The U.S. health-care system is unprepared to cope with the Alzheimer's crisis – even if there were a treatment in the near future, according to a new study.
If there were a treatment for Alzheimer's in 2020, the study found that people would have to wait a year and a half for access because of a shortage of specialists and equipment to diagnose and treat the disease.
An estimated 2.1 million people could develop dementia while waiting for treatment over the next two decades, researchers found.
The study by researchers from Rand Corp. identifies a secondary public health challenge: whether the health-care system is prepared to identify and treat millions of people – many of whom won't yet be showing obvious signs of memory loss.
There is no approved treatment to alter the relentless course of Alzheimer's, and many experimental drugs have failed to slow or halt its progress.
But that is not the only challenge to fighting the disease, the study found.
An estimated 15 million Americans suffer from mild cognitive impairment that may be an early sign of Alzheimer's. Once a treatment is available that can prevent or slow the disease, they will need to be screened.
"All of a sudden, the numbers explode," said Soeren Mattke, a senior scientist at Rand who did the study. "There are really large numbers of patients, many of whom will not have signs of early-stage memory loss. We need to process them all, to find the ones that do have Alzheimer's pathology – and that means moving a lot of patients through the health-care system."
The researchers found shortages: not enough specialists who would be able to screen and diagnose the early stages of the disease, a lack of imaging scanners that would be needed to confirm the diagnosis, and insufficient infusion centers where patients would receive a drug by IV.
The study found the wait time would shrink over time – to a little over a month by 2030. But those bottlenecks in access matter when a disease is progressive, and the study highlights that the scientific challenge of developing a safe, effective drug is only the first step.
Access to a future Alzheimer's drug will depend on insurers' paying for it and patients' being able to afford it.
The Rand report doesn't assess the financial effects of an Alzheimer's treatment on insurers, patients or Medicare, but it shows that even making the drug rapidly available to the right patients will strain the health-care infrastructure if today's workforce and infrastructure trends continue.
For years, companies have been racing to develop treatments, only to slam into the stubborn and complex biology of the disease.
Microsoft co-founder Bill Gates announced this week a $50 million investment in the Dementia Discovery Fund, a global investment fund working to identify novel treatment targets.
Repeated high-profile Alzheimer's drug failures have made one thing increasingly clear: Once people are in the grip of dementia, it's too late. Any successful treatment probably will need to be given when the disease is nascent – before it has significantly eroded people's memories and personalities.
But that will make deploying a drug more challenging, since it won't simply be given to people who are clearly ill.
The biggest concern Mattke discovered was a lack of specialists qualified to screen, diagnose and treat patients.
Data presented at the Alzheimer's Association International Conference this summer revealed that 20 states had provider "deserts" where they were projected to lack sufficient neurologists to treat patients with dementia. The worst-equipped states for the projected burden of dementia in 2025 were Wyoming, North Dakota, South Dakota, South Carolina and Oklahoma.
Other barriers – such as insufficient imaging scanners to help diagnose the disease and not enough infusion centers to deliver an IV drug to people – may be easier to rapidly change, because those issues will require investment but not years of training.
"When we have that therapy – whether it's 2020 or 2022 or 2025 – when we have that therapy, what are the other pieces of the puzzle that need be in place so we're helping as many people as possible as soon as possible?" asked Heather Snyder, senior director of medical and scientific operations at the Alzheimer's Association.