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September 21 is World Alzheimer’s Day. Its purpose is to raise awareness about Alzheimer’s disease (AD) and other diseases and to provide help and hope to patients and families worldwide. Additionally, September has been designated as the “World Alzheimer’s Month” and various initiatives are being implemented.
The number of elderly people with dementia in Japan is expected to reach approximately 7 million by 2025, similar to that of people with mild cognitive impairment (MCI). In Japan’s super-aged society, dementia is a common condition that affects everyone.
However, the estimated number of patients with AD who continue to receive treatment is approximately 800,000, and early examination and diagnosis are challenging.
On World Alzheimer’s Day, CareNet and Macromill CareNet surveyed 197 physicians (98 specialists and 99 non-specialists) who treat patients with early-stage AD among CareNet members.
<Survey period>2023/08/08 – 2023/08/15
・The progression status of patients with AD at the time of hospital visit was 27% for “MCI” and 29% for “mild AD” among specialists, while it was 47% for “MCI” and 27% for “mild AD” among non-specialists. Regarding the reasons for visiting a hospital for early-stage AD, 33% of specialists responded “direct visit,” followed by “referral from a non-specialist (clinic)” at 29%. Among non-specialists, “direct visit” was the most common (56%), followed by “referral from the nursing facility” (14%).
・Regarding possible changes in AD treatment after the release of a new drug, 50% of specialists answered “increase in requests for early examination and consultation from patients (families),” followed by “Patients will be more likely to be referred by local medical institutions” (34%). An increase in the number of patients visiting hospitals is expected.
Other improvements in medical treatment are also expected, such as “strengthening outpatient dementia and memory loss services” and “starting to recommend PET scans.”
・For non-specialists, changes in patient (family) behavior are envisaged, such as “increase in requests for early examination and consultation from patients (families)(29%)” and “Increasing numbers of patients who directly visit facilities with specialists(31%).” Furthermore, it is expected that early detection and prevention by family doctors will increase; for example, “more patients will be recommend tests and treatment” and “more patients will be referred to other doctors at an earlier stage.”
・Regarding concerns about the diagnosis and treatment after the launch of new drugs, the most common concern was “How to judge risks and benefits, such as treatment effectiveness , testing, and treatment costs and safety,” answered by 58% of specialists and 46% of non-specialists, followed by “the diagnostic criteria for MCI before PET diagnosis,” answered by 35% of specialists and 39% of non-specialists. The need for an accurate diagnosis and treatment considering drug profiles is increasingly important.
In the last 12 months, specialists have treated an average of 74.5 patients with AD (including suspected AD), of whom 50% had early-stage AD (MCI, 22%; mild AD, 28%). Among non-specialists, early AD accounted for 64% (MCN, 36%; mild AD, 28%) of the 56.7 treatment patients, with non-specialists having a slightly higher proportion of patients with early AD than specialists.
[Table 1]
In response to the question, “what is the progression of AD (including suspected AD) at the time of the hospital visit?” “MCI” was indicated by 27% and 47% of specialist physicians and non-specialist physicians, respectively. Additionally, 56% of the visits were to specialists and 73% to non-specialists for “early AD,” including mild AD.
[Table 2]
Regarding the response to the question “how did the patient with early-stage AD (including suspected AD) come to you?” the most common response was “direct visit” (33%), followed by “referral from a non-specialist (clinic)” (29%) for specialists. For non-specialists, the “direct visit” was the most common (56%), followed by the “referral from a nursing home” (14%).
In the treatment of early-stage AD by non-specialists (family doctors), there are many cases in which the disease is discovered and diagnosed at an early stage, which shows that there is local cooperation, including referrals from nursing care facilities.
[Table 3]
“What information channels do you use to obtain information on new drugs for early-stage AD?” The most common response for specialists was “medical information websites” (68%), followed by “conferences and research meetings” (52%), “pharmaceutical company lectures(including web lectures)” (50%), “academic journals, medical journals, and books” (47%) and “doctors (supervisors and colleagues)” (41%). Specialists have more opportunities to obtain information from doctors and the Web.
Among non-specialists, the most common response was “medical information websites” at 71%, followed by “Pharmaceutical company lectures (including web lectures)” at 42%, and “academic journals, medical journals andbooks” at 37%.
[Table 4]
“How would your Alzheimer’s practice change if new drugs for early-stage AD became available?” The most common response to the question “early consultation and consultation requests from patients (family members) will increase” (50%) was given by specialists, followed by “patients will be more likely to be referred by local medical institutions” (34%) and “patients will be more willing to be referred to a facility where they can undergo PET testing” (30%). An increase in the number of patients visiting hospitals was envisaged. Other expected improvements in the practice of the specialist include “strengthening the outpatient dementia and memory loss clinic” (34%) and “patients with suspected AD will be more likely to recommend a PET scan” (29%).
Among non-specialists, “early consultation and consultation requests from patients (family members) will increase” (29%) and “increasing numbers of patients who directly visit facilities with specialists” (31%) were reported. It is also expected that the early detection and prevention of dementia by family doctors will increase, as “they will be more likely to recommend tests and treatment,” “increase early referrals to other doctors,” and “increase preventive activities for dementia from doctors.”
[Table 5]
When asked the open-ended question, “if a new drug for early AD became available, what would the benefits be for doctors?” the most common response from specialists and non-specialists was “more treatment options.” This suggests that the current dementia treatment cannot adequately meet the needs of patients and their families.
[Table 6]
When asked “what concerns do you have about the possible diagnosis and treatment of MCI when new drugs become available?” the most common concerns were “how to judge risks and benefits, such as treatment effectiveness, testing, and treatment costs and safety,” at 58% for specialists and 46% for non-specialists.
Furthermore, 35% of specialists and 39% of non-specialists answered “diagnostic criteria for MCI before PET diagnosis.” This suggests that raising awareness of early AD (MCI) diagnostic criteria for family doctors to recommend testing and treatment to patients and their families is important at the time of the launch of a new drug.
[Table 7]
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