Understanding Alzheimer's Disease and Vascular Dementia
The Alzheimer's Society has recently (June and July, 2025) responded to two significant developments in dementia care: the government's 10-Year Health Plan for England and a decision by the National Institute for Health and Care Excellence (NICE).
Alzheimer's disease is a progressive neurological disorder and the most common cause of dementia. It's characterized by the buildup of abnormal proteins in the brain: beta-amyloid plaques outside neurons and tau tangles inside them. These protein clumps disrupt cell communication and ultimately lead to the death of brain cells. This process causes symptoms such as memory loss, confusion, and changes in behavior, which worsen over time.
Vascular dementia, the second most common type of dementia, is caused by reduced blood flow to the brain, often due to a stroke or a series of small strokes. This lack of blood flow damages and kills brain cells. Symptoms can vary depending on which part of the brain is affected.
Over the past 30 years, significant progress has been made in understanding the pathology of Alzheimer's disease. Researchers have identified the key role of amyloid and tau proteins, paving the way for the development of disease-modifying treatments like donanemab and lecanemab. These treatments aim to slow the progression of the disease by targeting and removing these proteins, a major shift from previous medications that only managed symptoms. This scientific progress, much of which was funded by organizations like the Alzheimer's Society, has led to these breakthroughs.
Personal Context and Reflection
Thirty years ago also, whilst at university, I had the opportunity to complete an extended project on the pathology of Alzheimer's disease. At the time, I was inspired by working as a care assistant in nursing homes, where I witnessed the many forms the disease takes and how families cope. The symptoms I saw varied greatly, and there was a mix of joy and laughter alongside the significant challenges.
This personal experience provides some perspective on the progress that has been made in the last three decades. It raises the question: as an aging population, how far have we come? Are we effectively detecting and treating Alzheimer's and other forms of dementia as early as possible?
Great news! We have donanemab and lecanemab now, amazing progress from the 30 years back rudimentary understanding of the pathology.
Response to the 10-Year Health Plan
The Alzheimer's Society welcomes the government's 10-Year Health Plan, particularly its commitment to a blueprint for improving dementia care. Professor Fiona Carragher, Chief Policy and Research Officer, noted that the plan shows the government is listening to the needs of people with dementia and their families by focusing on more accessible, community-based services. The society believes that if implemented correctly, the plan has the potential to significantly improve the lives of the 826,000 people in England with dementia by enhancing diagnosis and providing timely, tailored, and local support. However, they urge for swift delivery, as people with dementia have already waited too long.
NICE's Rejection of Alzheimer's Treatments
The Alzheimer's Society expressed disappointment with NICE's decision on June 19, 2025, to not recommend donanemab and lecanemab for use on the NHS. According to Professor Carragher, this decision is a "setback" and means that these treatments, which can slow the progression of the condition, will remain out of reach for most eligible patients.
The society points out that even if these treatments were approved, the NHS is not currently equipped to deliver them. They argue that the "science is flying but the system is failing," as the health system lacks the necessary infrastructure, such as early diagnosis and access to specialized diagnostic tests. The Alzheimer's Society is calling on the UK government to make long-term investments to prepare the NHS for a future where these new treatments are available, stressing that the needs of people with dementia have been overlooked for too long.
There’s a way to go, isn’t there.
Author: Simon Walker, Founding Director, RLS. August 2025.