Dementia breakthroughs face diagnostic bottlenecks

Muscat: The fight against dementia has hit a historic turning point, driven by accelerating scientific breakthroughs, new disease-modifying therapies, and early-detection blood tests. However, a major global report warns that millions of patients — particularly across the Middle East and the Global South — risk being left behind due to health system bottlenecks, diagnostic delays, and pervasive social stigma.
According to the World Alzheimer’s Report 2026, published by Alzheimer’s Disease International (ADI), healthcare systems must urgently modernise to deliver faster diagnoses and fairer access to clinical trials.
Local experts emphasise that public education is the first line of defence. Dr Hamed al Sinawi, senior consultant in old age psychiatry at Sultan Qaboos University Hospital and Chairman of the Oman Alzheimer's Society, stressed that raising public awareness of early symptoms is essential so families can spot changes early and seek medical diagnosis.
Similarly, Dr Mahmood al Hinai, senior consultant neurologist, Khoula Hospital, noted that while response to recent screening drives has been encouraging, fear and stigma still deter many.
'We have had quite a few people who eagerly came forward... because of their awareness about the importance of early diagnosis,' Dr Al Hinai said. 'But on the other side, many people are still reluctant and fearful... because they are unaware of the implications, as well as the stigma attached to the diagnosis itself... Counselling is very important, and explanations of early diagnosis, appropriate care plans, and how to manage implications must be conveyed.' Dr Al Hinai emphasised that memory loss is not a normal part of ageing. He recommends screening for individuals over 60 or 65 exhibiting cognitive changes, noting that initial assessments—evaluating language, behaviour, and daily habits—help rule out treatable metabolic conditions before advancing to lab work and MRI scans.
Beyond diagnosis, structural capacity remains a critical hurdle. Dr Al Hinai highlighted a shortage of specialised memory clinics, scarce treatment resources, and unclear long-term care pathways, calling on the private sector to partner with public health authorities.
The stakes are rising rapidly. More than 55 million people currently live with dementia globally, a figure projected to reach 139 million by 2050, with the steepest increases expected in developing regions.
For the first time, however, treatment options offer real promise. Breakthrough drugs such as lecanemab and donanemab target harmful amyloid proteins in the brain, slowing cognitive decline by roughly 30 per cent and offering early-stage patients an estimated eight to ten additional months of independent living.
Yet, as Dr Al Sinawi cautioned, these therapies carry serious risks—including brain swelling and microbleeds—requiring rigorous MRI monitoring. They are not a cure, but experts view them as a foundational step. Today, 158 potential drugs are in clinical trials targeting amyloid, tau proteins, inflammation, and vascular health.
The report also stresses prevention, noting that up to 45 per cent of dementia cases could be prevented or delayed through lifestyle interventions, including diet, exercise, cognitive training, and cardiovascular control.
Despite these advances, trial participation remains a critical bottleneck. Globally, 99 per cent of eligible patients are never referred to clinical trials, hampered by diagnostic delays that average three and a half years from first symptoms. Furthermore, less than 2 per cent of trial data comes from the Global South.
In response, ADI outlines ten key recommendations, urging governments to fund early diagnostic services, train primary care doctors, simplify trial participation through remote monitoring, and ensure research reflects diverse global populations.