Major dementia breakthrough could turbocharge UK diagnosis rates

A dementia scan breakthrough could boost diagnosis rates by doubling NHS capacity for crucial tests, pioneering research has found. Scientists have developed a method for producing "ultra-fast" MRI scans, slashing the time patients need to spend in the machine from 20-30 minutes to less than seven minutes. Guidelines recommend structural imaging to rule out other causes of cognitive decline or help pinpoint the type of dementia.

But many patients never receive a scan, and those who do are more likely to have computerised tomography (CT) scans which provide less detailed images. The new technique could allow hospitals to offer MRI scans to twice as many people with suspected dementia, dramatically increasing access to the technology.

Professor Nick Fox, an expert in neurology whose team pioneered the method at UCL's Functional Imaging Laboratory, said: "This is really exciting. It means that we can make MRI scans - that people deserve to have - much, much more available.

"One in three people don't get a dementia diagnosis at all, we estimate. And for those people who do, there are long delays and the recommendation that everybody should have a scan doesn't happen.

"This could at the very least double the number of MRI scans we can do. There's no reason why this approach can't be used across nearly all scanners across hospitals in the UK."

The Express was invited to try both scans and join the study, which was part-funded by Alzheimer's Society. Magnetic resonance imaging (MRI) uses a powerful magnet to align protons in the body. They are then knocked out of alignment by pulses of radio waves.

As the protons realign, sensors detect the energy released to gather information about the type of tissue, then convert this data into images. Lying still in the machine can be extremely challenging for patients who are claustrophobic or have memory problems and may forget this key instruction.

Using "clever physics", Prof Fox and his colleagues accelerated the scanning process so more information was gathered simultaneously. This cut the total scan time by almost two thirds. Once the time taken to get patients in and out of the scanner was accounted for, the experts said their method could at least double capacity.

The team showed three neuroradiologists anonymised images from 92 volunteers. The ultra-fast scans were found to be just as reliable as standard ones. Prof Fox said: "What we found was that, when we didn't tell them which scans were fast or standard, experienced neuroradiologists couldn't tell the difference.

"The diagnostic ability was just as good, and in some cases slightly better because there was less blurring from people moving. It made much more difference which radiologist looked at your scan, or which day of the week it was."

Latest NHS data for August showed 66% of people living with dementia were thought to have a diagnosis. Charities have warned this means one third are being left in the dark without support.

Prof Fox said the NHS and Government should be more ambitious about not only detecting dementia but providing a specific diagnosis of the underlying cause.

He added: "Saying 'it's dementia' is like saying 'it's a rash'. If you went to see your GP, you wouldn't accept them just saying 'yes, it's a rash'. You'd want to know if it's cancer, eczema, something else.

"Dementia just means brain failure, it's not working in the way it should anymore. But the underlying cause could be Alzheimer's disease, strokes, lots of different things. We can only make progress if we give people an accurate diagnosis and a much more timely, rapid one."

Scans are used alongside cognitive tests to determine the type of dementia. For example, a scan might reveal evidence of previous strokes or shrinkage in regions vulnerable to Alzheimer's disease, such as those related to memory.

But Labour's recent 10-Year Health Plan for England acknowledged that "the UK is far behind other countries in the levels of CT, MRI and positron emission tomography (PET) scanners for its population". The UK has 8.6 MRI scanners per million population - the lowest number among comparable countries.

The latest National Audit of Dementia for 2023/24 found that 44% of patients who visited specialist memory assessment services had a brain scan, although this varied from 0-90% depending on the service. Data for 2021 showed only 31.8% of brain scans performed for suspected dementia were MRI.

MRI scanners cost around £1million. Prof Fox said many hospitals could roll out the faster technique and boost capacity at little to no cost, although some scanners may require a software update.

The team now plans to work with hospitals to trial the ultra-fast scans. It is hoped the method could also be adapted for other types of body scans.

Improving the availability of MRI scans is particularly important due to the arrival of promising new treatments for Alzheimer's. Patients need an accurate and specific diagnosis to qualify for treatment, plus regular brain scans to monitor them for rare but serious side effects.

Lecanemab and donanemab - groundbreaking drugs that can slow Alzheimer's - are licensed in the UK but were rejected for NHS use after assessors decided the benefits were too small to justify their cost. Reducing the price-per-scan for monitoring could help reduce the overall cost of administering such treatments.

Study co-author Dr Miguel Rosa-Grilo, also of UCL, said: "This is really important because MRI is the state-of-the-art investigation that we want patients to have.

"Now with the potential of disease-modifying therapies, these scans are essential for diagnosis and monitoring so we need to be more efficient.

"We could get more scanners, but that requires a different approach and funds. This strategy essentially uses the scanners that are available, there's no hardware that needs to be updated."

The findings were published in Alzheimer's & Dementia, the journal of the Alzheimer's Association. Alzheimer's Society's associate director of research and innovation, Richard Oakley, described an early and accurate diagnosis as "the first step to getting vital care, support and treatment".

He said: "Dementia is the UK's biggest killer, but one in three people living with the condition haven't had a diagnosis.

"While MRIs aren't the only way to diagnose dementia, very few people with concerns about their cognitive health are offered one as part of the diagnosis process, mainly because they are expensive and not widely available.

"These faster MRIs, which take less than half the time of standard scans, could help end this postcode lottery in dementia diagnosis, cut costs and potentially give more people access to them."

Mr Oakley said MRI scans can be an uncomfortable and daunting experience for patients "so anything we can do to make it an easier process is really positive".

He added: "So far, this shortened MRI scan has been tested at one specialist centre with one type of MRI scanner, so more research is needed to make sure this works across different types of scanners and a diverse range of people. We're hugely encouraged by this progress and eager to see how it continues."

Health Minister Karin Smyth said: "Timely dementia diagnosis is crucial, so this new technology and its potential to get through more patients is incredibly exciting. We are working on how this can be rolled out across the NHS to rapidly increase its capacity to see more patients.

"Our ambition is a society where every person with dementia receives high-quality, compassionate care from diagnosis through to the end of life. This government remains committed to increasing diagnosis rates and ensuring people can access the appropriate treatment and support they need."

Dr Jeremy Isaacs, NHS England's national clinical director for dementia, said: "The NHS is always looking for ways to streamline diagnosis and make the most of our scanners to make diagnostic services as efficient as we possibly can for patients.

"Getting a diagnosis of dementia is the first step in supporting people. The sooner someone is seen, the quicker the NHS can help. Any research to help improve diagnostic capability or efficiency must be carefully considered."

Hanna describes her MRI scan experience

Within minutes of entering the machine, I learn that having an MRI scan is not a very pleasant experience. The white tube I'm lying in feels like it is rotating and the cacophony of mechanical whirring, chugging and beeping is uncomfortably loud - even through my ear plugs.

I'm not usually claustrophobic but for a moment I feel panic rising. I close my eyes, take some deep breaths and pretend I'm in a yoga class practicing Shavasana, also known as corpse pose or lying flat on your back.

Before entering the MRI room, I was asked to confirm several things including that I'm not wearing any metal and don't have any implanted or embedded in my body.

The checks were so thorough I began to feel paranoid. Did I have a hip replacement or an encounter with some shrapnel I've forgotten about?

Once lying on the bed, the research staff made me comfortable with cushions and a helmet to keep my head as still as possible throughout the scan.

The first scan using the standard imaging method takes around 20 minutes. Thankfully, it passes more quickly than I had feared. The second scan using the accelerated method takes just under seven minutes.

Throughout each test, I hear the machine running through various imaging sequences with different patterns of sounds. Some are like a blaring alarm. Lying still and trying desperately to ignore my itching nose, I soon see the obvious benefits of the faster scan.

Remaining still for 20 minutes is incredibly difficult. Someone in the early stages of dementia who is experiencing memory problems may even forget this crucial instruction. If they move too much, the scan becomes unusable.

When it's over, the staff show me squiggly images of my brain on a screen. A few days later, they inform me that my scan looks "completely normal - a good looking brain".

My scans will now be kept in their database for future research to improve this crucial technology.

Ever known someone with dementia to have an MRI scan? These scans are important but can be stressful as the person may find it hard to stay still for the required length of time.

The brilliant team at University College London, part-funded by Alzheimer's Society, has now published the first results of a method which can cut MRI scan times down from 20-30 minutes to under seven minutes without affecting the reliability of the scan.

In clinics today, MRI scans can be used as part of dementia diagnosis to rule out any other causes of cognitive decline and to help identify exactly what kind of dementia the patient has developed. However, they are expensive and not widely accessible.

Dr Miguel Rosa-Grilo, Professor Nick Fox, Professor Geoff Parker and colleagues have performed the first explorative study with patients to understand how a highly accelerated MRI could get us closer to a reality where every person living with dementia could be diagnosed with a scan.

This new MRI is more comfortable for the patient, could reduce the costs of scans, and could also help increase access to new disease-modifying treatments for Alzheimer's diseases as an MRI is a requirement before starting treatments like lecanemab and donanemab. Regular MRIs are also required for safety monitoring during treatment of these drugs.

Although these two particular drugs are not available on the NHS, a future is coming where we will have treatments available and we need to be ready to diagnose those people, so they can get the treatment early in disease progression.

We know that one in three people with dementia do not have a diagnosis. Yet a diagnosis is the important first step to getting the care and support that people need.

We need diagnosis to be faster and cheaper and available for everyone. Congratulations to Prof Parker and the team for getting us closer to that reality.

- Richard Oakley is associate director of research and innovation at Alzheimer's Society