When it comes to Alzheimer’s disease, early detection is not the end but the beginning

Through medical advancements in molecular imaging, this Singapore patient and doctor duo are working together to understand Alzheimer’s better

When a retired clerical worker in her 70s started experiencing periods of memory loss, she quickly understood that something was amiss. Her mother was a dementia patient and passed away two years ago. She continued monitoring her condition for 12 months, but did not experience much improvement. In late 2017, she was invited to attend a talk about dementia organized by the Singapore National Neuroscience Institute (NNI). After the talk, she was approached by NNI for a chance to investigate her symptoms deeper due to her family history. “I saw what my mother went through with Alzheimer’s and I would like to help others in the future,” says the woman, who is choosing to remain anonymous. This was how she met Associate Professor Nagaendran Kandiah, a Senior Consultant at the NNI’s Department of Neurology and Director of the NNI Dementia Program. “The focus of the NNI dementia research program is to investigate the pathophysiology of Alzheimer's disease and other neurodegenerative diseases. Due to our aging population, we are expecting a tsunami of people who will be affected by dementia in Singapore,” says Associate Professor Nagaendran. “Hence, it is crucial to provide more treatment options, including early diagnosis, that can delay the onset of dementia.” In the past, traditional diagnostic methods include detailed clinical interview and administration of questionnaires to assess thinking processes. However, with medical advancements such as an amyloid Positron Emission Tomography (PET) tracer recently made available in Singapore, Associate Professor Nagaendran has been able to combine radiopharmaceuticals and technology to provide his patients with a clearer diagnosis, earlier. Amyloid is a key bio-marker for Alzheimer’s disease. Accumulation of insoluble amyloid results in loss of brain cells in the areas of the brain that regulate memory, calculation and other thinking processes. Unfortunately, before the availability of amyloid PET scans in Singapore, amyloid levels could only be measured after death. “The techniques now enable quantification of amyloid in a living person, so a more precise understanding of the exact changes in the brain of patients with cognitive symptoms can be obtained,” says Associate Professor Nagaendran. The PET scan is done with a radiopharmaceutical tracer injected into a patient about to undergo the scanning process and the tracer binds to the beta-amyloid plaques in the brain, appearing brightly on the scan. When the results of the female patient’s scan showed up as positive, Associate Professor Nagaendran confirmed that she had pre-dementia due to Alzheimer’s disease. According to NNI, 50% of people with pre-dementia eventually develop dementia. The news was initially devastating, but the patient knew she needed to remain positive about her options. [caption id="attachment_13130" align="aligncenter" width="687"] Image of digital PET scan procedure courtesy of RadLink Asia and Singapore Radiopharmaceuticals.[/caption] These days, both Associate Professor Nagaendran and his patient are contributing to the quest to understand Alzheimer’s disease, with the hope of one day finding a cure. NNI is one of the few centres in the world where patients have undergone the necessary pre-requisite tests to be confirmed as pre-dementia cases, giving them access to anti-amyloid clinical trial options. Associate Professor Nagaendran continues to champion a better understanding of Alzheimer’s and disease-modifying treatments and his patient is enrolled in a clinical trial with an anti-amyloid intervention at NNI. She is now taking anti-amyloid medication, which is supposed to slow down the decline in memory and general function by reducing further build-up of amyloid in the brain. “I may be getting a bit more forgetful, but I’m still independent and can do things on my own,” she says. The availability of an amyloid PET imaging tracer in Singapore opens up treatment options for patients RadLink Asia’s Singapore Radiopharmaceuticals (SRP) is currently the exclusive manufacturer and supplier of the VIZAMYL molecular imaging agent following the license and regulatory approval for the manufacture and supply of the agent in Singapore. Since its approval, RadLink Asia’s Diagnostic Center in Singapore has administered more than 100 scans using VIZAMYL, with patients from countries such as Bangladesh and Thailand flying in to get tested. “The key value of VIZAMYL is that it can potentially detect Alzheimer’s early, maybe even 10 to 20 years before the patient shows symptoms. With this, patients can seek treatment earlier and reach better outcomes,” says Dr. Chang Yongqin, General Manager at SRP. “Fuelled by an aging population and increasing prevalence of chronic diseases, Asia has seen a dramatic increase in demand for better imaging and diagnostics,” says Royston Lek, Regional Managing Director of RadLink Asia. “It was important for RadLink to champion the availability of VIZAMYL in Singapore to continue driving Singapore’s status as a regional medical hub and bring about better access to advanced diagnostic and molecular imaging services in Southeast Asia.”