Atypical Alzheimer's patients deserve more focus

Alzheimer’s disease, which is the most common form of dementia, can cause a variety of early symptoms which may not include typical memory loss.

As well as creating issues with diagnosis, this means that some people with atypical Alzheimer’s disease may not meet eligibility criteria for some therapies, including anti-amyloid therapies.

A new study, published in Neurology, the medical journal of the American Academy of Neurology, found that most (70%–85%) would not meet eligibility criteria for anti-amyloid therapies, regardless of the type of atypical Alzheimer’s diagnosed. Many people were excluded because of their Mini-Mental State Examination scores, even though they were still in the early stages of the disease. This highlights a gap between how eligibility is judged for people with typical memory-led Alzheimer’s and those with less common forms of the disease.

This study was a retrospective, theoretical, eligibility analysis for anti-amyloid therapies, which included patients with atypical Alzheimer’s disease. Atypical Alzheimer’s diseases included posterior cortical atrophy, logopenic variant primary progressive aphasia, dysexecutive Alzheimer’s, and corticobasal syndrome because of Alzheimer’s.

The results are based on 184 patients with atypical Alzheimer’s.

Dr Sheona Scales, Director of Research, Alzheimer’s Research UK, said:
“When most people think about Alzheimer’s disease, they think about memory loss. But for some people, the disease first affects vision, language, planning or decision-making. Studies like this highlight that Alzheimer’s disease is not a single, uniform condition, and can affect people in very different ways.

“Many tools used to assess people for anti-amyloid therapies were developed around more typical, memory-led forms of Alzheimer’s disease. This study suggests they may not fully capture how Alzheimer’s affects people with less common presentations, raising important questions about whether current eligibility criteria reflect the diversity of the disease.

“This study also highlights the importance of making sure clinical trials reflect both the complexity of Alzheimer’s disease and the diversity of people treated in everyday NHS services. If research and eligibility criteria focus mainly on memory symptoms, people with atypical Alzheimer’s may be underrepresented, leaving important questions about how potential treatments work for these groups unanswered.

“Although anti-amyloid treatments are not currently available through the NHS, everyone affected by dementia deserves a timely and accurate diagnosis of the disease causing their symptoms. Studies like this show why understanding not only whether someone has Alzheimer’s disease, but how it affects them, is critical for accessing support, taking part in research, and preparing for future treatment opportunities.

“No single treatment will be right for everyone affected by dementia. Dementia is caused by a range of diseases, and Alzheimer’s disease itself can affect people in different ways. Anti-amyloid therapies are an important scientific advance, but continued investment in a broad and diverse research pipeline is essential if we are to develop the range of approaches needed to reflect the complexity of dementia and deliver treatments for the widest possible range of people affected by these conditions.”