Hydromethylthionine mesylate for treating mild cognitive impairment or mild or moderate dementia caused by Alzheimers disease ID6343

Alzheimer’s disease is a progressive neurological disease and is the most common cause of dementia.1* It is thought to be caused by the abnormal build-up of proteins in and around brain cells. These proteins are called beta-amyloid and tau.

Deposits of amyloid proteins form plaques around brain cells.1 Tau can aggregate into neurofibrillary tangles that form within brain cells.1*Mild cognitive impairment caused by Alzheimer’s disease refers to the set of symptoms that occur before the dementia stage of Alzheimer’s disease. These can include mild problems with memory reasoning attention language or visuospatial function depth perception.

Dementia caused by Alzheimer’s disease usually develops slowly from these initial symptoms.

Progression from mild to moderate dementia is characterised by further deterioration in cognition functional ability and associated behavioural and psychiatric symptoms.

Diagnostics used for Alzheimer’s disease such as positron emission tomography (PET) scan or cerebrospinal fluid (CSF) testing can be used to differentiate mild cognitive impairment or dementia due to Alzheimer’s disease from mild cognitive impairment or dementia due to other causes.2*3*The exact number of people with mild cognitive impairment caused by Alzheimer’s disease is unknown and estimates vary widely.

Approximately 210000 people in England have mild cognitive impairment present to the healthcare system and have clinical suspicion of Alzheimer’s disease.4*The number of people with dementia in England was estimated at 982000 in 2024 with 488000 cases of mild and 366000 cases of moderate dementia. 5* Alzheimer’s disease causes around 60 to 70% of cases of dementia.6 The largest risk factor for dementia is age with over 95% of all cases in people aged over 65.1*There is no cure for Alzheimers disease and there are currently no disease modifying treatments approved for use in the UK.

Current management of mild cognitive impairment and mild or moderate dementia caused by Alzheimer’s disease aims to improve cognitive non-cognitive and behavioural symptoms but does not slow progression of the underlying disease.*7 *8 NICE guidance (TA217 and NG97) recommends:• acetylcholinesterase (AChE) inhibitors (donepezil galantamine and rivastigmine) as options for managing mild to moderate Alzheimer’s disease• memantine monotherapy as an option for managing moderate Alzheimer’s disease for people who are intolerant or have a contraindication to AChE inhibitors• memantine in addition to an AChE inhibitor for managing moderate Alzheimer’s disease for people who are already taking an AChE inhibitor.There is no pharmacological management recommended for mild cognitive impairment due to Alzheimer’s disease.

NICE is currently appraising lecanemab and donanemab for treating mild cognitive impairment or mild dementia caused by Alzheimers disease.

Non-pharmacological management for mild to moderate Alzheimer’s disease includes risk factor modification social support increasing assistance with day-to-day activities information and education carer support groups community dementia teams home nursing and personal care community services befriending services day centres respite care and care homes.References*1.

National Health Service (NHS). Alzheimers disease. Available at: https://www.nhs.uk/conditions/alzheimers-disease/ [Accessed: June 2024]2. Albert MS DeKosky ST Dickson D Dubois B Feldman HH Fox NC et al.

The diagnosis of mild cognitive impairment due to Alzheimer’s disease:recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011 May;7(3):270–93.

McKhann GM Knopman DS Chertkow H et al. (2011) The diagnosis of dementia due to Alzheimers disease: recommendations from the National Institute on Aging-Alzheimers Association workgroups on diagnostic guidelines for Alzheimers disease. Alzheimers Dement 7(3):263-94.

Wailoo A. (2023) Estimates of the size of the English eligible population in for amyloid targeting therapies in Alzheimer’s Disease. NICE DSU Report. Available at: https://www.nice.org.uk/Media/Default/About/what-wedo/HTA%20Lab/Appendix-D.pdf [Accessed June 2024]5.

Alzheimer’s Society and CF. (2024) The economic impact of dementia Available at: https://www.alzheimers.org.uk/sites/default/files/2024-05/theannual-costs-of-dementia.pdf [Accessed: June 2024]6. World Health Organization. (2023) Dementia fact sheet. Available at:https://www.who.int/news-room/fact-sheets/detail/dementia [Accessed: June 2024]7.

Alzheimer’s Society: Mild Cognitive Impairment.

Available at:https://www.alzheimers.org.uk/about-dementia/types-dementia/mild-cognitiveimpairment-mci [Accessed: June 2024]