ALZHEIMER’S: THE GOOD NEWS

Yes, you did read that right. When it comes to this fright­en­ing dis­ease, there re­ally is cause for op­ti­mism, says writer Anne Mon­tague, who has her own rea­sons for find­ing out more...

Good Housekeeping (UK) - - Contents -

GOOD HEALTH

Any­one who has lived through de­men­tia knows the nag­ging fear that, in time, the same thing could hap­pen to you. Polls show it’s the dis­ease we fear the most. It is the cru­ellest of con­di­tions. I watched help­lessly as my beloved dad grad­u­ally lost his abil­ity to man­age day-to-day life, to read and write and fi­nally to speak, and to recog­nise his own chil­dren. I re­mem­ber won­der­ing whether that would be me and re­as­sur­ing my­self that I would be fine – science would find a cure.

As the years marched on, noth­ing came. But now, for the first time in many years, there is good news. Al­though it is now the lead­ing cause of death – mainly be­cause of an age­ing pop­u­la­tion in which the in­ci­dence of other killer dis­eases has gone down – re­search shows that the preva­lence of de­men­tia is not ris­ing as dra­mat­i­cally as pre­dicted.

In fact, over the past two decades, there has been a 20% fall in cases in the over-65s. And now, with a bet­ter un­der­stand­ing of how de­men­tia de­vel­ops, the prospect of ef­fec­tive treat­ments is fi­nally on the hori­zon. ‘We know more than ever about the hu­man brain and what goes wrong in com­plex dis­eases like Alzheimer’s,’ says Dr Rosa San­cho of Alzheimer’s Re­search UK. ‘Re­search into the dis­eases that cause de­men­tia has been gain­ing sig­nif­i­cant pace and is now start­ing to yield real break­throughs.’

All in all, it’s an ex­cit­ing time, thanks to the fol­low­ing game-chang­ers...

FALL­ING FIG­URES

While there’s no room for com­pla­cency, re­searchers from Cam­bridge Univer­sity found that rather than the pre­dicted 250,000 new cases an­nu­ally, there are now fewer than 210,000. The fall is mainly among men, and al­though no one knows pre­cisely why this has hap­pened, ex­perts point to the fact that we are liv­ing health­ier lives. ‘Phys­i­cal health and brain health are closely linked,’ says Dr Laura Phipps of Alzheimer’s Re­search UK. ‘While age re­mains the big­gest risk fac­tor for de­men­tia, bet­ter ed­u­ca­tion lev­els, less smok­ing and bet­ter heart health may have all played a role.’

SE­RI­OUS RE­SEARCH

De­men­tia is no longer the poor re­la­tion – over the past five years, there has been a sig­nif­i­cant in­crease in the fund­ing and po­lit­i­cal com­mit­ment to tackle it. In 2015, the Gov­ern­ment launched a five-year de­men­tia strat­egy and in­vested £300m in

In many ways, de­men­tia is where 20 can­cer was or 30 years ago

new re­search. ‘In many ways, de­men­tia is where can­cer was 20 or 30 years ago – we are start­ing to see re­ally pos­i­tive and ex­cit­ing changes,’ says Dr Phipps. ‘The am­bi­tion is to have an ef­fec­tive dis­ease mod­i­fy­ing treat­ment within 10 years.’

BET­TER UN­DER­STAND­ING

De­men­tia is not one dis­ease but an um­brella term for symp­toms that de­velop when brain cells stop work­ing as a re­sult of other con­di­tions. Alzheimer’s is the most com­mon cause of de­men­tia, where changes in the brain seem to re­sult from an ac­cu­mu­la­tion of two pro­teins – amy­loid, which re­sults in ‘plaques’, and tau, which causes ‘tan­gles’. ‘Re­search has fo­cused on the build-up of these ab­nor­mal pro­teins,’ says Dr Phipps. ‘Both seem to be im­por­tant – it may be that amy­loid is the judge and tau the ex­e­cu­tioner that trig­gers the nerve dam­age.’

Vas­cu­lar de­men­tia is the sec­ond most com­mon cause of de­men­tia and oc­curs when the blood flow to the brain is re­duced, af­ter a stroke or a se­ries of mini strokes or by changes in the small blood ves­sels in the brain. Al­though Alzheimer’s

af­fects two-thirds of de­men­tia suf­fer­ers, some peo­ple may have a com­bi­na­tion of dif­fer­ent types of de­men­tia.

EARLY DI­AG­NO­SIS

As the holy grail of a treat­ment that can de­lay or stave off de­men­tia be­comes more at­tain­able, it be­comes even more im­por­tant to catch the dis­ease early. Age is the big­gest risk fac­tor for de­men­tia and it is es­ti­mated that de­lay­ing the on­set by just five years would mean that the num­ber of peo­ple af­fected – and the cost to the UK econ­omy – would be cut by a third by 2050.

The ma­jor­ity of the drugs be­ing de­vel­oped seem most ef­fec­tive in pa­tients who are in the early stages of the dis­ease, but di­ag­no­sis can be dif­fi­cult. Cur­rent di­ag­nos­tic tech­niques are fairly crude – largely ques­tion­naires and tests that as­sess dif­fer­ent facets of mem­ory, lan­guage and at­ten­tion – and not 100% ac­cu­rate. Now re­searchers are de­vel­op­ing cheap, sim­ple eye and smell tests that may be able to de­tect the warn­ing signs of de­men­tia years be­fore any symp­toms ap­pear. Sci­en­tists at Lon­don’s Moor­fields Eye Hospi­tal found that some of the early changes in the brain as­so­ci­ated with de­men­tia can also hap­pen in the retina at the back of the eye. In a study of more than 33,000 peo­ple, they found a link be­tween poor cog­ni­tive abil­ity and the thin­ning of peo­ple’s reti­nal nerves. Re­searchers from Columbia Univer­sity Med­i­cal Cen­ter in the US are also look­ing at a scratch-and-sniff test – they found that low scores on de­tect­ing odours were as­so­ci­ated with de­men­tia and Alzheimer’s dis­ease.

NEW TREAT­MENTS

Af­ter years of frus­tra­tion, ef­fec­tive treat­ments may be in sight. ‘Over the com­ing years, we should see po­ten­tial new treat­ments for de­men­tia reach­ing the fi­nal stages of test­ing in peo­ple,’ says Dr San­cho. ‘There is real mo­men­tum build­ing to trans­late our un­der­stand­ing of the hu­man brain and what goes wrong in dis­eases like Alzheimer’s into new treat­ments as soon as pos­si­ble.’

Many of the drugs be­ing de­vel­oped tar­get the amy­loid that builds up plaques and leads to nerve dam­age. One of the most hope­ful is the an­ti­body drug ad­u­canumab, which is de­signed to mop up amy­loid be­fore it has a chance to ac­cu­mu­late. Early re­search found that it not only re­moved the build-up of amy­loid from the brain, but also slowed the de­cline in mem­ory and think­ing skills. Re­searchers are now re­cruit­ing peo­ple with early Alzheimer’s or mild mem­ory prob­lems to take part in a much larger trial.

Other drugs tar­get tau, the sec­ond pro­tein that be­haves ab­nor­mally in Alzheimer’s dis­ease. One new drug, known as LMTX, is de­signed to stop tau form­ing tan­gles and has been shown to re­duce brain shrink­age in peo­ple with mild to mod­er­ate Alzheimer’s. Peo­ple tak­ing the drug showed sig­nif­i­cant im­prove­ment in tests of cognition and per­for­mance in daily ac­tiv­i­ties af­ter 15 months of tak­ing the drug.

Sci­en­tists are also look­ing at new ways to use ex­ist­ing drugs. We know there is a con­nec­tion be­tween type 2 di­a­betes and Alzheimer’s and re­search is un­der­way to in­ves­ti­gate whether di­a­betes drugs could be used to

treat Alzheimer’s.

De­men­tia re­search has shown lifestyle fac­tors play an im­por­tant role

De­men­tia isn’t an in­evitable part of age­ing, say the ex­perts

De­men­tia: re­searchers are putting the pieces to­gether

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