Alzheimer’s Disease: Diagnosis and Access to Experimental Drugs

Question

Asked by

To ask His Majesty’s Government what plans they have to speed up diagnoses of Alzheimer’s disease and enable potential sufferers and their families to have earlier access to experimental drugs.

My Lords, every person living with dementia, alongside their friends, families and carers, has their own unique and important story. The modern service framework for frailty and dementia will consider what interventions should be supported to improve dementia care and diagnosis waiting times, which we know are too long in many areas. We are supporting earlier access to promising treatments through the MHRA-NICE aligned pathway and initiatives such as the early access to medicines scheme.

I thank my noble friend for that reply. I am glad to know that she understands the importance of early diagnosis because it is the only way to access drugs that will delay, although not of course cure, this disease. But families are sometimes reluctant to get a diagnosis because they do not want to recognise the reality of their relative’s condition. Could the Government consider giving the issue more publicity, perhaps even a public information campaign, to encourage families to seek help before the condition has advanced so far that no drugs can be of help?

I thank my noble friend for her tireless work and dedication to this area. I want to reassure her that in developing the MSF we will consider what interventions should be supported to improve diagnosis, and a public information campaign will be in the mix. We have published the D100 assessment tool to support systems to improve dementia diagnosis, care and support, and it incorporates the dementia care pathway, including diagnosing well. During their NHS health checks, those aged over 65 should be made aware of the signs and symptoms of dementia and guides to memory clinics.

My Lords, does the Minister accept that, prior to a diagnosis of dementia or Alzheimer’s, many people are diagnosed with mild cognitive impairment and sometimes there is a very long gap between that diagnosis and ultimately a diagnosis of Alzheimer’s? Will she look at the way in which the new plan is drafted to ensure that once a diagnosis of mild cognitive impairment has been given, there is a much quicker follow-up? Sometimes it is years later, and by then it is too late. I should declare that I am an ambassador for the Alzheimer’s Society.

I thank the noble Baroness. I will just reflect on exactly what she has said as it is so important. We know that even without a definite diagnosis, so many preventive interventions could be made. If the early signs are there, they should be flagged up, and individuals can then take their own preventive measures and particularly, I hope, be supported by their friends and family to delay the onset, but also to make sure if signs start to get worse, they can be rapidly progressed along the system.

My Lords, new research shows that finger-prick blood tests, alongside online brain tests, could revolutionise dementia diagnosis and offer a low-cost, scalable way to identify people who may be at higher risk of Alzheimer’s disease. What are the Government doing to support research in this area to enable the rollout of this innovative test?

The noble Baroness has touched on a really important issue. There is an enormous amount of research going into this area, for very obvious reasons. This is one area that would make so much sense, and I am sure it has been picked up. What is important about the modern service framework is that all these measures are picked up and looked at. The speed with which we can fast-track research now is a fundamental factor in supporting the outcomes we are looking for.

Does the Minister agree that while the current generation of drugs is not very efficacious—and, sadly, more research recently has demonstrated that it is not terribly good—the most important reason for early diagnosis, as we have said, is to get the services in that people need? We are talking about nearly 1 million people now, and usually the GP is not the person who diagnoses—it is usually the home help or the person next door. We need rapid access for people to be able to get assistance to get the diagnosis they need—otherwise, we will never get anywhere near medication.

The noble Baroness is absolutely right and, if we stay as we are, the projected figures moving forward to 2040 are, frankly, terrifying. I recognise what she is saying. Do not forget that grandchildren spend so much time with their grandparents and often are the first to notice changing behaviour. I think that picks up on the point made by the noble Baroness, Lady Pitkeathley, about an awareness campaign so that when people pick up on the symptoms, they know where to go to get support. Early prevention and intervention have to be the key.

My Lords, early intervention can clearly be critical, but one of the barriers to early access, particularly to new drugs, is the current modelling of NICE. I think there is a level of criticism of its cost-benefit analysis in that sometimes it does not take sufficient cognisance of the health and economic impact, not simply on the person suffering from dementia but on the family and the carers, many of whom, for instance, are missing from work for long periods to care for their relatives. Will the Government commit to looking at that modelling to try to make sure that in the future the cost-benefit analysis is fit for purpose?

The noble Lord is right: there has been a real increase in awareness of the cost to the economy and the personal cost to those who become carers. I would like to reassure him that the focus on research from this Government is intense, but we must make sure that the drugs that are brought forward have the claimed impact. I know noble Lords will be aware of the current appeal into two drugs that are deemed to be possible. It would be completely inappropriate for me to comment, as the appeal is going forward. Those cases will be heard on 8 July, and we look forward with interest to the outcome.

My Lords, NHS England’s target is for at least 67% of people with dementia to receive a formal diagnosis, yet we know that many areas struggle to meet that benchmark. Given what noble Lords have said about early intervention, but also that new Alzheimer’s treatments are most effective in the earlier stages of the disease, what is the department doing to target areas that do not meet the benchmark to ensure that we are quickly diagnosing as many patients with these conditions as possible, so that they can either move to adapted care or be given more innovative drugs when they are available?

The basis for me, and I hope the noble Lord agrees, is that we need much more robust co-creation at local level with different parts of the system coming together—health with local authority—bringing together the funding streams and making sure that they come up with the correct amount of input in their particular areas. Every geographic area is different, and we need to come up with a bespoke means of dealing with this so that we can move at pace in this area.

My Lords, will the Minister comment on the Government’s position on the rollout of anti-obesity drugs? The preliminary findings indicate that they will reduce the amount of dementia in future populations. Although that is experimental, it is really important that we look at it.

I was reading an article about this very subject just this morning, and it is fascinating. I do not think we really know the half of what the impact of these drugs is going to be on the wider health of people. So yes, we need to keep a very close eye on it for unexpected consequences and, hopefully, in this case, unexpected benefits.

I suggest that the Minister looks again at the evidence produced recently by Novo Nordisk, the manufacturer of Wegovy drugs for obesity reduction, to see whether what was just said still applies in the new study.