Is your practice ready for Alzheimer’s patients?

Blog Posts  |  29 June 2020  |  By Tom Pasquariello, PharmD, BCPS, BCMAS, PMSP, PRS

With so many primary care offices struggling to figure out telemedicine and how to handle patients concerned with contracting COVID-19, it is easy to forget about the surge in Alzheimer’s cases. According to the Alzheimer’s Association, it is estimated that more than five million American’s over the age of 65 have the disease, and the number is expected to almost triple over the next 30 years.1 Unfortunately, Alzheimer’s treatment demands so much more than prescribing medications, it requires constant care from loved ones, neighbors, friends, medical facilities, and more. With a shortage of physicians, especially primary care, it makes it difficult to find time for patient consultation on dementia care.

We are left to turn to published research to provide a guide on where Alzheimer’s care goes from here. Over the past 20 years, 146 medications have been tested and rejected to help us get the answers we seek. Those medication trials demanded the collaboration of thousands of researchers and hundreds of thousands of willing subjects. The Food and Drug Administration (FDA) has only approved four drugs during this time that have had modest symptom-reducing effects, but they do not alter the subsequent path of Alzheimer’s disease.2

Recently, a long-awaited promising medication candidate was rejected by the FDA. This anti-amyloid monoclonal antibody, biologically manufactured, was intended to target toxic amyloid similar to the way that our own antibodies attack infectious bacteria.2 This rejection came as a surprise to many, as this medication not only reduced brain amyloid content, but also appeared to delay cognitive decline. Although this medication is not being further studied, there are an estimated 132 other Alzheimer’s medications being tested in 670 trials.2 While these medications are being tested, what else could potentially be done?

Since treating Alzheimer’s with medications can be quite challenging, researchers are looking for ways to slow the progression through early detection. A study published in Current Biology revealed high blood levels of RNA produced by the PHGDH (Phosphoglycerate Dehyrogenase) gene, which is critical for brain development and function.2 If successful, a future blood test could help identify patients that will develop Alzheimer’s years before they show symptoms. The PHGDH gene decreases production of RNA and proteins as people get older. Study findings suggests that the overproduction of extracellular RNA (exRNA), a specific type of RNA, by the PHGDH gene could provide an early warning sign of Alzheimer’s disease in elderly patients.2

As much as we know about Alzheimer’s, there is still so much that remains to learn. Finding preventative measures to slow the progression and/or treatment therapies to stop or reverse the procession are extremely difficult. It will take a team effort by scientists, clinicians, research subjects, caregivers, funding agencies, and EHR solutions partners like Veradigm, who can provide real-world evidence to hopefully improve the approach to Alzheimer’s.


References:
1https://www.drugs.com/news/u-s-primary-care-docs-unprepared-surge-alzheimer-s-cases-88861.html
2https://www.brightfocus.org/alzheimers/article/whats-new-alzheimers-treatment-pipeline
3https://healthitanalytics.com/news/new-biomarker-could-help-detect-alzheimers-disease-earlier

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EHR   real-world-evidence   preventative measures   alzheimer's