A silent epidemic: Alzheimer’s costs Americans billions of dollars a year. Why VCs should be excited about the potential for early detection
My grandfather was diagnosed with Alzheimer’s about ten years ago. It came out of the blue. I remember waiting in line for a popular Vancouver restaurant with my extended family. My grandfather went to the restroom but didn’t return. Panicked, my family raced around the neighborhood searching for him. We returned home mystified and worried and called the police for help. But as we entered our living room, we found him sitting comfortably in front of the TV, surprised to see us and wondering why we were so relieved. Alzheimer’s had silently claimed a victim. Our lives were forever changed.
Deadly, heartbreaking, and expensive. The personal toll and monetary cost borne by Alzheimer’s patients and their friends and family is already high and rapidly increasing. In 2020, the disease will cost Americans an estimated $305 billion. By 2050, The Alzheimer’s Association projects that this could rise as high as $1.1 trillion, with 1 in 10 Americans over age 65 affected. Sadly, medical science has not found an answer to this debilitating disease and the negative consequences that come with it. In fact, while deaths from other major causes such as heart disease fell from 2000–2015, deaths from Alzheimer’s have doubled.
There have been no breakthroughs for a cure; the disease is almost always fatal. Alzheimer’s was described as “one of the most intractable problems in medicine” by Pam Belluck of the New York Times in 2018. One of the obstacles that makes finding a cure so difficult is that we have an incomplete picture of what causes the disease. Various theories have been proposed, but the scientific community has not reached a consensus. In fact, one prominent theory is that Alzheimer’s is not a single disease with a single cause. What we do know is that the disease is linked to the buildup of amyloid beta and tau proteins in the brain. This buildup leads to formation of insoluble fibrils and plaques, causing neurofibrillary tangles with neurons that impair their function. Billions of dollars have been invested into research forays, from drugs targeting amyloid proteins to neurochemical enhancers. Yet, current approved drugs only treat symptoms.
Although scientific barriers make investing significant capital into the pursuit of an Alzheimer’s cure a risky bet, there remains a huge opportunity for venture capitalists to improve the lives of millions while making a prudent monetary play.
Enter early detection.
Detecting Alzheimer’s before it reaches its later, more severe stages is an important step towards finding a cure. In recent years, we have gained a greater understanding of what the key indicative biomarkers of the disease are: the amyloid beta protein, the tau protein, and neurodegeneration or neuronal injury. These advances make early detection increasingly feasible.
Additionally, early detection is a huge market opportunity. The 2018 Alzheimer’s Disease Facts and Figures special report from the Alzheimer’s Association found that “if those who will get Alzheimer’s disease were diagnosed when they had mild cognitive impairment, before dementia, it would collectively save $7 trillion to $7.9 trillion in health and long-term care costs”. As an added benefit, early detection could segue into new insights for a cure. If at-risk individuals are identified in the general population early on, they can participate in clinical trials earlier. This would increase the odds of drug experiments preventing or reversing the development of Alzheimer’s, solving the current problem of clinical trials being conducted on patients in the late stages of the disease, when treatments may be less effective. Perhaps most importantly, early detection has priceless medical, social, and emotional benefits for the patients and their families and friends. Receiving an early diagnosis allows patients to try a wider variety of treatment options, giving them a better shot at fighting symptoms. Early diagnosis also affords patients the opportunity to make lifestyle changes (such as exercise and diet) that have been shown to slow the progression of the disease, plan for the future with loved ones, and attack Alzheimer’s head-on while they are able to testify for themselves.
Alzheimer’s progresses slowly through three main stages: early, middle, and late. An early-stage Alzheimer’s patient is still able to live life independently, but may begin to display subtle signs of memory loss. Diagnosing an individual with Alzheimer’s at the early stage is crucial because they can still live well and slow the progression of the disease with exercise and medications such as cholinesterase inhibitors and Namenda. At the middle-stage, symptoms of dementia become more pronounced and noticeable, and the patient generally requires assistance to participate in day-to-day activities. Late-stage Alzheimer’s is heartbreaking. The patient experiences severe dementia, is unable to converse or interact with their surroundings, and eventually loses control of movement. Oftentimes the character of the patient changes as their memory of themselves and their loved ones fade. Perhaps the most insidious part of Alzheimer’s is that it is frequently not recognized by the individual or their family and friends until it is mid-stage or later. The early symptoms of memory loss are often ignored as part of the normal aging process. The individual is rarely able to judge the severity of the dementia onset. Families get used to their older relatives forgetting small details. It is only when something major happens, as with my family at the restaurant, that the true magnitude of the disease is realized.
Equally as important as the three main stages of Alzheimer’s is a preceding condition called mild cognitive impairment, characterized by noticeable cognitive changes that don’t affect everyday life and experienced by 15–20% of those aged 65 or older. Mild cognitive impairment is important because it represents the earliest point where individuals at a high risk of experiencing Alzheimer’s can be diagnosed.
Currently, clinical diagnosis of Alzheimer’s is mainly done through a series of clinical and cognitive tests assessments. Over the recent years, we have seen the emergence of biomarkers to support more comprehensive and biological characterization of patients. One proposed framework is the classification system called A/T/N (Amyloidβ/Tau/Neurological damage) when dementia is suspected. Today, the diagnosis can be confirmed through brain imaging using a Positron emission tomography (PET) scan to look for the spaghetti-like amyloid proteins known as tangles in the brain — a distinct sign of Alzheimer’s. This assumes, however, that a patient has already been referred to a dementia specialist and that PET scans would be readily available which is not the case. With aging populations worldwide, it is estimated that millions of people will seek a diagnosis in the coming years. Unfortunately, these current diagnostic methods are costly, inaccessible to many, and often not used until Alzheimer’s has progressed past its early stages.
The expense and inaccessibility of brain imaging for early diagnosis of Alzheimer’s has opened up a major opportunity to reshape the clinical standard. As such, there has been increased venture attention. Neurotrack, which uses cognitive assessments through eye-tracking to assess cognitive functions, raised $21 million in Series C funding led by Khosla Ventures. MyndYou, which tracks changes in “cognitive complexity” to look for early signs of dementia, raised $4 million in Series A funding led by AI Life Sciences. Altoida, which uses virtual and augmented reality tools to predict the onset of Alzheimer’s, raised $6.3 million in Series A funding led by M. Ventures. Despite this, Alzheimer’s research still receives just a fraction of the funding put into other major diseases such as cancer. According to UsAgainstAlzheimer’s, Alzheimer’s research receives $550 million annually compared to the $5.7 billion invested in cancer research. This is not to say that we should compare the two diseases, but rather to show that an influx of capital into innovative approaches in Alzheimer’s research would be warranted.
At DigitalDx, we’re backing Optina.
Optina is developing a Retinal Deep Phenotyping platform that uses a hyperspectral camera to detect biomarkers associated with Alzheimer’s up to ten years before brain damage or dementia symptoms present themselves. We believe retinal scans are the future of early Alzheimer’s diagnosis for a couple of reasons.
On the scientific side, eyes provide a non-intrusive, unobstructed view of blood vessels, nervous tissue, and connecting tissue. The retina is the only part of the central nervous system that can be examined directly and retinal neurons develop from the same progenitor cells as the brain. These properties allow Optina eye scans to detect retinal deep phenotypic feature changes and help in the assessment of brain health through beta amyloid status tests. Optina’s hyperspectral camera collects lots of data about potential indicators, including beta amyloid and other promising early-stage biomarkers. This data is analyzed by an algorithm to predict outcomes and inform decisions.
Economically, Optina’s eye scan is significantly more cost effective than traditional tests, almost ten-fold cheaper than the cost of current-day PET scans.
Alzheimer’s does not discriminate. However, a shortage of neurologists combined with the limited access that primary care providers have to diagnostic tools has resulted in a “wait-and-see” approach for many. This delay has the potential to be extremely harmful, allowing the disease to progress undiagnosed due to systemic inefficiencies and leaves many without a good option for early detection. Increasing the availability of diagnostic tests for all of us to take when needed is important, equitable, and potentially life-saving. Optina’s calling card is this increased access — a non-invasive, inexpensive eye scan that can be in every optometrist’s office as an optional add-on to yearly checkups and available in eye clinics and drugstores across the country.
This is a game-changing vision and one that DigitalDx believes in wholeheartedly.
Early detection of Alzheimer’s is an exciting, impactful problem to tackle as well as a great investment opportunity in line with the strong performance of the digital health sector. The time is now. Despite the nation entering a potential period of economic turbulence, healthcare diagnostics as a whole is a recession-proof sector and the market opportunity will only continue to increase. The continued rise of diseases like Alzheimer’s should prompt our medical systems to include brain health at the forefront of checkups alongside physical and cardiac health, and the venture capital community should be excited about both the cause and the investment opportunity.
