The race to ‘catch’ dementia early

Neck scans, genetic tests and apps are being developed that could predict your risk before you show any signs of this cruel disease, reports Victoria Lambert

Screening for early signs of dementia would seem like a curate’s egg: it’s important to understand if you are at risk of the condition, yet there is nothing that can be done if you find out you are. Given that dementia affects more than 850,000 people in the UK, with that figure set to hit one million by 2021, who could be blamed for not wanting advanced warning?

In the search for a cure, scientists are focusing on screening for early indicators of the condition: the hope being that by finding those most at risk, breakthroughs can be made in prevention and treatment.

Current methods of predicting if you are likely to get the disease can be quite invasive, such as lumbar punctures, or expensive, like PET amyloid scans.

But research from University College London (UCL) released last week suggests screening for some types of dementia could be as quick as a five-minute neck scan, which could be carried out as part of a general midlife check-up. Other initiatives include using artificial intelligence (AI) and genetic monitoring.

“Dementia is a term applied to a collection of progressive cognitive symptoms that affect more than one domain,” explains neuroradiologist Dr Emer Macsweeney.

Currently, we recognise the condition when an individual has developed obvious symptoms and the underlying disease causing dementia is quite advanced. These can manifest as loss of “short-term memory or visual spatial awareness, over a period of at least six months. There are lots of illnesses that cause dementia – the best known of which is Alzheimer’s. These are what we are trying to screen for.”

Dr Macsweeney, CEO of Re:cognition Health, a research organisation and healthcare provider, says that “more often than not, people are only investigated when they present with advanced symptoms. The illness may be slow or easily confused with something else, such as depression.

“The important thing is to detect who is at significant risk of developing dementia before their illness starts to cause significant and irreversible brain damage. It’s like measuring blood sugar levels to spot diabetes before it can cause organ damage.”

For former professional football player Dave Serella, 66, who lives in Lytham St Annes with his wife Pat, 65, early diagnosis has meant treatment with the drug Aricept (donepezil). It is one of the few drugs found to be useful in treating mild to moderate dementia.

Serella’s first symptoms began about six years ago, when his wife noticed he was becoming forgetful of names and places, but both put it down to age.

However, two years ago, after more incidents of confusion, Pat arranged for her husband to attend a memory clinic via the GP practice where she worked as a secretary. After a series of cognitive tests, Alzheimer’s was diagnosed.

Although formal diagnosis took a long time, Serella’s illness has been picked up early. It is estimated that dementia affects one in 14 people aged over 65, and one in six aged over 80.

Former Nottingham Forest, Walsall and Blackpool player Serella is pragmatic about the situation, describing it as “one of those things. I am a very positive person,” he adds. “I don’t sit around at home sulking. I do struggle to remember things, so now I write things down in a little book – only then I forget where I put the book.”

The research Dr Macsweeney is involved in seeks to identify cases like Serella’s even earlier. New medication is being developed “which is designed to treat the underlying abnormalities in the brain which destroy cells. If you can give these treatments early, you prevent further cell destruction,” which causes symptoms like confusion.

While some drug trials are for those with mild forms of diagnosed dementia, others are looking to recruit people who are not actually showing symptoms. Dr Macsweeney explains: “We are looking to identify people with known risk factors and then find a treatment to lower their risk factors so they don’t develop symptoms.”

These risk factors include high levels of amyloid or tau proteins in the blood, which destroy healthy cells.

“We also look at the apoe gene, which everyone has in pairs,” she says. “We’re looking for a specific type of apoe called E4. Research tells us that if you have two copies of this gene, your risk of dementia is raised compared to the rest of the population.”

Much research is in its early stages, warns Dr Aoife Kiely, research communications officer at the Alzheimer’s Society. “The UCL neck scan study evaluated how strong the pulse was in the neck as blood travelled to the brain. Too strong might suggest that damage could be done to small blood vessels in the brain, which might cause ministrokes or bleeds, and increase the chance of cognitive decline.

“But while this is a good study, it is difficult to evaluate how much of a difference this scan makes. Cognitive decline doesn’t necessarily guarantee the onset of dementia.”

The Alzheimer’s Society is currently working with researchers at the University of Oxford on an AI app, Gamechanger, which could be used to help to improve future diagnosis.

AI technology is being studied, too, by researchers at the University of California in San Francisco to detect subtle changes in the way the brain uses glucose, as this can also be a sign of early Alzheimer’s. A new study of 40 patients showed the technology could detect the disease six years before conventional diagnosis.

Accurate early diagnosis, the ultimate goal of all of this research, is crucial for three reasons, Dr Macsweeney says. “You can enter clinical trials and get access to medication that may slow down symptoms and disease progression.

“You can make plans and develop coping mechanisms, put systems in place to determine your own future and maintain independence for as long as possible.”

Lastly, she says, “about a third of risk factors for development of dementia can be reduced. This is particularly true of intervention with exercise – 40 minutes three times a week – but also you need to have a good diet, get plenty of sleep, don’t smoke or drink too much alcohol, and keep the brain really active through socialising, learning an instrument or reading.”

She adds: “One of the things I hear most often from people with mild or moderate dementia is that they didn’t realise they could join trials that may make a difference to the progression of their disease.

“They think there is nothing they can do because there is no cure, yet if they become involved in research, they may benefit from a new medication.

“Most of all, they will have some hope returned. It is tough being diagnosed with such a feared disease.”

Serella adds: “I don’t think there will be a cure in my lifetime but I hope there are things I can continue to take which slow dementia down. I just want to carry on as long as I can. I’m happy with that.”

If you are over 18 and do not have dementia, you can sign up to be a Gamechanger at Alzheimers.org.uk/ gamechanger

‘The important thing is to detect who is at significant risk before their illness starts’