The new year always brings hope, but this January that hope was palpable for the over 50 million people with Alzheimer’s Disease (AD) worldwide, their families, friends, and clinicians when the Food and Drug Administration (FDA) granted accelerated approval for Leqembi to treat mild cognitive impairment or dementia due to AD. For the first time, a therapy will be available to slow the otherwise relentless progress of AD. Compared with prior medications in the same class, the clinical trial results that led to the FDA’s approval of Leqembi reveal significant, clinically demonstrable benefits – slowing disease progression by about 30%.
While it is unclear how impactful Leqembi may be for each individual and the benefits will need to be balanced against risks and costs, these findings mark a true inflection point in the battle against AD. They also underscore the need to implement a long overdue transformation of our healthcare system and evolve clinical practices to ensure early detection and empower individuals to make timely intervention choices; time is of the essence with the FDA’s full approval decision date set for July 6th.
Our current approach to Alzheimer’s and other dementias is largely reactive: routine screening is rare, and evaluation occurs only when patients or families raise concerns. Furthermore, evaluations are largely reliant on specialists with limited availability – even in places with the highest supply of them. This means that dementia diagnoses happen on average over a decade too late, and that treatment simply promotes years of disability rather than preservation of function and quality of life.
Borrowing lessons from car racing, I propose a pit stop model for brain care to win the brain health race, meaningfully address the threat of dementia, and help people benefit from scientific advances in a timely and most effective manner.
Scheduled pit stops were introduced at the 1963 Daytona 500 by the Wood Brothers Racing team. Before then, drivers pushed their cars to the brink, hoping they would not break down. When one did, a team of mechanics ran to retrieve it, towed it to the pit lane for repairs, and hastily returned it to the track. Unfortunately, often too much time was lost, or damage was beyond repair. When the Wood Brothers introduced scheduled pit stops, they won the race and transformed car racing for good. It is time to make a similar transformation in brain care and draw the full benefit from Leqembi and other medications expected over the next few years.
Brain care pit stops can start as regularly scheduled checks to screen for cognitive problems, taking into consideration each person’s age, gender, race, health, and circumstances. To make this happen and capitalize on the potential of new treatments, we must:
Since their introduction in 1963, pit stops have changed the car racing game and continued to evolve; the brain care pit stop model can similarly revolutionize brain health at this pivotal moment. By using the latest practices and technology, we can evolve to monitor patients longitudinally, inform when and why to ‘pit stop’ for a PCP visit, and indicate when to engage a specialist. This will improve the care of patients with dementia and enable health systems to translate scientific advances – like the approval of Leqembi – rapidly and smoothly for the benefit of all. As a first step, we must focus on quickly implementing brain care pit stops as an efficient and effective primary care workflow to empower individuals to minimize their risk of cognitive decline, detect problems early, and adopt interventions to address them.
Photo: Andreus, Getty Images
Editor’s Note: The author has confirmed that he has no financial relationship with Eisai, the Japanese company that makes Leqembi. Nor was he involved in clinical trials of the drug.
