Title: Aducanumab for treating mild cognitive impairment and mild dementia caused by Alzheimer's disease [ID3763]
Funder: Department of Health and Social Care

Abstract: Alzheimer’s disease is a progressive neurological disease and is the most common type of dementia accounting for 50 to 75% of dementia cases[1]. It is thought to be caused by the abnormal build-up of proteins in and around the brain cells including beta-amyloid proteins. Deposits of amyloid proteins form plaques around brain cells[2] and disrupt neurone function. 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 visual depth perception. Alzheimer’s disease usually develops slowly from these initial symptoms and progression is characterised by deterioration in cognition, functional ability and behaviour. Differential diagnosis of Alzheimer’s disease for people with mild cognitive impairment compared with other types of dementia is not always clearly defined._x000D_ _x000D_ The number of people with dementia in England was estimated as 748,000 in 2019, with 107,100 cases of mild dementia.[3] Therefore, the number of people diagnosed with mild dementia due to Alzheimer’s disease could be up to 80,325. The largest risk factor for dementia is age, with approximately 95% of all cases in people aged over 65.[4] The exact number of people with mild cognitive impairment is unknown. Mild cognitive impairment is prevalent in 5% to 20% of all people over 65, however not all of these people will go on to develop Alzheimer’s disease.[5] There is a higher risk of developing dementia in people with mild cognitive impairment, even though there is a considerable variability in annual risk estimate of less than 5% to 20%.[6]_x000D_ _x000D_ There is no cure for Alzheimer's disease. Current management of mild cognitive impairment and mild dementia due to Alzheimer’s disease involves symptomatic relief of cognitive, non-cognitive and behavioural symptoms. NICE guidance (TA217 and NG97) recommends acetylcholinesterase (AChE) inhibitors (donepezil, galantamine and rivastigmine) as options for managing mild to moderate Alzheimer’s disease and memantine as an option for managing severe Alzheimer’s disease or for people with moderate Alzheimer’s disease who are intolerant or have a contraindication to AChE inhibitors. There is no pharmacological management of mild cognitive impairment due to Alzheirmer’s disease. Non-pharmacological management includes 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._x000D_ _x000D_ References_x000D_ 1. Alzheimer’s Society: Alzheimer's Society's view on demography. Available at: https://www.alzheimers.org.uk/about-us/policy-and-influencing/what-we-think/demography [Accessed: December 2020]._x000D_ 2. National Health Service (NHS). Alzheimer's disease: Causes. 2018. Available at: https://www.nhs.uk/conditions/alzheimers-disease/ [Accessed: September 2020]._x000D_ 3. The London School of Economics and Political Science - Care Policy and Evaluation Centre. Projections of older people with dementia and costs of dementia care in the United Kingdom, 2019–2040. 2019. Available at: https://www.alzheimers.org.uk/sites/default/files/2019-11/cpec_report_november_2019.pdf. [Accessed: December 2020]._x000D_ 4. Public Health England. Dementia Profile. 2019. Available at: https://www.gov.uk/government/publications/dementia-profile-april-2019-data-update/statistical-commentary-dementia-profile-april-2019-update [Accessed: September 2020]._x000D_ 5. Alzheimer’s Society: Mild Cognitive Impairment. Available at: https://www.alzheimers.org.uk/about-dementia/types-dementia/mild-cognitive-impairment-mci [Accessed: November 2020]._x000D_ 6. Langa KM, Levine DA. The diagnosis and management of mild cognitive impairment: a clinical review. 2014. Available at: https://jamanetwork.com/journals/jama/fullarticle/2040164. [Accessed: November 2020].

Lay abstract: To appraise the clinical and cost effectiveness of aducanumab within its marketing authorisation for treating mild cognitive impairment or mild dementia caused by Alzheimer’s disease.

Research activity codes: 6.1 PHARMACEUTICALS
Health categories: NEUROLOGICAL