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Alzheimer Europe’s European Parliament lunch debate focuses on improving the diagnosis of Alzheimer’s disease thanks to European research collaboration

Tuesday 05 December 2017

On 5 December Alzheimer Europe (AE) held a successful lunch debate in the European Parliament co-chaired by MEPs Heinz K Becker (Austria) and Olga Sehnalová (Czech Republic) which focused on improving the diagnosis of Alzheimer’s disease thanks to European research collaboration. The lunch debate gathered over 95 people including MEPs Nessa Childers (Ireland) Marian Harkin (Ireland), Lambert van Nistelrooij (Netherlands). Peter Kouroumbashev (Bulgaria) and Keith Taylor (UK). The audience included representatives from 24 Alzheimer Europe member associations, several pharmaceutical companies plus all members of Alzheimer Europe’s European Working Group of People with Dementia (EWGPWD) and their supporters.

Heinz K. Becker MEP, opened the lunch debate and welcomed all participants. Mr Becker stressed the need for more political will at European level to help solve the dementia problem and address the needs of the growing elderly population. By 2060 28% of the population will be aged over 65 and 12% aged over 80. According to figures the number people currently living with dementia are 8.7 million in European Union and this number is expected to at least double by 2040. In light of these figures Mr Becker called for better coordination at European level and the need for a high level European coordinator for dementia.

This lunch debate looked at the advances and improvements through European research in diagnosing AD. However despite these advances, it is estimated by Alzheimer’s Disease International (ADI) that only a quarter of people with dementia worldwide and half of people in high-income countries have received a formal diagnosis.

The first speaker, Prof. Philip Scheltens, (VU University Amsterdam, Netherlands) said that thanks to biomarkers there has been a paradigm shift in diagnosing Alzheimer's disease and Alzheimer's dementia. Prof.  Scheltens gave a very interesting historic overview of the diagnosis of AD. For a long time, a diagnosis of Alzheimer’s disease (AD) could only be confirmed postmortem after a brain autopsy. One of the undoubted key advances in AD research is the emergence of biological measures (biomarkers) and imaging techniques which allow a definitive diagnosis of Alzheimer’s disease in living persons. Biomarkers can be assessed by neuroimaging i.e. MRI and PET scans or cerebral spinal fluid (CSF) analysis which are also increasingly being used to diagnose Alzheimer's disease in research studies and specialist clinical settings.

Prof. Scheltens highlighted the fantastic progress in diagnosis, illustrating that being able to detect brain changes early, now gives a better window of opportunity to help identify new treatments to prevent Alzheimer's dementia. He said it is easier now through the discovery of amyloid to give a preclinical diagnosis of AD even if there are no symptoms. This in effect means that AD can be diagnosed before the onset of dementia.

The second speaker Prof. Pierre Krolak-Salmon (University Hospital of Lyon,France) presented the 2nd European Joint Action on Dementia – Act On Dementia. Prof. Krolak-Salmon highlighted the fact that diagnosis is often too late and post diagnosis support is insufficient as well as inappropriate in many European countries. To address these challenges he introduced a diagnostic framework centred on primary care detection which could promote and enhance a timely diagnosis of Alzheimer’s disease and other neurocognitive disorders thanks to a better collaboration between general practitioners and specialists.

In order to redeem today’s great promises of big data and artificial intelligence to change and support clinical practice the third speaker Dr Jyrki Lötjönen, (Combinostics, Helsinki, Finland) introduced the PredictND project’s clinical decision support tool. Currently the time from symptoms to diagnosis can take an average of 20 months in Europe and less than 50% of people get the diagnosis. This new tool compares all patient data (neuropsychology, imaging biomarkers quantified by the tool and cerebrospinal fluid biomarkers) to data from a high number of previously diagnosed subjects to support clinicians in their decision making for an accurate diagnosis. In the PredictND prospective study, the clinical decision support tool was evaluated with 800 patients from four European memory clinics. Dr Lötjönen emphasised that artificial intelligence can support clinicians in decision making and the results show that the confidence of clinicians increased on their decisions, enabling earlier diagnosis. In his conclusion Dr Lötjönen said that having more efficient diagnostics is essential in solving the huge challenge of dementias.

The final speaker Dr Elisabetta Vaudano from the Innovative Medicines Initiative (IMI) talked about the IMI portfolio of AD projects supporting research in the diagnosis of Alzheimer’s disease, and how IMI is supporting disease areas with high unmet needs. As well as IMI, the European Union also supports a number of different research efforts on the diagnosis of Alzheimer’s disease and other neurodegenerative disorders through various programmes including the EU health programme, Horizon2020 and the Joint Programme for Neurodegenerative Diseases Research (JPND).

The two IMI projects that focus on diagnosis are AMYPAD (Amyloid imaging to prevent Alzheimer’s disease) which looks at the diagnostic value of amyloid imaging and MOPEAD (Models of patient engagement for Alzheimer’s disease) which compares different approaches to engage potential Alzheimer’s disease patients.

MOPEAD identifies four strategies to detect memory complaints at their initial stage and provide timely diagnosis. Dr Vaudano also highlighted some barriers to this diagnosis which include: misidentification of early stages of dementia as “normal” part of ageing (a lot of “hidden disease”), denial by patients and/or families and social stigma associated with diagnosis and a lack of definitive screening and diagnostic testing.

AMYPAD aim is to to explore the impact of amyloid PET imaging on diagnostic thinking in the work-up of patients with SCD-plus MCI, and dementia. to improve the understanding, diagnosis and management of Alzheimer’s disease through the utilisation of ß-amyloid PET imaging. The AMYPAD initiative further aims to improve the diagnostic work-up of people suspected to have Alzheimer’s disease and their management, to understand the natural history of the disease in a pre-symptomatic stage and select people for treatment trials aiming at preventing Alzheimer’s disease

Dr Vaudano stressed the need for collaboration at European but also at global level to address the dementia challenge, amongst patients, scientists, industry and healthcare professionals. Dr Vaudano said that despite the fact we still do not have a cure diagnosis remains critical to stress the importance of diagnosis: improve access to medical and support services; to provide an opportunity to make legal, financial and care plans while affected individual is still capable; reduce heath care costs by delaying placement in a nursing home and  current treatments may only work if started early.

This lunch debate showed there has been huge progress in the development of new tools including the discovery of novel biomarkers for the diagnosis of AD at its earliest stages . It is possible that ultimately it will lead to new and better treatments and better disease management. However  more and better collaboration is necessary to impact decision making where it matters most for patients. In her concluding remarks, Olga Sehnalová said that it was important to bring the issue of Alzheimer’s disease to the European Parliament and that the new trend in diagnosis gave us hope for a future cure. She then handed over to Iva Holmerová, Chairperson of Alzheimer Europe who thanked everyone for coming including the sponsors of the event, Eisai, GE Healthcare, GSK, Lilly, MSD, Pfizer and Roche.