Cover Story
Alzheimer ’ s could one day become a treatable disease
Therapeutic options are still no match for the disabling condition , but better treatments may be on the horizon
“ Dementia robs millions of people of their memories , independence and dignity , but it also robs the rest of us of the people we know and love .”
When his grandfather developed the symptoms of Alzheimer ’ s disease , Dr Jason �arlawish experienced first-hand the limited healthcare support available for patients with the condition . He decided then that treating the brainwasting disease and all its associated problems would be his life ’ s mission .
“ Alzheimer ’ s is one of the most underdiagnosed and undertreated causes of disability , � the co-director of the Penn Memory Center at the University of Pennsylvania and author of the book The Problem of Alzheimer ’ s told Global Health Asia-Pacific . “ So as a physician it struck me as an incredible amount of unmet need to be addressed , and I tried to take that on .”
Such ambition led him to specialise in the management of the disease that plagues millions of patients with cognitive functions loss , such as memory , caused when brain cells die . Worse , the disease chips away at personal identity or the core of who we commonly think we are . And Alzheimer ’ s is just one of the most common causes of mental impairment broadly known as dementia .
The lack of proper care for these conditions is exemplified by the fact that there are no specific doctors trained to treat dementia . In contrast , other common long-term conditions , such as cancer and heart disease , have spawned a growing army of specialised oncologists and cardiologists in both medical and surgical care .
“ Are there Alzheimer ’ s doctors out there ? And the answer is , not really . The typical neurologist is not trained as an Alzheimer ’ s doctor , the same goes for the typical psychiatrist , and even the typical geriatrician . Moreover , there are few people who pursue careers in neurology , psychiatry , or geriatric medicine ,” said Dr Karlawish .
The dearth of experts can , to a certain extent , explain why the world is failing to address the challenge of dementia , as the World Health Organization declared last September in a new report highlighting the limited number of healthcare providers able to handle the condition . It also underlined the great variability across countries , with poor-resourced nations coming off worse .
The average number of ( psycho ) geriatricians , for instance , ranges from 0.02 per 100,000 population in low-and-middle-income countries ��MICs� to 2.2 in high-income countries , which also report much greater availability of residential and long-term care facilities . The low numbers also hide a worrying trend in many countries where trained personnel in nursing homes and long-term care facilities are stigmatised and their work is not adequately recognised by society . They are typically low-paid and are not offered psychological support , leading to high turnover rates that affect care �uality and availability .
“ Dementia robs millions of people of their memories , independence and dignity , but it also robs the rest of us of the people we know and love ,” said Dr Tedros Adhanom �hebreyesus , Director-�eneral of the World Health Organization , in a press release . “ The world is failing people with dementia , and that hurts all of us . Four years ago , governments agreed a clear set of targets to improve dementia care . But targets alone are not enough . We need concerted action to ensure that all people with dementia are able to live with the support and dignity they deserve .”
Diagnosis can be smooth in resourced facilities The first hurdle for people with Al�heimer ’ s is to get an accurate diagnosis . This is a significant global problem considering that fewer than half of the countries that provided data to the WHO reported they could diagnose at least 50 percent of dementia cases , according to the report .
The good news is that standard diagnostic procedures allow trained doctors to detect Alzheimer ’ s in an easy and quick way .
�In well-resourced healthcare systems with welltrained staff , it ’ s �uite possible to accurately identify people who have cognitive impairment and identify those people whose cognitive impairment is caused by Alzheimer ’ s disease ,” said Dr Karlawish . “ The problem is the healthcare systems of many countries are not adequately resourced to deliver that quality care .”
To diagnose the condition , doctors usually talk to family members to understand how and whether the patient ’ s skills and behaviours have changed over time while assessing cognitive functions like memory and reasoning . Brain scans are often done to identify the two defining pathologies of the disease , pla�ues and tangles of two proteins called amyloid and tau whose
28 SEPTEMBER 2022 GlobalHealthAsiaPacific . com