DEAR DR. MICHELLE,
Why isn’t my doctor spending more time on my cognitive concerns? I’ve brought it up numerous times but he never seems to address it.
Doctors spend 10-15 minutes on average with a patient during each visit. This is hardly enough time to address all issues or even to hear all of their patient’s concerns. Proper assessment, discussion, and treatment planning for cognitive concerns takes time and expertise that most doctors don’t have. While primary care physicians are on the frontlines of seeing patients with memory and cognitive issues, most do not feel prepared to handle these cases. When surveyed, a large majority of doctors report that they do not have enough training, knowledge, time, or resources to adequately assess or treat cognitive impairment. In addition, the reimbursement doctors are generally able to receive for managing cognitive symptoms is not financially feasible. The fact that your doctor isn’t addressing your cognitive concerns does not make him a bad doctor. He is probably providing the best services he can within the current economic climate of our health care systems.
Memory concerns, beginning around age 50, are common and most turn out to be normal cognitive aging. I recommend that you find a specialty group or practice that has the time, resources, and expertise to help you. This may include a geriatrician, neurologist, psychiatrist, psychologist, or clinical research practice. You can also ask your doctor for a referral or see if a friend or internet search will get you closer to the right specialist. You will find resources in your community and you will benefit from the connection.
DEAR DR. MICHELLE,
I’ve been reading about Alzheimer’s drugs that have or haven’t received “accelerated approval” from the FDA. What does this mean, especially in terms of access to these drugs?
The intention of the accelerated approval process by the FDA is to get needed drugs to patients faster, particularly where there is an unmet need. Alzheimer’s Disease is a condition that falls into this category: there is no cure and we need better treatments. Aduhelm (Biogen) and Leqembi (Eisai/Biogen) are two monoclonal antibody drugs for Alzheimer’s that have received accelerated FDA approval. These drugs are “available” for those who can pay out of pocket and have a provider willing to prescribe and manage the patient on the drug. These limitations mean that accelerated approved drugs are still not widely accessible. The FDA requires additional data on the accelerated approved drugs by way of a clinical trial or registry before they may receive traditional approval. Beyond that, Medicare will determine whether or not they will provide coverage for these medications and under what conditions.
The bottom line is that, in the case of these Alzheimer’s drugs, accelerated approval still does not provide access for the majority of the population. For most, still the only way to access Aduhelm and Leqembi will be through a clinical trial or a patient registry. Information about the current Aduhelm trial can be found on clinicaltrials.gov. Further details about a Leqembi trial or registry have not yet been announced.
*Michelle Papka, Ph.D. is the Founder of The Cognitive and Research Center of New Jersey (The CRCNJ) in Springfield, NJ. The mission of The CRCNJ is to provide no-cost diagnostic, treatment and supportive resources through clinical research opportunities to people affected by Alzheimer’s disease and other cognitive disorders.
