Puneet Agarwal on Advances in Alzheimer’s Care
By Arunima Rajan
In an interview with Arunima Rajan, Puneet Agarwal, senior director, neurology at Max Super Speciality Hospital, Saket talks about how memory care has progressed in recent years in India.
How has the field of memory care progressed in recent years, particularly in terms of early detection, biomarker testing and prevention strategies?
The field of dementia care has seen remarkable advancements in the last few years, especially in early detection, biomarker testing, early intervention and personalised prevention strategies for dementia patients. Following are the key developments in the dementia care:
Early Detection
Cognitive Assessments and AI: AI driven algorithms and digital cognitive tests through detecting functional changes (cognition, movement or speech impairments) or through detecting pathological abnormalities on brain scans, have revolutionised the early detection of dementia by analysing subtle changes in speech, behaviour, and memory before it becomes clinically evident. They have become the digital biomarkers for early dementia.
Neuroimaging: Advanced neuroimaging techniques, such as PET scans and MRI, are able to detect early brain changes in dementia patients even before cognitive symptoms appear. These images can identify amyloid plaques and tau tangles in early stage of Alzheimer’s disease.
Digital and Wearable Devices: Wearable devices like smartwatches, pocket sized tracking devices, telecare systems, smartphones with medication reminders help assessing and recording sleep patterns, physical activity, and cognitive function in at risk dementia patients for early detection.
Biomarker Testing
Blood-based Biomarkers: PrecivityAD test is a major breakthrough in the development of blood tests to detect biomarkers associated with Alzheimer’s disease, such as beta-amyloid and tau proteins. It is a non-invasive alternative to cerebrospinal fluid tests and neuroimaging.
Genetic Testing: Advancements in genomics has clinical significance in both research and personalised care. Genome sequencing is helping in identifying variants like APOE ε4 associated with Alzheimer disease.
Cerebrospinal Fluid (CSF) Testing: CSF tests allow for early and accurate diagnosis of early dementia by measuring amyloid 42, tau, and phospho- tau. Increased levels of CSF Neurofilament (NfL) is seen in Alzheimer’s dementia.
Prevention Strategies
Lifestyle Interventions: Lifestyle changes like interventions in diet, exercise, cognitive training can significantly reduce the risk of developing dementia. Initiatives to address modifiable risk factors such as smoking, alcohol consumption, and inactivity must be undertaken.
Pharmacological Prevention: Newer drugs against amyloid and tau protein deposition in brain like monoclonal antibodies Lecanemab and Donanemab have potentially slowed the disease progression in early Alzheimer’s disease.
Vascular Health: As cardiovascular risk factors are directly involved in development of dementia, managing high blood pressure, diabetes, and cholesterol has become a key prevention strategy in dementia care.
4. Personalized and Precision Medicine
The new approach is focussed on providing customised treatments to dementia patients based on their genetic, biomarker and lifestyle profiles which can prevent and delay the progression of dementia in them.
What do you consider to be the most pressing challenges in Alzheimer’s care today and how is Max healthcare addressing these issues?
The most compelling challenges in Alzheimer’s care include delay in diagnosis, limited therapy options, caregiver burden, and the exuberant cost of care. Early detection of dementia is a big challenge as patients remain unrecognised until later stages. Current treatment options, usually manage symptoms without stopping disease progression. The burden on caregivers is massive involving emotional, physical, and financial stress which often overwhelm the families. Moreover, expensive long-term dementia care makes access to treatment very difficult for many dementia patients.
Max Healthcare is addressing these issues head on through a multi-faceted approach. We, at Max hospitals, are using advanced diagnostic tools, such as PET scans and blood-based biomarkers, for early and more accurate diagnosis of Alzheimer’s dementia. We are also involved in clinical trials (research works) for innovative dementia therapies like anti-amyloid drugs, aimed at delaying the disease progression.
To support caregivers in all possible manner, Max Healthcare offers comprehensive care programs that provides resources, education, and counselling to them so as to reduce the caregiver stress and ensure better patient care. We are also promoting dementia friendly environments by organising community-based programs and support groups.
In terms of cost, Max Healthcare is working on developing more accessible and affordable care plans, providing both in-patient and out-patient services customised to individual needs of dementia patients.
Can you describe the key components that make Max Healthcare’s memory care program successful in supporting both patients and their families?
Max Healthcare’s Memory Care Program aims at providing a holistic approach to support both Alzheimer’s patients and their caregivers. Key components of this comprehensive approach include:
Early Detection & Advanced Diagnostics: Max Healthcare is utilizing newer cutting-edge diagnostic tools, such as neuroimaging and blood-based biomarker tests, to facilitate early diagnosis of Alzheimer’s disease so that timely intervention can be done to halt disease progression and improve quality of life.
Multidisciplinary Care Team: The dementia care program brings together neurologists, geriatricians, psychiatrists, clinical psychologists and rehabilitation team to deliver comprehensive care tailored to the individual’s needs and to support their cognitive, emotional, and physical disabilities.
Personalized Care Plans: Depending upon the dementia patient’s clinical status, treatment plans are customized including medication management, cognitive therapies, and lifestyle modifications.
Caregiver Support & Education: Max Healthcare also recognises the caregiver’s burden and stress involved. We, at Max hospitals, offer counselling sessions, education regarding the disease progression in patients, and support groups to maintain the mental health of the caregivers of dementia patients.
Community Engagement & Dementia-Friendly Initiatives: The Max dementia care program promotes dementia-friendly communities and conduct workshops and social activities that enhance patient interaction and reduce stigma regarding the disease.
How does Max healthcare implement a multidisciplinary approach to Alzheimer’s care? Could you elaborate on the various specialists involved and how you ensure effective collaboration?
We, at Max healthcare, are managing Alzheimer’s dementia and other dementias using multidisciplinary approach to provide customized and comprehensive treatment to these patients. The dementia team includes Neurologists, who are involved in diagnosing and further managing the progression of the disease; Psychiatrists and clinical psychologists are involved in managing the neuropsychiatric and neurocognitive aspects of dementia i.e. mood disorders, anxiety, or depression associated with the disease. Geriatric medicine physicians are involved in managing the overall health and age-related concerns of the patient; Physiotherapists assist patients in maintaining their muscle strengths for mobility and physical wellbeing. Occupational therapists help dementia patients, who are gradually losing their intellectual and motor skills due to disease progression, to lead a more independent life by providing them with tools and techniques to adapt to their daily routines. Speech and language therapists are involved in training these patients with language issues due to disease progression. Dieticians in the team help in ensuring that patients follow a balanced diet, which is also an important aspect of managing Alzheimer’s symptoms and overall health. Social workers and counsellors are involved in providing emotional and community support to the patients and their caregivers so as to ensure effective patient care.
At Max Healthcare, we take care of every aspect of patient’s well-being by effectively collaborating with dementia care team through regular case discussions, shared care plans, and clear communication among the specialists, caregivers and the dementia patients.
What are some promising trends or areas of research in memory related care that you are particularly excited about? How is Max Healthcare contributing to or implementing these advancements?
Some promising trends in memory-related care include precision medicine, digital therapeutics, and biomarker research.
Precision medicine, which is involved in tailoring treatments to the individual’s genetic and molecular profiles, offers a ray of hope in Alzheimer’s dementia care by targeting the biological pathways and slowing the disease progression. Max Healthcare is actively involved in clinical trials focusing on disease targeting treatments so that patients can access these innovative therapies easily under one roof.
Another exciting area of interest is digital therapeutics, which utilizes newer technologies to enhance memory and cognitive function. Tools such as AI-driven cognitive training platforms, wearables that monitor cognitive health, and apps for caregiver support are now the integral part of memory care. Max Healthcare is adopting these innovative technologies and offering them to dementia patients and their caregivers to manage symptoms and enhance quality of life.
Dementia Biomarker research is transforming the way for diagnosis of dementia. Blood tests and imaging techniques that detect Alzheimer’s years before symptoms appear have improved significantly and these advances help in early detection and implementation of intervention strategies. Max Healthcare, with its advanced diagnostic facilities, is contributing by incorporating these biomarkers in routine Alzheimer’s screening. Also, regenerative medicine involving stem cell therapies to repair damaged brain cells are showing promising results. Max Healthcare remains at the forefront by promoting research collaborations and staying in sync with global advancements in memory care.