People living with dementia worldwide today number 50 million. Due to increasing life expectancy this number is expected to more than triple to 152 million by 2050. The annual global cost of dementia is currently over one trillion dollars and is expected to double by 2030.

What is true in Greece?

In the present phase in our country 250,000 people suffer from dementia and 350,000 people from mild mental disorder (the guardian of dementia). In total the population of people with mild or severe mental problems exceeds half a million. If we take into account that for each patient with dementia the lives of 2-3 carers-family members are significantly affected, we realize that this is a condition that directly affects 1.5 million Greek citizens. The annual cost of this condition in our country is estimated at 3 billion euros.

Dementia, with the most common form of Alzheimer’s disease, always progresses over time. Today we use drugs (cholinesterase inhibitors and memantine) that control symptoms, maintain functionality and quality of life for patients and caregivers. In addition, there are non-pharmaceutical psychosocial interventions provided in the Day Care Centers of the Alzheimer organizations that exist in many cities in Greece.

Advances in the treatment of dementia

A major development in the treatment of this disease was the approval of lecanemab by the FDA in July 2023 for the treatment of mild cognitive impairment (MCI) and mild dementia due to Alzheimer’s disease. Lecanemab is humanized monoclonal antibody, which binds to brain β-amyloid and leads to a significant reduction in the burden of amyloid plaques in the brain of Alzheimer’s disease patients, resulting in a significant slowing of the clinical deterioration of the disease (~27%).

It is the first approved treatment for Alzheimer’s disease that acts on the underlying pathophysiological mechanisms of the disease, while the approved treatments I use today (cholinesterase inhibitors, memantine) offer only symptomatic treatment. An application for the approval of lecanemab has also been submitted to the European Medicines Agency (EMA) and the decision is expected within 2024.

In which patients is lecanemab indicated?

Lecanemab is indicated for selected patients with confirmed early Alzheimer’s disease, its administration does not require a documented diagnosis with biomarkers (pathological proteins in the cerebrospinal fluid or amyloid PET). Lecanemab is administered twice a month intravenously with hospitalization and its use, as shown by the data of clinical studies, requires strict adherence to a monitoring protocol and management of serious side effects, such as ARIA (amyloid-related imaging abnormalities: radiological disorders amyloid-related) and reactions during the infusion among others. For this reason, the use of lecanemab in clinical practice, especially in the initial stages, must be done in specialized medical structures-centers that have the required infrastructure and the appropriate human resources for its safe administration.

In our country, as is done in all advanced countries, the mechanism for selecting suitable patients for the administration of lecanemab must be prepared. Taking into account the high number of patients candidates for receiving lecanemab and the particularly increased needs and requirements in the initial stages of its administration, it is considered appropriate to organize and institutionalize its administration framework in advance. Patient organizations are already pushing for the administration of the drug by insurance organizations internationally and in our country.

The National Dementia and Alzheimer’s Observatory, Memory Clinics, and physicians in general receive many questions and requests regarding this issue.

The monoclonal antibody lecanemab is certainly not the miracle drug or radical cure for Alzheimer’s disease as described in some media or misperceived by some patient families. The cost of treatment with lecanemab is high! However, it is one of the first causal treatments for Alzheimer’s disease and despite the aforementioned limitations, it can be considered a great step forward.