Study confirms value of biomarker testing in dementia care

By Alison Palmer, Evaluation and Special Projects Lead, Brain Canada.

In 2021 we reported on the progress of Dr. Mari DeMarco’s IMPACT-AD project funded in part by Brain Canada, which was evaluating the implementation of a comprehensive biomarker testing strategy for Alzheimer’s disease.

Dr. DeMarco’s work led to a first-in-Canada diagnostic testing program for Alzheimer’s disease, the National Alzheimer’s Disease Biomarker Testing Program based at St. Paul’s Hospital in Vancouver. The program offers testing to patients from across Canada and offers tools for clinicians, patients and family members to support testing implementation. The test measures proteins known as biomarkers in the cerebrospinal fluid surrounding the brain and spinal cord. An important addition to the medical toolkit for diagnosing Alzheimer’s disease, it can detect the disease even when only mild symptoms are present, enabling an earlier, more accurate diagnosis.

The IMPACT-AD project, now complete, investigated the impact of biomarker testing across multiple facets of care and well-being. Specifically, Dr. DeMarco and her team looked at how the Alzheimer’s disease test impacted medical decision-making, personal decision-making, and health economics.

What’s the impact?

The team’s findings, summarized in a series of research articles linked below, revealed significant and positive changes in clinical management with biomarker testing, including decreased use of healthcare resources, optimization of therapy, and increased use of counseling by patients and family members. Patients and their families reported that the test provided much needed answers and assistance with longer-term planning for themselves and their families.

Ann Bil, a woman living with dementia, and Kristi Wijnsma, her daughter, discussed why they enrolled in the IMPACT-AD project and how they used the results on the Dementia Dialogue, a podcast supported by the Public Health Agency of Canada that provides people with lived experience a way to share their stories with each other and the broader community.

“Our story is that when we sought support and were given the opportunity to get clarity on what it was that we were dealing with, it came with peace, a better capacity to be able to support Mom, to access resources, and to process our own feelings around Mom’s health and what she was experiencing,” Kristi explained.

I would encourage everybody who’s on this path … there are now options for you to get clarity on what you probably intuitively know is going on for you. I’m hopeful that will give people a sense of security and hope for the future.

Kristi Wijnsma

Accurate and timely diagnosis has never been more important. The Alzheimer Society of Canada’s Landmark Study estimates the number of people living with dementia in Canada will increase by 187% from 2020 to 2050 – with more than 1.7 million people likely to be living with dementia by 2050. New drugs have been developed to target and clear the clumps of proteins that form in the brain because of Alzheimer’s disease. These drugs have the greatest potential if used early in the disease, that is, when symptoms first appear.

Via the creation of a national biomarker testing program, we have readied the health system for the arrival of these [new Alzheimer’s disease] therapeutics. There is now a pathway for testing, for persons with symptoms of the disease, to help assess whether they have Alzheimer’s pathology and are candidates for these therapies.

Dr. Mari DeMarco

Prospective patients can speak with their doctor about Alzheimer’s disease biomarker testing—testing can only be ordered by a specialist in dementia care, such as a geriatrician or neurologist.

What’s next?

Dr. DeMarco and her team recently received additional funding from British Columbia Ministry of Health to explore how newly developed blood tests for Alzheimer’s disease could be incorporated in the medical care pathway in Canada. This new study—Blood tests for Early diagnosis of Alzheimer’s disease and caRe Support (the BEARS study)—leverages knowledge gained from IMPACT-AD study. They’ve also received funds from the Canadian Institutes of Health Research and the Canadian Consortium on Neurodegeneration in Aging to develop on-demand continuing medical education on biomarker testing for Alzheimer’s disease.

Dr. DeMarco is also co-leading the development of a new clinical guidance document on Alzheimer’s disease biofluid testing via the Association for Diagnostics and Laboratory Medicine, a global scientific society dedicated to clinical laboratory science and its application to healthcare.

Links

Dementia Dialogue

Key publications

https://alz-journals.onlinelibrary.wiley.com/doi/pdfdirect/10.1002/trc2.12464

https://alz-journals.onlinelibrary.wiley.com/doi/pdf/10.1002/trc2.12463

Dr. Mari DeMarco was awarded an Improving Health Outcomes and Quality of Life Team Grant of $684,000 from Brain Canada in 2017. These grants provided opportunities for unorthodox collaborations between multidisciplinary teams of researchers (including social sciences), clinicians, allied-health workers, carers and patients to explore novel approaches to improving patient-oriented health outcomes, including quality of life, over a reasonably short period of time. Dr. DeMarco’s project was funded in partnership with Michael Smith Health Research BC, University of British Columbia’s Faculty of Medicine and Djavad Mowafaghian Centre for Brain Health, Women’s Brain Health Initiative, St Paul’s Foundation, and in collaboration with the Alzheimer Society of Canada and the Canadian Consortium on Neurodegeneration in Aging (funded by Canadian Institutes of Health Research and partners).