State of the Art on Advances and Challenges in the Management of Patients with Alzheimer’s Disease

Challenge 1: Developing Treatments to Cure or Slow the Progression of Alzheimer’s Disease

In France, four medications are available to treat cognitive symptoms in Alzheimer’s patients, but they are not reimbursed: donepezil, rivastigmine, galantamine, and memantine. The first three are acetylcholinesterase inhibitors, which prevent the breakdown of the neurotransmitter acetylcholine (an essential molecule for proper neuron function). The fourth, memantine, blocks NMDA (N-methyl-D-aspartate) receptors, protecting them from excitotoxicity. However, the French National Authority for Health (HAS) deemed the medical benefit of these treatments insufficient in 2016, leading to the withdrawal of reimbursement since August 2018.

As a result, one of the key challenges in Alzheimer’s disease is developing treatments that can cure the disease or at least slow its progression. Most promising new treatments are immunotherapies, but they are still under development. The two most advanced are lecanemab from a partnership between Eisai and Biogen, and donanemab from Lilly. Both are anti-amyloid drugs targeting amyloid plaques, which contribute to disease progression.

Lecanemab was approved for commercialization by the U.S. Food and Drug Administration (FDA) in January 2023, but the European Medicines Agency (EMA) rejected its approval in Europe, citing insufficient benefits compared to side effects such as brain bleeding and swelling. Donanemab received FDA approval for U.S. market entry on July 2, 2024, and is currently under review by the EMA for potential European commercialization.

Other therapeutic approaches are also being explored, such as antisense oligonucleotides. This challenge extends beyond biotech companies to other healthcare stakeholders. For instance, REGEnLIFE is developing a non-invasive medical device using photobiomodulation targeting the brain and gut to treat Alzheimer’s disease and concussions. The goal is to expose mitochondria to photonic and magnetic emissions to reduce disease-related inflammation.

Challenge 2: Improving Prevention and Making Alzheimer’s Disease Diagnosis More Accessible

Only 35% of French people with a neurodegenerative disease are diagnosed¹¹, and 40% of Alzheimer’s cases could be prevented or delayed with appropriate preventive measures.¹https://alzheimer-recherche.org/la-maladie-alzheimer/quest-maladie-dalzheimer/prevention/ Improving prevention, through a better understanding of risk factors, and enhancing diagnosis are therefore essential. Currently, diagnosis relies on either medical imaging, which is costly, or lumbar puncture, an invasive and painful procedure with potential risks.

Several blood tests are in development to detect the disease. One test, developed by Swedish researchers, reportedly has an accuracy of over 91%.²https://www.liberation.fr/societe/sante/alzheimer-de-nouveaux-resultats-prometteurs-pour-un-test-sanguin-avoir-un-diagnostic-le-plus-accessible-possible-est-crucial-20240801_HNXVE57AVJACFDOYS2IM66U4TM/³https://www.estrepublicain.fr/magazine-sante/2024/08/22/maladie-d-alzheimer-les-resultats-tres-prometteurs-d-un-simple-test-sanguin#:~:text=Un%20test%20sanguin%20serait%20capable,taux%20de%20pr%C3%A9cision%20de%2091%20%25.) This type of test could simplify and improve access to Alzheimer’s disease diagnosis.

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Challenge 3: Adapting Patient Care Both in Hospitals and at Home

Hospital Care for Alzheimer’s Patients

The average age of Alzheimer’s patients at diagnosis in France is 70⁴https://www.frm.org/fr/actualites/alzheimer-interview-florence-pasquier, and the Vaincre Alzheimer Foundation estimates that 225,000 new cases are diagnosed each year.⁵https://www.vaincrealzheimer.org/la-maladie/quelques-chiffres/ Hospitals must therefore adapt to accommodate elderly patients with this condition, as hospital stays can lead to disorientation, reduced autonomy, and worsened health outcomes. This adaptation can be achieved through dedicated care organization and specialized training for healthcare professionals.

The Sainte-Périne Hospital (APHP) exemplifies this commitment to adapting hospital environments for Alzheimer’s patients. A new building, set to open in late 2024, will feature 260 single-occupancy rooms, including a specialized unit for Alzheimer’s and related diseases. Key design features include structured sub-units, well-lit spaces promoting patient safety, and a modernized logistics platform.

A notable initiative in this field is the “Towards an Alzheimer-Friendly Hospital” project, launched by the Médéric Alzheimer Foundation in partnership with the French Hospital Federation and FEHAP (Fédération des Établissements Hospitaliers et d’Aide à la Personne privés et solidaires). This project has been renewed with a funding allocation of €50,000.

Home Care for Alzheimer’s Patients

For patients in the early or moderate stages of the disease, optimizing home care is a priority. Significant progress was made through the 2008-2012 Alzheimer’s Plan, which introduced Specialized Alzheimer’s Teams (ESA). These multidisciplinary teams provide rehabilitation and home-based support services upon medical prescription.

Beyond traditional nursing homes (EHPADs), which cater to Alzheimer’s patients with significant loss of autonomy, new types of accommodations are emerging for younger or more independent patients, such as shared housing arrangements. These settings allow for daily social interactions—crucial for slowing cognitive decline—while offering support from activity coordinators, home care assistants, and healthcare professionals.

In the context of demographic shifts, improving treatments, prevention, diagnosis, and patient care for Alzheimer’s disease is an increasingly critical public health issue. Research efforts to understand the disease’s origins and mechanisms are essential for developing new therapeutic and diagnostic strategies, ultimately improving patient care.

The France Alzheimer Association has launched a call for proposals titled “Research Programs with France Alzheimer”, offering grants of up to €125,000 for research projects spanning 12 to 36 months, starting in December 2024.

At Alcimed, we closely monitor healthcare innovations and can support you in developing and launching new products and care solutions for patients with neurodegenerative diseases. Feel free to contact our team!

About the Author,

Auriane, Consultant in the Healthcare Team at Alcimed, France.