Dr. Sanjay Gupta

Dr Richard Isaacson is a world-renowned neurologist and researcher. Photo: Florida Atlantic University  

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A researcher at the Spanish hospital where the study was carried out. Photo: Hospital de la Santa Creu i Sant Paul

New dementia research found that people with two copies of the APOE4 gene, one inherited from each parent, will almost certainly develop the biological signs of Alzheimer’s disease. Photo: Hospital de la Santa Creu i Sant Paul

Amyloid plaques and tau, or neurofibrillary tangles, are hallmarks of Alzheimer’s disease. Photo: Shutterstock 

Dr Juan Fortea, the director of the memory unit at the Hospital de la Santa Creu i Sant Pau, in Barcelona, Spain, was the study’s lead author. Photo: Hospital de la Santa Creu i Sant Pau

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Timothy Rittman, the neurologist who led the dementia research at Cambridge University. Photo: Cambridge University

A brain scan showing signs of dementia. Photo: Getty Images

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The approval in the US of a new drug that slows the onset of Alzheimer’s makes Rittman hopeful about the future of dementia treatment. Photo: Cambridge University

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“Measuring the way we control our eyes may provide us a non-invasive way of determining brain health,” says Dr Thomas Wilcockson, a senior lecturer in psychology at Loughborough University, in the UK. Photo: Loughborough University 

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Lifestyle

Health & Wellness

Health

On World Alzheimer’s Day, we examine how a timely diagnosis can prepare someone with early dementia, and the pros and cons of a new drug


On World Alzheimer’s Day, we examine how a timely diagnosis can prepare someone with early dementia, and the pros and cons of a new drug.
