Canadians will soon be able to access drug therapies to treat Alzheimer’s disease, and a new report is calling on governments to speed up how quickly dementia is diagnosed and the access to treatment.
The drugs could still take 12-18 months before they become available, but the report says improvements to early diagnosis and better treatment could improve quality of life for those who receive it.
Access to the drugs relies on how soon patients get a diagnosis, and whether the provinces and territories have the resources needed to deliver the treatments.
Alzheimer’s affects memory, thinking and behaviour, while dementia is a general term for memory loss, language, problem-solving and other thinking abilities, according to the Alzheimer’s Association. Alzheimer’s is the most common cause of dementia, a group of symptoms that can affect about one per cent of Canadians.
“So thinking about now that we have this wonderful new treatment for early-stage dementia, how do we then implement it as part of the dementia care pathway which we don’t currently have,” said Ngozi Iroanyah, director of health equity and access with the Alzheimer’s Society of Ontario.
The report released this month set out seven calls for governments, public drug plans and health authorities.
They include securing public reimbursement and funding a comprehensive dementia care pathway, establishing a coordinated dementia-care infrastructure, and expanding early-diagnosis capacity.
Early diagnosis is a key factor, as two new therapies could soon be available to the public: lecanemab and donanemab. Lecanemab marketed by Eisai Co. and Biogen as Leqembi, while donanemab is marketed by Eli Lilly as Kisunla.
Health Canada has approved both drugs, and the Canada Drug Agency recommended public reimbursement of lecanemab, and positive draft recommendation for donanemab.
But governments of all levels will need to negotiate with drug manufacturers to determine the price, and then each province and territory decide whether it will be part of their public drug plan. This could result in either drug not being available for public use for another 12 to 18 months, the report says.
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“They’re only for the type of dementia that’s caused by Alzheimer’s, and even among people with Alzheimer’s, they’re only effective and safe in the very early stages of Alzheimer’s, like when we can just begin to recognize it in the clinic,” said Dr. Eric Smith, director of the Cognitive Neurosciences Clinic at the University of Calgary. “If it’s someone who’s eligible for these new treatments for Alzheimer’s where the treatment is limited to people in mild stages, there’s a bit of a ticking clock.”
Smith said the treatments can slow down the decline of Alzheimer’s disease, though not stop it completely, but still can help create a better quality of life.
Getting a diagnosis can take time and the longer it takes could limit the treatment that can be received, the report stressed. In some cases, patients could wait 18 to 24 months or longer before even getting a diagnosis due to where you live.
Iroanyah said dementia is a “pathway” from identifying symptoms to getting a health-care provider to finding a specialist and then to treatment. But there’s added factors including getting consistent monitoring, MRI scans, infusion services and more that may not be as accessible in rural areas or those from lower socioeconomic statuses.
“When we compare it, for example, to the cancer care path that we have in Canada and Ontario, you get a diagnosis of cancer and you’re ushered into this system,” Iroanyah said. “For dementia, we don’t have that corridor, you’re just told you have dementia, you’re supposed to just sort of, ‘off you go’ and hope that you can figure it out along the way.”
She added the Alzheimer Society of Ontario is calling on governments to put more work into supporting those with dementia and Alzheimer’s because while early diagnosis is the first step, it has to go beyond that.
That means ensuring they can get on the right medications, education of what both dementia and Alzheimer’s are, and ensuring the health-care system has the resources it needs.
“A lot of people say, ‘Hey, your memory impairment with aging is normal,’ there is a stage where it’s no longer normal,” said Sylvia Villeneuve. “I think that we also kind of, you know, pass this information so when do we think that it’s more in line of a start of Alzheimer’s disease versus kind of normal aging.”
Villeneuve, director of the Centre for Studies on Prevention of Alzheimer’s Disease in Quebec, said governments and agencies also need to make an effort to get the disease-modifying therapies and other treatments into the health system.
But it’s not just the health-care system, Villeneuve said work needs to be done to support things that will decrease the risk of developing Alzheimer’s such as being more active, keeping your brain healthy with more education, and reducing loneliness.
“You can do all the sport in your life, that doesn’t mean that you’re not going to have Alzheimer’s disease, but you could at least reduce your risk of eventually having the disease or maybe postpone it for a few years,” she said.
Alberta’s government said in an email it is working with Alberta Precision Laboratories and health professionals to prepare for emerging Alzheimer’s treatments.
“This includes ensuring the appropriate testing, patient eligibility, treatment, and monitoring processes are in place,” said a spokesperson for the Ministry of Primary and Preventative Health Services.
The Ontario government said in an email it has made “record investments” in dementia care, including $4.1 million to expand access to care supports.
“We continue to carefully review new and emerging therapies through rigorous, evidence-based processes to ensure patients have access to safe, effective treatments they need, when they need them,” a spokesperson for the Ministry of Health said.
In an email to Global News, the federal government said it is working to improve prevention, care and support for those with dementia and Alzheimer’s.
“We also benefit from the advice of the Ministerial Advisory Board on Dementia, which brings together researchers, health professionals, caregivers and people with lived experience to identify opportunities to improve the lives of people living with dementia,” said Alexandre Bergeron, spokesperson for Health Minister Marjorie Michel.
As new therapies become available, Iroanyah stressed governments need to be prepared to respond.
