心灵很重要：聚焦印度的阿尔茨海默病

Mind Matters: Shining thespotlight on Alzheimer’sDisease in India RUPANWITA GHOSH,Associate Medical Director, Medical Sciences and Strategy, IQVIA APAC Table of contents Introduction1Diagnosis of Alzheimer’s disease2Management of Alzheimer’s disease3Clinical research scope for India in Alzheimer’s disease6Large patient population and genetic diversity6Rising prevalence of Alzheimer’s disease in India6Potential for biomarker research7Cost-effectiveness7Strengthened infrastructure and training7Global data sharing7Stable and favourable regulatory environment7Linguistic and cultural diversity8Caregiver roles and responsibilities8English-speaking healthcare professionals8Growing pharmaceutical industry8Dementia clinical research in India8Conclusion9Acknowledgment9Disclosures9References10About the authors12 Introduction The prevalence of Alzheimer’s disease in India has become a growing concerntoday. As per recent data, Alzheimer’s disease prevalence in India is 7.4% amongadults over the age of 60 — meaning about 8.8 million Indians are currently livingwith Alzheimer’s disease.1By 2050, people over 60 years of age are predictedto constitute 19.1% of the total population. This alarming trend is attributedto various factors, including an aging population, reduced trends in fertility,increased life expectancy and evolving lifestyles. Worldwide, according to the Global Burden of DiseaseStudy (GBDS) 2019 within the span of 2019-2050 thenumber of dementia cases will undergo a whoppingincrease of 166%, impacting the lives of ~152·8 millionindividuals; these estimates are similar to the predictionsby WHO. Furthermore, this elevation in the number ofdementia cases is projected to be highest (up to 330%) for countries like India that scale low on theSocio-Demographic Index (SDI). In 2019, India was the4thlargest contributor to the global burden of dementiaand by 2050 it is expected to surpass Japan and USAto become the country with the 2ndlargest number ofdementia cases (next only to China)(Figure 1).2 In this white paper, we strive to deep dive into thediagnostic and management trends for Alzheimer’sdisease in India vis a vis the Western counterparts aswell as look into the challenges India faces and theopportunitiesthatIndiahastoofferintheAlzheimer’sdisease clinical research arena. Diagnosing Alzheimer’s disease sometimes may presentwith few unique challenges especially in rural areasdue to factors like limited access to specialized care inunderstanding dementia and varying literacy levels. The urban metros in India have healthcare infrastructurewhich is fast approaching global healthcare standards.Hospitals and clinics such as Kokilaben Hospital inMumbaiandCAREHospitalsinHyderabadofferspecialized clinics for early diagnosis and managementof Alzheimer’s disease. Initiatives like the Alzheimer’s andRelated Disorders Society of India (ARDSI), a registerednon-profitorganizationthatworkin20pluscitiesacrossIndia also provide support and resources. PET scans,specificallyamyloidPETandtauPET,areincreasinglyused in India for the diagnosis and management ofAlzheimer’s disease, particularly in cases with uncleardiagnoses or when monitoring disease progression. Diagnosis ofAlzheimer’s disease In India, the diagnostic methods [patient’s familyhistory, medical records, neuroimaging, cognitive tests,biomarkers, and laboratory tests (in order to rule outthyroid problems, metabolic issues, kidney disorders,anemiaandvitaminB12deficiencyetc.)aresimilartothat applicable in Western countries. In addition, non-pharmacological interventions, suchas cognitive stimulation therapy and physical exercise,aim to enhance the well-being and functional abilities ofAlzheimer’s patients. Management ofAlzheimer’s disease In India, the management of Alzheimer’s diseaseprimarily involves the use of cholinesterase inhibitorslike donepezil, rivastigmine, and galantamine whichaccount for half of the market share of Alzheimer’sdrugs in India. NMDA (N-methyl-D-aspartate) receptorantagonist, memantine, make up 20% of the marketshare, while combination therapies and anti-amyloidmonoclonal antibodies comprise 25%4(Figure 2).Newer disease modifying medications like Lecanemaband Donanemab are available but not widely accessiblein India yet. In addition, traditional Indian medicine(Ayurveda) utilizes herbs like Bacopa monnieri,Centella asiatica, and Withania somnifera,which are believed to have neuroprotective andcognitive-enhancing properties. Emerging treatment approaches, includingimmunotherapies and disease-modifying drugs, areunder development and in clinical trials. Thesetherapies target the underlying causes of Alzheimer’s,i.e. amyloid plaques and tau tangles, rather than justmitigating symptoms. InnovativemedicationsofferhopeinthefightagainstAlzheimer’s. A notable example is Aducanumab,marketed as Aduhelm and developed by Biogen. Whilegaining FDA approval in the United States in 2021,its use had sparked debates due to concerns abouteffectivene