The bearable lightness of being comprehensive and free Alzheimer’s disease screening promotes dignified ageing
The award-winning film Still Alice depicts a linguistics professor who struggles with her early-onset Alzheimer’s disease (AD). She begins to feel disoriented and realizes that she is gradually losing her memory. Cognitive deterioration due to AD scars not only the sufferers themselves, but also their relatives and friends.
Hong Kongers today can expect to reach the age of 85. The city enjoys the world’s longest life expectancy. Unfortunately, longevity doesn’ t always mean living well. One in every 10 people aged 70 or above suffers from dementia (i.e., severe cognitive impairment), affecting memory, thinking, behaviour, emotions, and daily activities. AD is the commonest cause of dementia accounts for approximately 60–80% of cases. Since many people with early AD may mistake the symptoms as part of normal ageing, many people with mild cognitive impairment or suspected early AD will not seek medical attention until the cognitive impairment become severe enough to affect daily activities. Recent studies have demonstrated that 45% of dementia can be prevented if we can enhance brain health by optimizing various risk factors of dementia. Promoting brain health may slow deterioration even among those with early AD.
The United Nations Decade of Healthy Ageing (2021–2030) advocates multisectoral changes that align healthy ageing with the United Nations’ Sustainable Development Goals (SDGs). In response to these global initiatives and the pressing need to reduce dementia burden in Hong Kong, the Charles Kao CUHK ‘Brain Health Education And Tailor-made Measures for Prevention of AD’ Service (abbreviated to BEAT AD) was launched in 2023. It is a joint endeavour of the Charles K. Kao Foundation for Alzheimer’s Disease and CUHK.
This comprehensive, community-based service seeks to mitigate the growing burden of dementia by screening people at risk of AD or with suspected early AD and reducing such risk or rate of disease progression through positive lifestyle changes and vascular risk management. Sponsored by Dr Brigitte Lin Ching Hsia who also acts as the project’ s ambassador, the service is free for 18 months and is expected to benefit around 800 Hong Kong residents aged 60 to 80.
Promotional video of the Charles Kao CUHK BEAT AD Service (Source: BEAT AD Service)
Eligible Hong Kong citizens need to complete an online survey on the BEAT AD website. Those who demonstrate subjective cognitive complaints will be offered a face-to-face assessment of their cognitive performance and control in the clinical risk factors of AD. In addition, a picture of the fundus will be taken for assessment of brain health. At a follow-up visit one to three weeks later, a nurse will discuss with participants their assessment results and formulate personalized preventative measures for those with suboptimal control in AD risk factors and/or positive retinal imaging. Those who have genuine cognitive impairment will be further recommended to seek medical attention for further formal work-up of early AD.
The fundus camera on the BEAT AD truck employs the world’ s first AI model capable of detecting people who are at risk of AD solely through retinal images, a technology developed by an international team led by CU Medicine. The retina is an extension of the central nervous system. The eye is therefore a window that can show abnormal changes in the blood vessels and nerves of the brain that are associated with AD.
The model has about 80% accuracy. As fundus photography is widely accessible, non-invasive and cost-effective, it is increasingly being used to screen people’s brain health or risk of AD in the community, so that early preventive treatments such as multidomain lifestyle changes could be vigorously practised to prevent development of AD pathologies.
The average cost of caring for a dementia patient is roughly HKD$187,145 per year. A key feature of AD is the buildup of an abnormal substances in the brain, beta-amyloid plaques. Anti-amyloid drugs have been developed to help clear these plaques and are effective in slowing progression of the disease if it is applied at the early stage of AD when the cognitive impairment is not severe enough to interfere daily activities.
‘However, the cost of applying these FDA-approved new drugs for treating early AD and of performing frequent MRI brain to monitor potential side effects of these drugs is around HKD$300,000 per year, which are unaffordable for many people’ says Professor Vincent Mok Chung-tong, Mok Hing Yiu Professor of Medicine at CUHK and co-director of the BEAT AD Service. ‘The BEAT AD service, in identifying people with risk factors of AD or those with suspected early AD and providing community education and tailormade preventive recommendations to these individuals, helps address the pressing needs of reducing dementia burden by a more affordable mean’.
Social determinants of health involve a range of factors that affect people’s health, including social inclusion, education and access to affordable health services of decent quality. ‘Underprivileged elderly people are at risk of dementia as they lack the awareness and resources to do health checks’ , he adds. When individuals have obvious symptoms that affect their daily activities, it is too late to offer treatments that can reverse the symptoms.
Besides placing a burden on the public healthcare system, dementia also affects the labour force, as family members lacking resources to employ carers need to quit jobs to care for their loved ones as they experience a cognitive and physical decline. The caring process and potential stigmatization of the disease could be distressing to caregivers. Therefore, early screening and intervention can ease the social cost.
The BEAT AD team has also planned to collaborate with the Neurocognitive Centre of the CUHK Medical Centre to establish a ‘neurocognitive registry’ to advance medical research on dementia. Cases screened to have suspected early AD and are potentially eligible for anti-amyloid drug can be referred to the Neurocognitive Centre for subsidized diagnosis and treatment at the Centre. Initiatives such as partnering with Wong Tai Sin District Health Centre in conducting service similar to that of BEAT AD to elderly citizens in Wong Tai Sin serve as pilot projects to further its social impact.
Dr Chiu Ha-ying, co-director of BEAT AD service, says: ‘Thanks to Dr Lin’s dedication in sponsoring and promoting the service, it has received a warm welcome’. As of August 2024, the service has screened 487 elderly citizens. Majority (85%) have relatively normal cognition but have suboptimal control of AD risk factors (e.g., lack of physical activity, high cholesterol). While 15% have cognitive impairment requiring further medical work-up for early AD, yet they were not aware of the severity of their symptoms and the need to seek medical attention. Another 15% of participants were screened to be positive by the retinal imaging, suggestive of having suboptimal brain health. 135 participants with either suboptimal control of AD risk factors and/or positive retinal imaging received personalized interventions and completed 6-month follow-up.
‘Our customized service includes health education on diet, workout (both aerobics and muscle strengthening), and cardiovascular risk management. Marked improvements have been seen after interventions’ , she adds. The multidomain lifestyle interventions draw on the research findings of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER).
The goal of building sustainable cities is a transformative agenda to nurture an environment in which people grow, flourish and live with dignity. Many factors that cause irreversible brain health decline and AD are potentially modifiable. Leveraging CUHK’ s expertise in dementia research and collaboration with local health care service providers, the team has developed interdisciplinary synergy for early diagnosis and community education to build an inclusive society and a sustainable health care system for a more equitable future.
Former CUHK Vice-Chancellor Professor Charles K. Kao (right), the Nobel prize-winning ‘father of fibre optics’ , suffered from Alzheimer’ s disease (AD) for years before he died in 2018. By then, his wife Gwen Kao (left) had long been campaigning to raise community awareness about the disease
Guests toast at the BEAT AD Charity Gala Dinner. The dinner, which was held on the night of 9 November 2024 to enhance dementia awareness, raised over HK$5 million to support the ‘BEAT AD Service’ programme, enabling its extension for another 3 years after completion of the present pilot phase (Source: BEAT AD Service)
Jenny Lau is an editor in the Communications and Public Relations Office, The Chinese University of Hong Kong.