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 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.