Are we entering a new era of dementia treatment?
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A Q&A with Sunnybrook Neurologists
Over the next five years, researchers estimate that more than one million people in Canada will be living with some form of dementia. Dementia is a general term characterizing a decline in cognitive abilities like memory loss, problem-solving, language and behaviour and mood management. Alzheimer’s disease is the most common form of dementia.
The cognitive decline caused by dementia and Alzheimer’s disease has a significant impact on everyday life. People with dementia will begin to experience difficultly performing usual tasks and activities, and require more support from caregivers as the disease progresses.
While there is no cure, clinicians and scientists remain hopeful as we enter a new era of dementia care. Of these innovations is the recent Health Canada approval of disease-modifying therapies (DMTs), or Amyloid Targeting Therapies, like lecanemab, for the treatment of Alzheimer’s.
We spoke with Dr. Sara Mitchell and Dr. Mario Masellis, Neurologists in Sunnybrook’s Hurvitz Brain Sciences Program to learn more about the new era of dementia care and what it means for people and loved ones affected by Alzheimer’s disease.
What is the current state of dementia care in Canada?
Dr. Masellis: There are two very important aspects of the current state of dementia care in Canada – diagnostics and symptom management.
There are a number of clinical assessments, diagnostic and cognitive tests, neurological exams and family history conditions that play a vital role in determining an initial dementia diagnosis.
Sunnybrook is one of the few centres in Canada to provide Amyloid PET Scans for the diagnosis of Alzheimer’s disease. These nuclear medicine brain scans help detect and measure the amount of amyloid plaques in the brain, a protein associated with the development of Alzheimer’s. This scan helps clinicians accurately diagnose the presence of Alzheimer’s disease as well as determine how far the disease has progressed. Before amyloid PET imaging, these plaques could only be detected by examining the brain at autopsy.
Because there is no cure for Alzheimer’s disease, there is a focus on treating the symptoms associated with the disease. Patients diagnosed with Alzheimer’s may face a variety of cognitive symptoms, including memory loss, behavioural and mood changes, restlessness, depression and anxiety. Management of these symptoms could include medications or behavioural modification strategies like occupational therapy. Some patients may see benefits from these strategies, but they do not target the root cause of Alzheimer’s or change the progression of the disease.
Primary care providers and programs like Ontario Health atHome also play a tremendous role in dementia care, providing patients with a support worker who help them live safely and comfortably at home for as long as possible.
What are disease modifying therapies (DMTs) or amyloid targeting therapies, and how are they different than other medications or treatments?
Dr. Masellis: After long and reiterative clinical trials, Health Canada recently approved the drug, lecanemab, for clinical use. Lecanemab is made up of monoclonal antibodies, which are designed to bind to and remove amyloid plaques from the brain. Unlike current therapies that aim to manage Alzheimer’s symptoms, DMTs are targeting one of the main proteins associated with the development of the disease.
By targeting the build-up of amyloid plaques, lecanemab has been shown to slow down the progression of Alzheimer’s disease and cognitive decline by an average of 30 per cent in clinical trials.
It’s also important for patients to understand that the therapy also has a risk of serious side effects know as amyloid-related imaging abnormalities (ARIA). This can include inflammation and bleeding in the brain, which can be detected through an MRI scan. Much like the current state, diagnostics like MRI will continue to play a critical role in dementia care and understanding neurodegeneration in the brain.
How will DMTs impact dementia care and what does it mean for patients and families affected by Alzheimer’s disease?
Dr. Mitchell: DMTs are ushering in a new era of Alzheimer’s care and shifting focus from symptom management, to targeting the root cause of the disease. What this means is that DMTs are slowing down the progression of Alzheimer’s and keeping people cognitively healthy and independent for longer. This has significant impacts on the patient, as well as their families and caregivers.
The support of loved ones and caregivers is essential in dementia care. Not only can this include physical care like administering medication, keeping track of appointments or assisting in everyday tasks like bathing or cooking, caregiving requires an immense amount of emotional labour. As Alzheimer’s progresses, and patients experience symptoms like memory loss, it can be extremely difficult for loved ones to experience their family battle with the condition.
How is Sunnybrook leading the way for the new era of dementia care?
Dr. Mitchell: Through the collaborative clinical and research teams in the Hurvitz Brain Sciences Program, across Sunnybrook’s care programs and our community partnerships, we are leading the way for patient-centred dementia care, thought leadership and advocacy. Our interdisciplinary clinics can provide comprehensive care tailored to the unique needs of each patient.
Patient and caregiver education will continue to play an integral role in dementia care. As new treatment pathways become available, it is important that they are equipped with the information they need to make informed decisions and advocate for their care.
The approval of DMTs like lecanemab is an exciting step forward to a new era of dementia care, but there is still much work that needs to be done before they can become a standard part of patient care in Canada.
There are strict eligibility requirements for those who can receive lecanemab. It is estimated that only around 10% of patients assessed for cognitive impairment will meet criteria for the therapy. Time is of the essence with the delievery of this therapy, as it is only effective for those in the early stages of the disease. Our hope is to develop a rapid access referral model so that eligible patients are sent to the right avenue of care before there’s further disease progression
Although lecanemab has been approved by Health Canada, it is not yet covered by provincial health plans, like OHIP. It is estimated that an 18-month course of the treatment will cost $54,000 and until the treatment is included in provincial health plans, patients would have to pay out of pocket or depend on private insurance for coverage.
More information on DMTs in Canada
There are strict eligibility requirements for those who can receive lecanemab, and although it has been approved for use in Canada, it is still pending coverage by provincial health plans. For more information about lecanemab and what it means for Alzheimer’s care, view some helpful resources:
• Canadian Consortium on Neurodegeneration in Aging (CCNA)
• MINT Memory Clinic: Anti-amyloid therapies video series and lecanemab fact sheet.
