Patients With Alzheimer Disease Negatively Impacted by the COVID-19 Pandemic

Tabby Khan, MD, MPH

This is a 2-part interview. Check out Part 1 of the interview here.

September 21 was World Alzheimer’s Awareness Day, and as of late, news in this field has shown the diagnosis rates for Alzheimer disease (AD) are slowly rising in younger adults. Based on this recent research, there is a need for clinicians to pay more attention to the cognitive decline that is occurring in the younger population besides the usual patients with this condition who are over 65 years in age.¹

Komodo Health compared its research from 2020 and 2021 and saw that there has been an 18% increase in early-onset AD for patients who are between the ages of 45 and 65 years.¹ Data also showed that patients older than 89 years had a nearly 27% decrease in AD diagnoses, which contrasts previous findings from Komodo Health’s researchers.

Women were also diagnosed with the AD twice as much as men, according to Komodo’s analysis.¹ The researchers noted that this is because women tend to live longer than men. Future research will need to provide more insight into identifying cognitive decline earlier, healthcare systems can provide better quality care for patients.

In learning more about the impact of COVID-19 on patients with AD and how telehealth helped with providing care to those patients, NeurologyLive^® had a talk with Tabby Khan, MD, MPH, medical director, Komodo Health. Khan spoke about how telehealth helped patients get the care that they needed during the pandemic, noting that it was only a quick solution to the problem of not getting high quality care when doctor’s offices were closed down. She also mentioned current research moving forward in the field of AD and trying to find a more effective way to diagnosis patients earlier on.

NeurologyLive^®: Do you think the COVID-19 pandemic negatively impacted people that live with Alzheimer?

Tabby Khan, MD, MPH: COVID-19 was very isolating for a lot of people. It was much more exacerbated in patients that struggle with their activities of daily living who have memory deficits. Nursing homes and long-term care facilities, where a lot of patients [with Alzheimer] live, were hit pretty hard by COVID-19 and I think that it truly did have an impact. Part of it is, I do wonder if these over 89-year-old patients having this 27% decrease is because these are patients that are so high risk for COVID-19 that they elected to not go into the doctor unless it was an emergency. We've seen a lot of people postpone care and this is some of what Komodo has published around the impacts of COVID-19.

It is perfectly logical to believe that people were also not going in for their primary care appointments and getting screened for neuropsychological diseases such as Alzheimer. I think that we're going to be seeing the ramifications of these impacts that COVID-19 has had on the overall health care system for years. If you're having this conversation 20 years from now, and we're talking about people in their early 50s getting diagnosed with Alzheimer and how they're doing, then maybe that's going to be very different from how people who are diagnosed in their 60s progressed. There are also new drugs coming out all the time, so there's that component to consider as well. But it'll be interesting to see the longitudinal real-world evidence that comes from these changes.

Do you think that telehealth has helped patients with Alzheimer get the care that they need during the pandemic?

Telehealth is wonderful and it has provided access to care for a lot of patients that otherwise wouldn't be able to get it. I do sometimes wonder, is everything able to be picked up via telehealth? I think there's a lot that is and it's a great tool for talking about symptoms and the next steps. But I think that we need a combination of both telehealth and in person. Komodo collaborated with Omada Health on a study recently, where we looked at what percentage of procedures just have to be done in office versus what can be done in telehealth. This is something that the industry, as a whole, is really thinking about. I think that telehealth is a great screening tool and, specifically, if we can figure out a way to do a lot of this neuropsychosocial testing, it may really help those older patients.

I think it has potential specifically in the Alzheimer's therapeutic area but there's still a lot we have to work out first. If we talk about race, race is inextricably linked to social determinants of health. It is no secret to anyone that patients of color face a lot more obstacles interfacing with the health system than other patients. This comes down to a variety of things, such as there are more patients of color that don't have a working internet connection and then there are White patients. Should those patients be denied the ability to engage in telehealth because of that? I find that to be a problem and something that we need to work on as a country. Making sure that all patients have reasonable access is also huge.

Telehealth is great, but it is a band aid over a bullet hole. What about people that didn't have providers to begin with? How do you build up that relationship with someone through just Zoom? I think that's really challenging, specifically within the psychiatric neurology space, because so much of your engagement with your provider, and your willingness to tell them things is based on that relationship that exists. It's a great adjunct. I don't know if it can stand alone within the neuropsych space, but I'm glad it exists and it certainly will help patients down the road.

What else can you say about research with Alzheimer disease moving forward?

Every piece of research that I do, I always see a jumping-off point. I think that we've identified some really interesting trends that we've seen both kind of around this uptick in younger patients getting diagnosed, the drop off and older patients getting diagnosed. The fact of the matter is that Alzheimer is more prevalent in women, and the next step here is really thinking about what we can do with those data. We need to figure out how to better identify these patients before they get diagnosed and how to better provide support services to patients that have the diagnosis. We need to kind of work with a variety of different stakeholders within this space, whether it is pharma, whether it is the government, or whether it's clinicians themselves, and figuring out the answers to these questions. Komodo’s mission is to reduce the global burden of disease. I think Alzheimer's is a disease that has extremely high morbidity as it has a tremendous impact on individual patients, as well as their families and this is something that we need to do better at. This is a call to action more than anything else and prompts us to do more to look into it.

Transcript edited for clarity.

REFERENCES
1. Komodo Health . Homepage. Published 2020. Accessed November 5, 2020. https://www.komodohealth.com/