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Current Alzheimer Research and Recommendations for Future Clinical Trials

With diagnosis rates of Alzheimer disease increasing, Tabby Khan, MD, MPH, spoke to the need to focus on cognitive decline in younger patient populations.

World Alzheimer’s Awareness Day this year was on September 21, and recent data in the field is showing that the diagnosis rates for Alzheimer disease (AD) are slowly rising in younger adults. Clinicians need to now focus more on the cognitive decline that is affecting the younger population in addition to the typical patient over 65 years old.

According to Komodo Health research data, patients between the ages of 45 and 65 years had an increase in early-onset AD while patients older than 89 years had a decrease in AD diagnoses from 2020 to 2021. In addition, Komodo’s research analysis demonstrated that women were diagnosed with the AD twice as more than men. This occurs, the authors noted, possibly as a result of women tending to live longer than men, as seen with recent life span trends. Therefore, healthcare systems can provide better care for patients when there is more insight offered by future research to identify those at risk for cognitive decline earlier.

In learning more about the current research of AD, and the treatments for the condition, NeurologyLive® had a talk with Tabby Khan, MD, MPH, medical director, Komodo Health. Khan spoke about how these findings can inform national public health response to AD, the value of real-world data in detecting at-risk populations, and it is used to drive innovative solutions across the healthcare industry.

NeurologyLive®: What is the most recent research done in this field?

Tabby Khan, MD, MPH: One thing at Komodo, we are a health data company, and our cornerstone product is what we call the healthcare map. The healthcare map provides us with information about 330 million lives, so 330 million patients throughout the US. We've just spent years aggregating data from kind of across the spectrum. This really has broad reach because we partner with so many different companies across the board. We queried these data, our 330 million lives, and we wanted to draw some conclusions about the impact of Alzheimer.

Specifically, we looked at the age breakdown and at a temporal component to see how things have changed between 2020 and 2021. Lastly, we really looked at gender. The 3 kinds of really important pieces that we were able to find is that for patients ages 45 to 65, had an 18% increased in early-onset Alzheimer. While patients over the age of 89 had the decrease by 27%, and Alzheimer's diagnoses between 2020 and 2021. Women diagnosed with a disease was occurring at 2 times the rate of men from 2020 to 2021. This is aligned with what's reported in the literature for a variety of reasons. Women live longer. I think women are also more likely to see physicians than men are, across the board at all ages. One thing that I like to compare this to is, in my past life, I worked in orthopedic surgery research, and we talked about how there's always gender differences in terms of when people seek care. In men, for example, people go in for knee replacements when they have a hard time playing golf. For women, women go in for knee replacements when they have a hard time getting in and out of bed. Two very different things. This is something that we have to probe more into the data for. What are these events that trigger women to go in for neuropsychosocial testing that could be diagnosing them with Alzheimer at an early age versus what's happening with men.

What should be the focus in researching Alzheimer disease?

Gender is a big one based on our data, as well as previously reported information—women are diagnosed more. One hypothesis is certainly that women live longer than men. This is a disease that kind of happens when patients get older; however, the additional data point that we found that we're seeing an increase in these early onset cases that are taking place between 45 and 65 [years of age]. The gender breakdown of that is that kind of next step in analysis that we could do using our data.

Komodo is really well positioned to do some of these analyses because we have such a broad range of patient data. I'm a physician by training and I come from a background where I've done a lot of small-scale studies just at our specific institution. One huge limitation I found with those is that they were underpowered. There are a lot stronger conclusions you can draw from 330 million lives than 162 lives, which is the size of a study that I did prior to joining Komodo. Specifically, we should focus around gender because we are seeing a lot of gender-specific differences in a variety of diseases, and it certainly seems like Alzheimer is one of them.

The other thing is that when we talk a lot about gender, we also can't discount other demographic factors. Another thing that I would really like to see is race. We talk a lot about disparities in care, and one thing that Komodo is very passionate about is being able to highlight those and provide actionable solutions to address them. We've recently started really putting at the forefront of our offerings, our race and ethnicity data. We can't assume that just because we see a trend in diagnosis and treatment and prognosis amongst white women, [that] we [will] see the same for black women, or the same for white men versus black men. There's a lot of information about how there are myths about how black patients perceive pain, and we talk about how black patients perceive cognitive decline, forgetfulness, etc. The presence of large-scale data sets such as Komodo’s data, enables that and enables us to look at patients that have been diagnosed, what happened in their patient journeys prior to diagnosis, and how [we] can leverage that information to really come up with important ways to identify these patients before their disease gets to a point where it can't be actioned upon.

What can you say about the different treatment options that are available for people living with this condition?

There's nothing that truly cures Alzheimer, but there are some treatments that can slow progression. There are all of these apps that tell you, if you do this app for 20 minutes today, it decreases your chance of getting Alzheimer down the road. Then there are various procedures, like cognitive stimulation, or you can take various drugs that help with symptomatology throughout the course of the disease yet don't really cure it. At the same time, if you identify risk factors early on, that's when you can engage in some of these more holistic things like brain exercises and essentially trying to slow down the progression of disease with medication. Once a person starts showing signs of memory loss problems with judgment, like communication issues, impact activity of daily living, the only thing you can really do is slow that down.

Part of how physicians are choosing treatments for this disease, both medical treatments, and more invasive stuff, as well as more holistic things, whether it's neuro psychological exercises [or something else], it's all based on kind of age, medical history, and severity of disease. Also, how well medications work within someone's lifestyle, the patient preference, family preference, and what their family support system looks like. These are attributes [that] can really identify in the data and create an algorithmic way to approach these patients. We gain a lot of information from clinical trials, but at the end of the day, we have to see what patients in the real world actually are exhibiting when they're given certain therapies, both medical as well as interventional in general.

Transcript edited for clarity.