9 Milestones From Dementia Research in 2020
Medical headlines in 2020 have been understandably focused on the COVID-19 pandemic. But whilst the release of vaccines against this disease signals the beginning of the pandemic’s end, neurodegenerative diseases such as dementia remain without cure or effective treatment. Despite unprecedented financial pressure put on scientists, charities and institutions by the pandemic, research into these conditions has not ceased over the last year. Here, we present leading dementia charity Alzheimer’s Research UK’s list of advances that have improved our ability to diagnose, understand and overcome dementia in 2020.
Hope or hype for aducanumab?
Earlier in 2020, the US drug regulator (the FDA) announced that the potential Alzheimer’s drug, aducanumab, has been accepted for a priority review process. The drug, created by pharmaceutical company Biogen, targets amyloid, a protein that builds up in the brains of people with Alzheimer’s at an early stage in the disease. The priority review means that the FDA is aiming to decide about aducanumab early in 2021. The drug will need to be approved by regulators before it could be offered more widely to the general population.
Whether or not aducanumab is approved by the FDA, we will need to see new treatments coming through the development pipeline. Alzheimer’s Research UK’s Drug Discovery Institutes have been awarded funding for a further five years following a successful review process. These Institutes will continue to seize on the latest findings from academia, identify new treatments approaches and act as a bridge between the pharmaceutical industry and university research
A new initiative to diagnose dementia earlier
Earlier this year Alzheimer’s Research UK launched the Early Detection of Neurodegenerative diseases (EDoN) initiative. Spearheaded by the charity, EDoN brings together leading research and support organizations, working to develop digital devices that can detect diseases like Alzheimer’s 10-15 years before symptoms start.
Key support from Bill Gates has allowed this project to ramp up even in the face of the pandemic. Researchers have been recruited to key positions in the project and are working in a number of large, ongoing research studies as the pilot phase of the initiative is well underway.
Chair of the EDoN Board, former UK Prime Minister, David Cameron, said, “The number of people with dementia is set to triple by 2050, to over 150m people around the world. Not only does this cause untold harm and heartbreak to millions of families, but it is completely unsustainable for our health and social care systems.
“Early detection is a critical missing piece of the puzzle when it comes to effectively treating this devastating condition. EDoN is bringing together leading international academics, technology companies and clinical experts in an initiative with scope and ambition that reflects the scale and importance of the challenge we are facing.”
A new focus on mild cognitive impairment (MCI)
Top clinicians and dementia experts from the NHS, universities, pharmaceutical organizations and charities have called for a fresh focus on how early memory and thinking changes known as MCI should be recognized, diagnosed, and treated.
Any future dementia treatments are likely to need to be given early in the disease process, making a strategy for dealing with early memory and thinking changes even more important.
“What we really need to see is national guidance to ensure that people with MCI receive the same treatment wherever they are in the country, and this should involve a strategy for allowing people to get involved in research,” said Dr Ross Dunne, consultant psychiatrist from Greater Manchester Mental Health NHS Foundation Trust. “A national plan would help support people across the UK who are experiencing these symptoms, create consistency in how we diagnose MCI and accelerate research into better treatments.”
12 risk factors for dementia identified
A report has estimated that the number of dementia cases worldwide could be reduced by 40% if 12 risk factors for the condition could be eliminated. Excessive alcohol use, traumatic brain injury (TBI) and pollution are three new risk factors that feature in this updated model.
Dr Rosa Sancho, head of research at Alzheimer’s Research UK, said, “As new studies continue to develop the evidence base on dementia risk, the report has identified three new risk factors for dementia. More evidence on the complex topic of sleep is needed before we can make a judgement on its impact on dementia risk, but we hope this report will act as a catalyst for further research.
“With no treatments yet able to slow or stop the onset of dementia, taking action to reduce these risks is an important part of our strategy for tackling the condition. Prevention strategies must be underpinned by robust evidence and while our understanding of dementia risk is growing, there is still much we need to know about the different risk factors for dementia.”
Dementia rates falling by 13% per decade over last 30 years
Over the past three decades, the incidence rate of dementia in Europe and North America appears to be declining. This is more pronounced in men than women and is likely to be driven by changes in lifestyle. With other dementia risk factors such as obesity and diabetes on the rise, this apparent decline in dementia rates may not continue for long.
The research was previously presented at Alzheimer’s Research UK’s Research Conference in Harrogate.
Dr Sara Imarisio, head of strategic initiatives at Alzheimer’s Research UK said, “We know that recent decades have seen a radical decline in smoking rates for men. While many people may have been persuaded to stop smoking due to an increased risk of cancer or heart disease, it is also a key risk factor for dementia.
“In future, prevention strategies that combine drug treatments and lifestyle changes may be the most effective strategy to limit the impact of dementia. While new drugs take many years to develop, lifestyle changes are available to us all.”
Blood tests predicting risk of dementia are announced
Researchers in Sweden found levels of certain blood-based proteins predicted worsening memory and thinking in a group of people with MCI.
“Blood tests for predicting the risk of Alzheimer’s disease are getting ever more advanced. In this well-designed study, levels of a form of tau coupled with a protein indicating neurodegeneration were able to predict who developed more severe memory and thinking problems. However, further studies in larger groups of people will need to replicate and verify the accuracy of this approach,” said Imarisio.
“One intriguing finding is that these markers predicted a change in memory in thinking in both people with and without the Alzheimer’s risk gene, APOE4. Genetic testing can present ethical challenges, especially as it can have implications for a patient’s family members. A blood test that does not need a genetic test would be most beneficial in the clinic.
“While there are other types of biological test that can help determine the cause and likely course of memory and thinking problems, blood tests are much more affordable than brain scans and more straightforward and acceptable to people than a lumbar puncture.”
AI development could help revolutionize research into the diseases causing dementia
An artificial intelligence (AI) solution pioneered by London-based AI lab, DeepMind, can determine the shape of many proteins quickly and at relatively low cost.
Diseases like Alzheimer’s involve the build-up of abnormally folded proteins that cause damage to nerve cells in the brain.
The structure of a protein determines how it behaves. Understanding its formation is a key goal of researchers and can help them design drugs that could help the brain get rid of harmful proteins.
Commenting, Imarisio said, “Proteins are essential for living and during the diseases that cause dementia they go awry. Working with proteins, understanding their structure, looking at their effects on behavior in the brain, and developing drugs to target them goes to the very core of what our scientists do. We still do not have a drug to slow or stop diseases like Alzheimer’s but new and powerful technologies able to accelerate progress gives people hope.
“As the UK’s leading dementia research charity, we are spearheading research initiative using AI to try and revolutionize how we view dementia in the future. We must wait to see the full data before we can understand the true impact of today’s announcement. Biology is complex and not only is the shape of a protein important, but the interactions it has with others. We must work to capitalize on the powerful technologies of today, but to do so we need to see investment in research increase. With Alzheimer’s Research UK set to lose vital funding because of COVID-19 we need the government to honor their commitment to double spending on dementia research to ensure progress is not lost.”
Why have antipsychotic prescription rates increased for people with dementia?
Latest figures analyzed by Alzheimer’s Research UK’s trustee Prof Rob Howard, of University College London, show that since lockdown there’s been an increase in prescription rates of a type of medication called antipsychotics in people with dementia. Previous Alzheimer’s Research UK’s research helped establish the risks associated with the long-term use of antipsychotics in this population.
The drugs can have a powerful sedative effect and should only be used for people with dementia where there is no alternative for dealing with challenging behavior. Although we have made progress in reducing their use, more work is needed.
It’s clear COVID-19 is disproportionately affecting those with dementia. It is possible that some of the increase in prescription is related to delirium management, although worryingly it is also possible that the increase was in response to worsened agitation and psychosis in relation to COVID-19 restrictions.
A boost to the Race Against Dementia
Sir Jackie Stewart’s Race Against Dementia charity, in partnership with Alzheimer’s Research UK, has supported a new £1.5m funding call. Designed to power outstanding early career scientists in their pursuit of innovative solutions to the big questions in dementia research, the second round of the successful scheme will give researchers unique access to development opportunities, including a mentorship from figures in the world of Formula One racing.
The COVID-19 pandemic has put efforts to find a life-changing treatment for dementia in jeopardy. Our survey of UK dementia researchers revealed 95% have had projects and trials delayed because of the virus. And one in three researchers are considering leaving their research field – leading to fears that we could lose a generation of dementia researchers. Supporting researchers at the earliest stages of their career is therefore a vital step for safeguarding progress in dementia research and achieving our vision of a world free from the fear, harm and heartbreak of dementia.