DEMENTIA

One of the greatest benefits derived from the advancement of medical science is the longer life expectancy people now have. But it brings with it an array of concerns and responsibilities, chief among them the need to come to terms with the fast-rising incidence of dementia. For far too long now it has been the poor relation of other forms of medical research, which subsequently has meant dementia attracting an inadequate level of research and public funding and support.

Dementia research is decades behind, for example, cancer, with six times more UK researchers working on cancer than dementia. This week, though, the Alzheimer’s Society which is calling for greater research and public support to treat the condition will receive a powerful endorsement for its work from the first G8 dementia summit. Dementia is an appalling and harrowing condition which destroys the final few years of a sufferer’s life, stripping them of their dignity, and the profound effects it has on families and those who provide care for the sufferer.

It is the growing incidence of the condition, however, that should now compel concerted action. Current estimates suggest some 35.6 million people around the world are living with dementia, including around 800,000 in the UK. Because of an ageing population, the World Health Organisation (WHO) has estimated that the number of people suffering with the illness could reach 115.4 million by 2050. In the UK alone, there are likely to be nearly a million people with the condition by the end of 2020.

David Cameron has said that tackling the condition is a ‘personal priority’. The Prime Minister has already announced a UK plan on research, care and awareness and that funding for dementia research will increase to around £66 million by 2015. Such announcements are always welcome but, given the scale of the challenge, seem far from adequate. The enormity of the problem in dealing with such an intractable disease needs to be recognised for what it is and for campaigners to pursue both research and funding support with the utmost vigour.

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ALZHEIMER’S BRAIN SCAN

NHS PATIENTS are to benefit from a new brain scan that will help doctors confirm or rule out a diagnosis of Alzheimer’s disease.

It is to be announced that Britain will be the first place in the world where the revolutionary technique will be available for free.

The test will mean that, for the first time, doctors will be able to definitively rule out Alzheimer’s in some patients for five years. Currently, one in five cases of the disease is misdiagnosed.

It could also help doctor s to confirm an existing diagnosis of Alzheimer’s, ensuring people get the treatment they need.

The test – which is believed to cost £810 per patient – involves giving the patient a tiny amount of a radioactive chemical called Amyvid which binds to the tell-tale plaques in the brain of a Alzheimer’s sufferer.

This chemical will show up the plaques on a brain scan for the first time, allowing doctors to definitively rule out Alzheimer’s in a patient for at least five years if no plaques are present. It means the patient will not be given potentially harmful treatments if they don’t need them.

Until this breakthrough, it has not been possible to definitively diagnose someone as having the disease until after their death.

Examinations of the brains of people who have died show that one in five people diagnosed with Alzheimer’s did not in fact have it, meaning they may have been given the wrong treatment while they were alive.

Plaques, however, can be present in other conditions and the new brain scan alone will not be enough to pinpoint the disease.

Dementia is one of the main causes of disability in old age, ahead of cancer, heart disease and stroke. Whilst there are 800,000 people with dementia in the UK, about two thirds of those are Alzheimer sufferers. By 2021, more than a million people are expected to have dementia. The disease is being described as ‘the key health challenge of this generation’.

The Amyvid test – developed by US drugs firm Lilly – has previously been used elsewhere in the world, but only through private health schemes.

The use of the technique by the NHS will be the first time it has been available as part of a state-funded health system. The first patients to benefit will be scanned at Charing Cross Hospital, part of Imperial College Healthcare NHS Trust, in London.

Although a negative scan would mean a person highly unlikely to develop Alzheimer’s in the next five years that would be no guarantee that the condition could develop in future years.

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12 December 2013…

PREVENTATIVE MEASURES

The scientific and medical fields have been waiting for a breakthrough drug treatment for Alzheimer’s for decades. An astonishing £25 billion has been spent worldwide on trying to develop one, and yet we still don’t have anything that can slow down, let alone stop, the disease.

It’s certainly true that drugs such as Aricept may help some patients with their symptoms, but only for a short while.

That leaves patients and their families in the hopeless position of waiting for the drug and pharmaceutical companies to discover a treatment.

It doesn’t necessarily have to be like that. There are other options.

There are things that can be done to improve the situation right now – but governments, charities and other research bodies need to make a long overdue switch to a new strategy: preventing the disease.

What needs to be understood is that nearly all that £25 billion has been spent researching and testing ways to stop just one thing that goes wrong in the human brain.

The idea has been to develop drugs to block or clear amyloid plaque – the sticky damaged protein associated with dying neurons.

It was a reasonable idea, but concentrating on it exclusively – without even considering any other options – has condemned millions to a decline that might have been slowed down or prevented. How many billions do you have to spend without a result before admitting it’s time to also look elsewhere?

Some of the money should have been spent on research into its prevention. If you can’t reverse the damage, the most obvious step is to stop it happening it all.

Scientists and medical practitioners know it is possible. In fact, research suggests that a strong commitment to prevention could cut the number of Alzheimer’s sufferers by 20 per cent by 2025.

One key thing that needs to be addressed is people’s diet. For instance, switching to a so-called Mediterranean diet – rich in fresh fruit, vegetables, nuts and olive oil – could have a real impact.

The G8 summit on dementia in London this week is aiming to develop a co-ordinated global action plan for tackling Alzheimer’s. A statement, signed by more than 100 leading international dementia experts from 36 countries, has been sent to health ministers calling for a major shift in direction.

These experts believe that any action plan can’t just involve drugs – it is imperative, they say, that in cutting your risk of developing Alzheimer’s requires improvements in diet and lifestyle.

Many lifestyle factors linked to heart disease also increase your risk of Alzheimer’s including high blood pressure, smoking and cholesterol levels.

More important still is that there are virtually no public funds available for trials to find out how exactly they contribute to Alzheimer’s.

Alarmingly, so little in the UK is spent on research into Alzheimer’s prevention. Over the past six years, UK Research Councils, which are funded by the Government, spent £140 million studying Alzheimer’s.

Yet, just 1p in every £1,000 went on prevention. And of the additional £49 million for dementia research pledged by this Government last year, not a single penny went on prevention.

This is tragic. For years researchers have had a chance to do something that had a reasonable chance of significantly reducing the number of people developing this disease. The Government and charities, however, have continually ignored it. Instead, billions went on a drug programme that was never shown to work.

Some people might wonder how experts can say prevention will definitely work and yet also claim it hasn’t been researched. In fact, prevention has been tested – by accident.

The proportion of people developing dementia has, surprisingly, been falling for the past 20 years. The medical journal, The Lancet, reported earlier this year that estimates for dementia in England should be reduced by almost 25 per cent.

This is partly the result of a deliberate prevention programme – but one aimed at heart disease, not Alzheimer’s. For the past two decades, people have been encouraged to make healthy lifestyle changes, such as stopping smoking and lowering blood pressure to protect their heart.

This, along with other social factors such as improved educational opportunities, has had a clear impact on Alzheimer’s risk. A healthy heart makes for a healthy brain. But just relying on measures already in place to cut heart disease risk isn’t nearly enough.

Although fewer people suffer heart disease, there has been a huge rise in obesity and diabetes, both also major risk factors for Alzheimer’s. Cutting Alzheimer’s rates is going to involve tackling diabetes risk factors as well.

Despite little funding, there have been pockets of important research on prevention.

Three years ago a controlled trial was undertaken in Oxford that showed brain shrinkage was cut by an impressive 90 per cent in people with memory problems after they took high levels of B vitamins.

Scientists in the U.S., Germany and Australia have also shown that supplements of omega 3 fatty acids, as well as exercise may cut the risk of Alzheimer’s.

Exercise seems to cut risk in several ways, including increasing oxygen available to the brain and encouraging new brain cells to grow. It also makes blockages in the brain’s blood supply less likely, cuts damaging inflammation and reduces depression (which raises Alzheimer’s risk).

A number of researchers now suggest that eating lots of sugar and other refined carbohydrates, which raise glucose levels in the blood, contribute more to diabetes risk than saturated fat does.

But only a proper programme of research will show for sure.

This is already starting to happen on the continent. The European Dementia Prevention Initiative has four trials underway looking at the effect on Alzheimer’s when you target heart disease risks and other lifestyle factors. The big pharmaceutical companies are never going to do this sort of research because it doesn’t make them money: they can’t patent exercise or nutrients.

What can make a difference is dedicated government funding for prevention.

More is needed than just money. We need a shift from thinking that only drug research and genetics and cell biology are proper science. It is very exciting being at the cutting edge of brain science, unravelling complex gene changes that cause neurons to die and the forming of damaged protein clumps. Big gains, though, in heart disease came from tackling risk factors such as smoking and raised blood pressure. Real progress to stop the terrifying rise in Alzheimer’s will come in the same way.

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14 December 2013…

A DRUG TO CURE DEMENTIA WITHIN REACH

David Cameron has said that a cure for dementia or a drug that can halt the disease in its tracks will be available by 2025.

This week, the prime minister pledged to double the amount that is spent on research into the devastating illness, and to help speed up the development of treatments.

At a summit in London attended by the health ministers of the G8 nations – including the US, Canada, Japan and France – he said that a cure was ‘within our grasp’.

There are around 800,000 adults in Britain with dementia – and 44 million worldwide – but these numbers are predicted to double in the next 40 years as the population ages.

But despite the vast numbers affected, there are only a handful of treatments available, and these only temporarily slow the advance of the disease. On Wednesday, the Prime Minister unveiled a package of measures, with the health ministers of G8 states promising to share more research across national boundaries and to cut the bureaucratic hurdles which delay treatments becoming available to patients.

Reinforcing the devastating effect of the illness, Mr Cameron said: ‘This disease steals lives, wrecks families and breaks hearts… If we are to beat dementia, we must also work globally, with nations, business and scientists from all over the world working together as we did with cancer, and with HIV and Aids.’

He added: ‘This is going to be a bigger and bigger issue; the key is to keep pushing. The challenge is huge and we are a long way from a cure, but there is hope.’

Last week, researchers from University College London said they hoped that a monthly jab capable of halting dementia in its tracks could become available within the next five years. The drug – solanezumab – is in trials and could be given to patients even before symptoms have developed if the disease is picked up in scans.

Ministers hope they can speed up the time it takes for drugs to come on to the market by removing some of the unnecessary safety checks and regulations.

It can take at least ten years for drugs to be offered to patients after they are first developed – but politicians believe this could be slashed to two or three.

Health secretary Jeremy Hunt who also attended this week’s summit, said: ‘The amount going into research is too little … We would like a cure to be available by 2025. It’s a big, big ambition to have. If we don’t aim for the stars we won’t land on the moon.’

Jeremy Hughes, chief executive of the Alzheimer’s Society, said: ‘The UK has demonstrated global leadership on tackling dementia.’

He added: ‘We have committed to a global plan, better support for people with dementia through research, and the Prime Minister has agreed to narrow the funding gap between dementia and cancer research – something we have long campaigned for… Dementia has come out of the shadows and is centre stage, but we must ensure G8 has a lasting legacy.’

Dementia is a progressive disease, meaning that symptoms cannot be reversed. Symptoms include loss of memory, mood changes, and trouble communicating. The most common types of dementia are Alzheimer’s disease and vascular dementia.