Parliament can bring all stakeholders together to work on Alzheimer’s disease, says MEP Jerković – Euractiv

The European Parliament can play an important role in bringing MEPs together and promoting cooperation between Member States to ensure that Alzheimer’s disease is fully integrated into the EU’s broader health strategies, said Socialist MEP Romana Jerković to Euractiv.

Despite affecting 7 million of its citizens, the EU’s health systems are unable to diagnose Alzheimer’s early and accurately. According to Alzheimer Europe, dementia patients and their carers suffer from a lack of access to affordable care services, complex and inadequate social protection systems and persistent stigmatization.

However, there are signs of progress. Most recently, the EMA’s previous decision to reject the approval application for the Alzheimer’s drug Lecanemab was repealed. At the political level, three other MEPs have also joined an alliance to bring these issues to the forefront of EU policy.

“This is crucial to address the full impact of Alzheimer’s disease and ensure that we reduce the gaps in Alzheimer’s care across the EU,” Jerković told Euractiv.

Jerković recently became co-chair of the European Alzheimer’s Alliance (EAA), a multinational and cross-party alliance to support European citizens living with the disease, after joining it to use her medical knowledge and political role to bring about positive change to advance the EU in relation to Alzheimer’s disease.

The Croatian MEP leads the alliance together with Lithuanian MEP Dainius Žalimas (Renew), who said joining the EAA is in line with his commitment to tackling the significant challenges of neurodegenerative diseases.

The EU’s health systems are failing

“Health systems in my home country of Lithuania and across Europe continue to fail to address the needs of people with dementia who feel stigmatized, are underdiagnosed and do not receive adequate social care services. Without adequate support, family caregivers face constant anxiety and risk developing psychological problems,” said Žalimas.

Jerković believes that despite the high burden, Alzheimer’s is not high enough on the political agenda – something she would like to change.

ENVI Committee Vice-Chair MEP András Kulja (EPP) told Euractiv he believes non-communicable diseases affecting the aging population will be on the agenda during this term. However, he stressed that the SANT Committee, as a separate committee with a specific mandate, should be the leading body in the fight against Alzheimer’s disease.

“I personally think this decision is very important because it shows that public health will be relevant in the next five years,” said Kulja.

Kulja, who began his medical career in psychiatry in Hungary and is also a member of the EAA, said the average European lives more than 70 years and the aging population is struggling to combat chronic and neurodegenerative diseases.

The European Parliament has been discussing Alzheimer’s disease for a long time and had already produced its own own-initiative report on the disease in 2010, which anticipated the problems outlined by Kulja. The report also encouraged Member States to establish biomarkers, measurable biological changes that could indicate a particular disease, to build on the development of new therapies for both dementia and pre-dementia.

Are blood biomarkers the key?

Kulja highlighted that, according to the World Health Organization (WHO), dementia is the seventh leading cause of death worldwide and that 10 million people are diagnosed with Alzheimer’s disease, the most common form of dementia, every year.

Despite its prevalence, diagnosing Alzheimer’s remains complicated: the methods required are invasive and expensive. However, according to the Alzheimer’s Society, a cost-effective, accurate and less invasive solution to these problems could be found in the form of blood-based biomarkers.

“Although these blood-based tests for Alzheimer’s disease have shown promising results in research studies and are available in various laboratories, they are not yet widely available for population-level screening,” says Dr. Meredith Bock, chief medical officer of virtual dementia care company Remo Health told Euractiv.

Bock explained that these studies have shown high accuracy in predicting Alzheimer’s disease pathology in the brain. However, further research is needed.

False positive results have significant consequences.

Jean Georges, chief executive of Alzheimer Europe, said the organization was against routine biomarker testing for diagnostic purposes in people without cognitive symptoms.

“Labeling people who test positive for amyloid as having preclinical Alzheimer’s disease can have significant negative psychological consequences,” Georges said in a statement.

There are open questions that need to be considered if population-wide screening is ever to be conducted, Bock said. This includes deciding at what age to offer the tests, considering the benefits to patients of being offered this test as a screening or diagnostic option, and how these considerations will change over time with new treatment options in the future change.

“The most effective strategy is to conduct targeted screening, focusing on people who already have cognitive problems or who may have a family history of Alzheimer’s disease and are at increased risk of developing the disease,” Bock said.

According to Alzheimer’s Disease International, biomarkers are expected to advance clinical care by providing information about the underlying causes of dementia. A survey conducted by the organization also found that doctors predict an increase in the number of patients seeking a dementia diagnosis and that options such as blood tests, combined with cognitive assessment and their own judgment or national guidelines, would facilitate their practice.

Blood biomarkers

If you were to do a blood biomarker test on a group of people with cognitive impairments, nine out of 10 results would represent a true diagnosis of Alzheimer’s disease, while one of those would be false positives, Bock explained.

“If you expand this test to people without cognitive complaints, the number of false positives will likely increase,” Bock said. “With any test, the important question is: How does this change what you would do next?”

Not much at the moment in the case of someone who doesn’t have cognitive problems but whose blood-based biomarker test shows they have Alzheimer’s proteins in their brain.

When asked what the future might hold for these biomarkers, Bock said there will be strong demand for such markers for other proteins. It is common, particularly in older adults, to have more than one protein present in the brain, which is referred to as “mixed pathology.”

The hurdles ahead include standardizing testing protocols and their interpretation, integrating biomarkers into clinical practice guidelines, and considering cost and accessibility, Bock said.

Dr. Aurelio Lorico, professor of pathology at the University of Touro, told Euractiv that amyloid-β and tau proteins, particularly phosphorylated tau, have shown some ability to reflect brain pathology.

Lorico highlighted a study conducted in Sweden of around 1,200 patients who underwent clinical evaluation due to cognitive symptoms. The researchers found that the blood-based biomarkers they analyzed had a diagnostic accuracy of about 90% in identifying Alzheimer’s disease, compared to about 60% accuracy achieved with clinical examination, cognitive testing and a computed tomography scan became.

“Significant progress has been made, but more research, clinical validation and regulatory approvals are needed before blood-based biomarkers can be widely used for Alzheimer’s screening,” Lorico said.

“When diagnosing Alzheimer’s patients, false positive results could lead to unnecessary anxiety for patients and their families as well as costly follow-up tests such as neuroimaging or cerebrospinal fluid analysis, while false negative results could delay diagnosis and delay early interventions, which may be missing the window for disease-modifying treatments,” Lorico said.

Prioritize research

Jerković and Zalimas believe that the Council and Commission must prioritize increased funding for research, particularly in the areas of early detection and innovative treatments. There is still a lot we don’t know about Alzheimer’s.

According to Lorico, an example of a still unresolved problem is the complex pathological mechanisms that lead to Alzheimer’s disease.

“Understanding the mechanisms of Alzheimer’s disease requires further work and could be an effective strategy to find new biomarkers and improve diagnosis, especially early detection of Alzheimer’s disease,” Lorico said.

(Edited by Brian Maguire | Euractiv’s Advocacy Lab )