Germany has already launched numerous initiatives to combat Alzheimer’s disease but needs to catch up in early detection, which could become essential for future medical treatment, researchers and medical experts told EURACTIV.de.
According to a report by the German Alzheimer Society, around 1.6 million people in Germany are currently suffering from dementia, with around 300,000 new cases every year.
Due to changing demographics and a steadily ageing society, the number of people affected is expected to increase to between 2.4 and 2.8 million by 2050, the report says.
Until now, the German approach to dementia has mainly focused on treating the symptoms and enabling social and community participation for those affected.
A new drug that for the first time addresses the causes of Alzheimer’s disease – which accounts for about two-thirds of all dementia cases – could open up new possibilities for treatment, for which early detection, however, is still crucial.
The current state of the fight against Alzheimer’s disease
Germany has launched a number of initiatives in recent years to prepare for the growing number of dementia patients.
Particularly with the National Dementia Strategy, which was adopted in July 2020, the German government hopes to sustainably improve the living situation of dementia patients and “create sustainable structures for the future,” a Health Ministry spokesperson told EURACTIV.
The strategy was developed in close cooperation with more than 70 stakeholders and is “nationwide in scope, anchored in partnership, binding in its goals and long-term in nature,” the spokesperson added.
In total, the strategy contains 27 goals and more than 160 measures to ensure the social participation of people with dementia, to support relatives and those affected and to further develop the medical and nursing care of people with dementia.
In addition, the Ministry of Health conducts annual monitoring to assess the implementation status and to make adjustments to the strategy.
Germany also performs well in terms of medical infrastructure and is “among Europe’s frontrunners,” says Lutz Frölich, head of the Central Institute for Mental Health.
This is particularly evident from a comparison with other EU countries. According to a report by RAND, Germany currently has around 24 dementia specialists per 100,000 inhabitants, more than three times as many as France and 30% more than Italy.
But, as Frölich pointed out, more needs to be done especially when it comes to raising awareness.
“The national dementia strategy in Germany is mainly centred on the nursing care of dementia patients,” Frölich told EURACTIV, stressing that more emphasis should be placed in particular on “general information for the population regarding early diagnosis and the chances of therapy”.
Early detection and new treatment
Early detection is particularly crucial to the treatment of Alzheimer’s disease.
“It is certainly the most important and hottest topic of all in clinical Alzheimer’s research,” Frölich told EURACTIV.
While in early detection, Germany relies on the use of psychological tests to determine the extent and type of cognitive impairment, completely new methods for diagnosing Alzheimer’s have been developed particularly in the last ten years.
While ten years ago the definitive medical detection of Alzheimer’s disease was only possible post mortem, so-called biomarker tests now make it possible to reliably detect the proteins responsible for Alzheimer’s disease – so-called amyloid plaques – allowing a diagnosis even before the onset of memory impairment.
Yet in Germany these tests are currently only carried out in exceptional cases due to the high costs involved. “Early detection of Alzheimer’s dementia in the form of screening people without symptoms is not considered useful due to the still insufficient therapeutic prospects,” the Ministry of Health told EURACTIV.
This could change with new treatment methods allowing earlier detection than the psychological testing methods currently being used in Germany.
The medical options for treating Alzheimer’s have developed rapidly in recent years. While treatment in the past was primarily focused on combating the symptoms, a new immunisation therapy now for the first time makes it possible to combat the causes.
Although the new drug has not yet been approved in the EU, scientists are confident:
“Immunisation against amyloid actually does not look bad,” said Christian Haass, professor of biochemistry at the Biomedical Centre of the University of Munich. According to him, several studies have already demonstrated the degradation of amyloid through the formation of antibodies.
Until now, the biggest challenge has been convincing payers that biomarker diagnostics offer real added value.
With this new immunisation method, the situation is now “paradigmatically different,” said Frölich, as “proving the clinical relevance of biomarker diagnostics hinges on treatment options.”
However, this new treatment method also has a catch: in order to be fully effective, the treatment would have to start before symptoms of memory loss appear.
“At the moment, the big problem is that immunisation starts far too late. We know that the disease starts a good 20 years before the doctor detects memory symptoms, in which it already irreversibly damages the brain,” Haass told EURACTIV, stressing the “urgent need for reliable tests for early detection”.
Challenges for infrastructure
If immunisation therapy for Alzheimer’s disease were to be approved in the EU, the medical care system would face enormous challenges, both with the biomarker diagnoses, which would have to start much more broadly and earlier, and the immunisation treatment itself.
Treatment and diagnosis are expensive, raising questions about who would bear the costs.
The immunisation treatment method is estimated to be around €48,000 per person. Menwhile, the biomarker tests cost between €1,500 and €4,000, depending on the method. As testing has to be widely available to detect the disease before symptoms appear, this would amount to huge sums.
Furthermore, many neurologists lack the necessary skills to perform the lumbar puncture required for diagnosis via the biomarker tests, which decreases the capacity to make them widely available.
However, another medical innovation could remedy the situation, as biomarkers can now also be detected in the blood, which would not only make diagnosis much easier, but would also help to reduce costs.
Although Frölich said that blood tests still lack “the clinically broad investigations”, the tests could be used in particular for early screening.
“At the moment, not all diagnostics will be based on blood testing, but you can screen people in advance and only need to do the more complex diagnosis on about 20%,” Frölich explained.
New strategies must also be developed for the new immunisation therapy itself to ensure the care of Alzheimer’s patients, as affected patients would have to be supplied with intravenous infusions over several months. In addition, the course of the infusion must be monitored by means of MRI examinations and tested for side effects.
In order to help the German health system cope with the increased effort, new models of cooperation must be developed in which hospitals, dialysis centres, general practitioners and outpatient memory clinics work together in close cooperation.
“Then we would have a division of labour that would not overburden anyone, but would still have more patients passing through,” said Frölich.
Although this cooperation would require a great deal of communication, “one should not underestimate the innovative strength of the medical colleagues,” he said. “It’s not witchcraft”.
[Edited by Frédéric Simon]
