The bad news: The number of people who will suffer from dementia in this country in the future will increase. Based solely on the demographic development - based on an estimate and based on the current treatment options and without any special consequences such as co-incidences with Corona, which Federal Minister of Health Prof. Dr. Karl Lauterbach warned (see p. 38) - in 2050 around 2.8 million Germans will have dementia, plus around 2 million with Alzheimer's dementia. The good news afterwards: The disease could soon lose its terror. However, this will only happen if the conceptual understanding of dementia changes and biomarker studies are carried out in very early stages and, on top of that, innovative (but already foreseeable) treatment options close the resulting knowledge-therapy gap. This became clear during a background discussion by the research-based pharmaceutical company Lilly entitled “Care for Alzheimer’s disease”. The following question was raised and discussed with the speakers: “Is early detection the key?”

>> In any case, the currently foreseeable pipeline of substances that can be used in the future to treat Alzheimer's dementia is certainly encouraging. Like Prof. Dr. med. As Oliver Peters (Charité Berlin) explained in his lecture on the prevalence, pathophysiology and causes of Alzheimer's disease, there are currently 143 active ingredients in development, 31 of which are in phase 3. Many of them work with the two proteins amyloid (15%, 20 active ingredients ) and tau (9%, 13), which trigger the progression of Alzheimer's disease in the biomarker model. Or, if influenced favorably, they would be able to delay the course of the disease, which occurs in six stages and cascades - possibly and even significantly, depending on the start of therapy.
This makes the crux of the matter clear: According to the current understanding of the disease, a person only has dementia when clinical symptoms begin.
tomatics with pathological changes in the nervous system accompanied by cognitive and functional impairments can be identified. Before that, however, as Peters, senior physician at the Clinic for Psychiatry and Psychotherapy at the Benjamin Franklin Campus of the Charité and head of the working group at the German Center for Neurodegenerative Diseases (DZNE), explained, there is “a very, very long period of time” that spans several decades can occur in which, with the appropriate predisposition, biological processes occur gradually and undetected. Although in the early stages those affected are usually not restricted in their everyday life or their independence, the pathological breakdown of amyloid precursor proteins and the ever-increasing formation of amyloid plaques in the brain have long since begun. Already here in the asymptomatic stages
0 and 1 (see Fig. 1), it would be possible to use innovative biomarker-based diagnostics in order to use the resulting “window of opportunity” for the early start of a suitable, targeted therapy strategy that may soon be available.
“We are trying to get further and further retrograde,” says Peters, suggesting a possible direction in the fight against Alzheimer’s. At the moment, however, symptomatic treatment is still state of the art because anti-dementia drugs have been approved for this purpose for a long time. Peters: “What we would like to do and what is a step into the future is secondary prevention, in which treatment is given immediately when the symptoms begin - with the aim of achieving greater clinical effectiveness.” It is The essence of chronic degeneration is that the later therapeutic intervention takes place, the less can be achieved. However, since in Alzheimer's dementia, brain damage that has already occurred (even in the asymptomatic area) cannot be reversed.
The idea is as follows: "The earlier we start treatment, the more effectively we can intervene in the pathological process that leads to dementia." “Dementia no longer occurs.” However, Peters continues, “if we manage to carry out primary prevention, i.e. to treat before the very first clinical symptoms have appeared.” In a few years, this approach could help improve the quality of life and independence of those affected much longer and, on top of that, reduce later costs associated with Alzheimer's disease.
Could. Because it costs money first of all.
In his lecture on the “Importance of early diagnosis and options for early detection,” Prof. Dr. med. Timo Grimmer (Technical University of Munich) said that biomarker-based diagnostics should be established because the current exclusively clinically based diagnostics of Alzheimer's disease are not sufficient for diagnosing the early stages.
For the early detection of Alzheimer's disease, CSF examinations for amyloid and tau proteins, PET scans* with radioactive tracers and, in the medium term, simpler blood-based biomarker tests that are still being developed and clinically validated should be used. There are already approved tests in the USA alone.
In general, however, the more markers that are positive, the more likely dementia is to develop in the next few years. But also: the earlier therapy is used, the greater this effect will be. It is important not only to make a prognosis, but to accompany it with a treatment option, whereby “we hope that more modifying therapies will be available to us in the future.” Grimmer: “We have to discover people who suffer from dementia but are still asymptomatic and can treat them if they are not yet in need of help.” In this way, serious disease progression could be averted or at least slowed down. Achieving this would be a great achievement for those affected and their relatives, but also for society. But since the early diagnosis required for this does not happen, “we miss out on people because no one looks early.”
Grimmer sees the duty less as specialist institutions such as the Polyclinic for Psychiatry and Psychotherapy at the Rechts der Isar Clinic and the Center for Cognitive Disorders at the Technical University of Munich, where he works, but rather to the treating family doctors. “My hope is that we have private practices “We can motivate general practitioners and specialists to do more for primary care,” said Grimmer. Together with residents, many of the modifiable risk factors for the development of dementia can be addressed, even without biomarker-based diagnostics, which of course have not yet been sufficiently adopted in the general practitioner setting (see Fig. 2, above).
According to Grimmer's hope, this would also have "huge potential to positively influence the prevalence of dementia." It should be noted that the more tests are available, the big challenge is to interpret the results as correctly as possible to create. All tests have limitations. Especially with blood tests, you always have to keep in mind that a certain number of false-positive and false-negative results can occur. The occurrence of false-positive results in particular is a major communicative task. It could happen that people who are confronted with a diagnosis of illness - whether correct or incorrect - can have short-circuit reactions, or at least lead to unnecessary fear and social disorders.
Nevertheless, early diagnosis of Alzheimer's dementia is the way forward for the two speakers; into one that will leave them partially unemployed. Because both are also heads of so-called memory clinics, which could become superfluous at some point. Peters: “We won’t need them anymore because the residents will take care of everything themselves and will take care of the more complicated, differential diagnostic considerations in front of the special outpatient clinics.
remain retained.”
Peters has in mind the successful 90:90:90 UNAIDS goal of the United Nations. The idea behind this is that 90 percent of those who already have the disease but don't notice it should actually be diagnosed. Another 90 percent of those who have been diagnosed should then receive appropriate therapy; combined with the hope that 90 percent of those who receive the therapy will not develop dementia or at least no need for care.
But one thing is needed: more money for early diagnostics. Politicians and society alike need to send a signal here and introduce appropriate remuneration, especially in the general practitioner sector, so that not only biomarker-based tests are carried out, but also more brain performance tests can be offered in suspected cases. <<
by: MVF editor-in-chief Peter Stegmaier