Last week’s reports that an experimental drug for Alzheimer’s disease may slow the disease, which affects about 6.5 million Americans over age 65, brings cautious optimism to millions of families.
Currently there’s little hope following such a diagnosis.
Sustained reversal of the progressive loss of memory and function is not currently possible, but if the diagnosis of Alzheimer’s disease is made early enough, psychosocial and pharmacologic treatments can improve overall quality of life, permit the institution of safety measures, and provide caregiver support and training. Doing so may minimize the use of costly medical resources and gives patients and their relatives time to anticipate future medical, financial, and legal needs.
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The social and economic implications of dementia include direct medical costs, direct social costs, and the costs of informal care. In 2015, the World Health Organization estimated the total global societal cost of dementia to be $818 billion. Although Medicare, Medicaid, and private insurance may pay much of the direct cost, families caring for patients with dementia bear the greatest burden of expense, estimated to be $234 billion in the United States alone.
The pain and anguish of this devastating disease also overwhelm millions of caregivers and relatives. Nearly half of primary caregivers of patients with dementia experience psychological distress, particularly depression. Many must leave their jobs in order to provide care and support for their loved one.
Many years ago, research led to the development of several medications (Aricept, Namenda) that have helped to slow the disease’s process, allowing patients to maintain function for longer periods, and thus delay ultimate transfer from home to nursing home. But the impact on slowing loss of cognition and function is minimal, and these medications have no impact on the burden of Beta-amyloid plaque in the brain, which is widely believed to be responsible for the cognitive loss that occurs in this disease.
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The Biogen/Eisai clinical trial whose results were released last week included nearly 1,800 participants with mild cognitive impairment or mild Alzheimer’s disease. The group of volunteers who received lecanemab, an anti-Beta amyloid antibody, experienced a 27 percent reduction in cognitive decline compared with the group that received a placebo. Although the Beta-amyloid theory is still being debated — there is also Tau protein to be considered as a possible cause of Alzheimer’s — the recent study with lecanemab, the largest clinical trial to date utilizing this approach, suggests that the progression of Alzheimer’s disease can be slowed, with results that seem to be more meaningful than what was found with Aduhelm.
The strong results of the trial boost the drug’s chances of winning approval and offer renewed hope for a class of Alzheimer’s drugs that have repeatedly failed or generated mixed results. And, as important, the prevalence of side effects was lower than with Aduhelm and other experimental medications.
Having witnessed the angst and heartbreak of loved ones watching their mom or dad suffer from this terrible disease, many families have told me that they would do anything to slow the disease’s pace. People crave more quality time with their loved one before they’re lost to the disease and no longer have the ability to have any meaningful interaction. But at what cost?
In medicine today, decisions regarding diagnostic and therapeutic interventions often are decided by cost-to-benefit ratio. If the benefit is minimal, and the cost is excessive, it isn’t likely that the intervention will be covered by insurance. And this new medication will be very expensive. Hospitals must invest in time, staff space, and equipment in order to provide intravenous monthly treatment.
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So here is my take. I get the cost, but more important, my patients, families, and caregivers need hope and dearly want any intervention that may be effective in slowing the course of this disease. So let’s give them that hope because the cost of not doing so is too high a price for any family to bear.
Dr. Richard Dupee is chief of geriatrics at Tufts Medical Center.
