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Beyond oncology, mAbs have found applications in autoimmune diseases, infectious diseases, and even neurological disorders. For example, biotech Biogen developed Aduhelm (aducanumab), a monoclonal antibody therapy for <anchor>Alzheimer's disease</anchor>. While its 2021 approval generated significant controversy, it serves as a testament to the power of biotechnology in addressing complex medical conditions.
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# How Can Alzheimer’s Impact Be Minimized through Early Diagnosis?

## Early diagnosis of Alzheimer’s disease may help minimize the physical, emotional, and financial impacts on patients and their families.

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Veronica Salib

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Published: 13 Sep 2022

Globally, a new dementia case develops every three seconds. According to Alzheimer’s Disease International, in 2020, 55 million people were living with dementia — a number that is expected to double by 2030 and quadruple by 2050. Of all the different forms of dementia, Alzheimer’s continues to be one of the most prevalent. An early Alzheimer’s diagnosis may help reduce the impacts of the disease, including physical, emotional, and financial burdens.

Steven R. Smith, MD, Chief Scientific Officer at Advent Health, sat with LifeSciencesIntelligence to discuss a study with the Davos Alzheimer Collaborative (DAC), which may lead to earlier diagnosis of Alzheimer’s disease and improve outcomes.

## Understanding the Problem

As research and medicine have developed, the average lifespan has nearly doubled in recent decades. With this progression, medicine has approached a new realm of issues related to aging, including dementia, such as Alzheimer’s disease.

Smith emphasized this in his interview with LifeSciencesIntelligence, saying the world has “a problem in front of us: the aging of the world and America. One of the things that we want to do as a healthcare system is learn how to more efficiently get people to the neurologist if they need to get to a neurologist but not go to the neurologist if they don't have to. We have a shortage of neurologists across the United States, and there aren't enough neurologists to care for all our Alzheimer's patients.”

## The Study

“The Davos Alzheimer Collaborative, called DAC, is a global study multinational study, and it's designed to begin to find ways to diagnose early dementia, Alzheimer's disease in particular before people progress too far down the stream. That screening methodology is one that typically is going to a doctor,” explained Smith.

“This unique study really is designed to find ways to get people where they need to go more efficiently and effectively,” he continued.

## The Tests

“It involves two things: one is a digital test, and the other is a blood test, a so-called biomarker for brain injury caused by Alzheimer's.”

Smith added, “That test measures the amount of plaque in the blood, which scientists believe causes Alzheimer's disease. This test has proven very effective, sensitive, specific, and an aide to the rest of the things I was just talking about for diagnosing Alzheimer's.”

When asked how this blood test compared to other tests on the market, Smith explained, “there are multiple different kinds of tests. The one DAC is using is based on a methodology called mass spectrometry, which is very sensitive and specific at measuring different proteins in the blood. There are a lot of ongoing studies comparing the effectiveness of these blood tests in finding early signs of Alzheimer's disease.”

Researchers opted for this diagnostic tool based on the nature of this study and the collaboration with the DAC to conduct international research.

According to Smith, “this particular test was chosen as part of the global initiative because DAC knew it was suitable for a multinational study as well, and that was a big driver in the design of using this particular blood test.”

## Early Diagnostic Benefits

As previously mentioned, early diagnosis of Alzheimer’s can have multiple benefits that minimize the disease impact.

#### Preparedness

One of the main benefits Smith highlights about early diagnosis is preparedness. An early diagnosis or understanding of risk can help patients and their loved ones better prepare for the progression of the disease.

“When one understands that they’re on a particular health course, they can do things. They can have deeper conversations with their family, community, and friends. Patients can begin to make plans for AMA and retirement or work. Many decision points come out of early diagnosis,” stated Smith.

#### Disease Progression and Prognosis

Smith told LifeScienceIntelligence that “the other reason DAC is interested is scientists now know from multiple lines of research that there are things that can be done individually which may reduce the slope of the decline of mental function of cognition and memory.”

The Alzheimer's Society states that dementia prognosis is impacted by multiple factors, including comorbidities, age of onset, and the stage of diagnosis. Earlier diagnosis and interventions are correlated with a better prognosis.

“For example, people who start an active lifestyle and begin to change their diet can reduce the rate at which their brain function and memory decline. That's a very positive note,” exclaimed Smith.

#### Cost Benefits

According to Alzheimer’s Disease International, in 2015, the cost of dementia spending amounted to 1.09% of the world’s GDP, equivalent to $818 billion. Currently, the United States spends $1.3 trillion on dementia, and that cost is expected to be over twice as much by 2030.

When prompted, Smith explained the potential cost and spending benefits of this research and the early diagnosis of dementia.

“There are going to be some cost savings if scientists can implement effective treatments between the diagnosis of mild cognitive impairment and the movement to full Alzheimer's disease,” stated Smith.

He implied that part of those projected savings is attributed to the potential for slowing disease progression.

Additional savings may come from a reduction of unnecessary tests and imaging. These diagnostic tools may provide additional insight into which further tests are necessary or can be postponed.

Smith explained, "people are so concerned about their brain health and memory that they seek care with the neurologist. They're getting a bunch of MRIs. They're doing a lot of testing that they might not need. My comment earlier is that patients want to get the right person to the right place at the right time to handle and avoid costs if they don't need these additional tests and imaging.”

“Then patients can spend money where they need to. And that kind of early detection, precision medicine, is something that must improve across healthcare systems.”

While he explained that the total economic impact has yet to be understood, he shared that “a large, well-known insurance company gave the researchers a call to talk more about what we're doing and to learn what we are learning along with us. That tells you that the Medicare population, the other Medicare supplements, and other insurance companies are very interested in what we're doing. I suspect we'll get quite a few more calls after we complete the stub study and publish the data.”

## Research Application and Future Directions

As this research progresses and develops, the hope is that these diagnostic tests will one day be implemented as a regular part of neurological screenings. Researchers will need to better understand the cost-benefit of this diagnostic testing and its efficacy across all patient populations before its universal implementation.

Additionally, the DAC will continue to study Alzheimer’s across multiple nations. Once these diagnostic tests are widely approved, clinicians must determine how and when to integrate their use into their daily practices.

#### Next Steps

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