Tag: Dementia

Blood Biomarkers for Alzheimer’s Disease: What do they mean for the NHS?

The Challenge of Diagnosing Alzheimer’s

Alzheimer’s disease (AD) is a leading cause of death in the UK as well as affecting nearly a million people. Currently, the diagnostic pathway for AD is based on clinical symptoms that emerge late in the disease, often after 20 years of progressive accumulation of intracerebral pathological AD features.  When memory, mood, or personality changes are noticed, individuals or their family usually seek advice from a general practitioner, who may perform some cognitive tests along with some general blood tests.  If cognitive decline is suspected, the patient is often referred to a memory clinic or to Old Age Psychiatry Clinics within Mental Health Trusts for further evaluation, aimed at confirming cognitive decline and ruling out reversible causes.

The Promise of Blood Biomarkers

Recent advances in blood-based biomarkers hold promise for transforming AD identification and care.  These biomarkers have shown similar sensitivity and specificity to positron emission tomography (PET) scan and cerebrospinal fluid (CSF) tests in specialist settings.  If reliably predictive blood tests were to become available at low cost in primary care, this could be transformative for AD identification.

The NHS and Blood Biomarkers

The UK’s National Health Service (NHS) is exploring how to adopt and integrate these innovations into its care model.  Initiatives like the Davos Alzheimer’s Collaborative (DAC) International Initiative, the AD RIDDLE study, and the UK’s Blood Biomarker Challenge aim to pilot real-world implementation and validation of blood-based biomarkers, with hopes of integrating them into the NHS within the next few years.

The Future of Alzheimer’s Care

Blood-based biomarkers have the potential to revolutionize early detection of Alzheimer’s disease, making diagnosis more accessible and affordable.  This could lead to earlier intervention and better outcomes for patients.  With a focus on affordability, accessibility, and robust post-launch monitoring, an Alzheimer’s care framework that is more effective, equitable, and capable of transforming the lives of those affected by the disease can be created.

Read more in our article in the Journal of the Royal Society of Medicine.

Twenty-year trajectories of cardio-metabolic factors among people with type 2 diabetes by dementia status in England

In a study published in the European Journal of Epidemiology, we assessed 20-year retrospective trajectories of cardio-metabolic factors preceding dementia diagnosis among people with type 2 diabetes (T2D).

We identified 227,145 people with T2D aged > 42 years between 1999 and 2018. Annual mean levels of eight routinely measured cardio-metabolic factors were extracted from the Clinical Practice Research Datalink. Multivariable multilevel piecewise and non-piecewise growth curve models assessed retrospective trajectories of cardio-metabolic factors by dementia status from up to 19 years preceding dementia diagnosis (dementia) or last contact with healthcare (no dementia).

23,546 patients developed dementia; mean (SD) follow-up was 10.0 (5.8) years. In the dementia group, mean systolic blood pressure increased 16–19 years before dementia diagnosis compared with patients without dementia, but declined more steeply from 16 years before diagnosis, while diastolic blood pressure generally declined at similar rates. Mean body mass index followed a steeper non-linear decline from 11 years before diagnosis in the dementia group. Mean blood lipid levels (total cholesterol, LDL, HDL) and glycaemic measures (fasting plasma glucose and HbA1c) were generally higher in the dementia group compared with those without dementia and followed similar patterns of change. However, absolute group differences were small. Differences in levels of cardio-metabolic factors were observed up to two decades before dementia diagnosis.

Our findings suggest that a long follow-up is crucial to minimise reverse causation arising from changes in cardio-metabolic factors during preclinical dementia. Future investigations which address associations between cardiometabolic factors and dementia should account for potential non-linear relationships and consider the timeframe when measurements are taken.

Are diagnoses of dementia being delayed by over-complex referral criteria?

Complex and time-consuming memory clinic referral criteria may be contributing to delays in the diagnosis of dementia, according to a paper published today by the Journal of the Royal Society of Medicine. Around 850,000 people are living with dementia in the UK but the number thought to have dementia substantially exceeds those with a formal diagnosis. Early diagnosis is a priority for the government and the NHS.

Currently GPs are responsible for referring patients for assessment and diagnosis by specialists, usually in dedicated memory clinics which set referral criteria. There is considerable variation in referral criteria, with requirements set by some memory clinics that exceed national guidelines. Requirements can include different combinations of cognitive tests, laboratory blood tests, urine tests and physical examination that vary between clinics.

Lead author Dr Benedict Hayhoe, of the School of Public Health at Imperial College London, says: “GPs have difficulty assessing patients with memory problems in strict accordance with guidance within a 10-minute consultation; in our experience a significant proportion of available consultation time can be taken up by carrying out just one of the brief cognitive tests.” He went on to suggest that, with current workload pressures on primary care, complex criteria involving multiple investigations are likely to provide a significant disincentive for referral.

The authors set out alternative approaches to speed up diagnosis. Dr Hayhoe said: “A primary care led process, perhaps staffed by practice nurses carrying out assessments according to protocols, may speed up diagnosis while reducing pressure on GPs and specialists.” He added that it may also be appropriate to allow some people with memory concerns direct access to memory clinics.

Dr Hayhoe concludes: “A system that discourages or delays referral for dementia is highly counterproductive; an urgent review of this area is necessary to establish a system that effectively supports patients and clinicians in early diagnosis, treatment and prevention“.

The article was reported by a number of media outlets including: The Times, The Express, The Alzheimer’s Society, Pulse and the Jersey Evening Post. The article was also reported by World First, homecare.co.uk, Care Appointments, and the Hippocratic Post.

Improving the safety of care of people with dementia in the community

Dementia care is predominantly provided by carers in home settings. We aimed to identify the priorities for homecare safety of people with dementia according to dementia health and social care professionals using a novel priority-setting method. The study was published in BMC Geriatrics.

The project steering group determined the scope, the context and the criteria for prioritization. We then invited 185 North-West London clinicians via an open-ended questionnaire to identify three main problems and solutions relating to homecare safety of people with dementia. 76 clinicians submitted their suggestions which were thematically synthesized into a composite list of 27 distinct problems and 30 solutions. A group of 49 clinicians arbitrarily selected from the initial cohort ranked the composite list of suggestions using predetermined criteria.

Inadequate education of carers of people with dementia (both family and professional) is seen as a key problem that needs addressing in addition to challenges of self-neglect, social isolation, medication non-adherence. Seven out of top 10 problems related to patients and/or carers signalling clearly where help and support are needed. The top ranked solutions focused on involvement and education of family carers, their supervision and continuing support. Several suggestions highlighted a need for improvement of recruitment, oversight and working conditions of professional carers and for different home safety-proofing strategies.

Clinicians identified a range of suggestions for improving homecare safety of people with dementia. Better equipping carers was seen as fundamental for ensuring homecare safety. Many of the identified suggestions are highly challenging and not easily changeable, yet there are also many that are feasible, affordable and could contribute to substantial improvements to dementia homecare safety.

DOI: 10.1186/s12877-017-0415-6