15 Mar 2018

Move more. Drink less. Don’t smoke. Eat well. Learn a language. Be kind. Be content.

It is claimed that many of the resolutions that people peg themselves against as part of their ‘new year, new me’ mantra can also help to stave off dementia – or can they? Considering that the World Health Organization (WHO) estimates that the number of people living with dementia globally will triple from 50 million to 152 million by 2050, researchers are under increased pressure to explore all options, no matter how unlikely they may be. Patients want to know what they can do to treat the condition, and an increasing portion of society wants to know what they can do to prevent it. The problem is that the focus of research doesn’t always reflect what the public wants to know.

According to a YouGov poll, 52% of people over 60 years old have identified Alzheimer’s as the disease that they are most concerned about, and pharmaceutical companies have spent £30 billion on research and development with no successful disease-modifying treatment to show for it. Compounding the ageing population, the level of concern, and the lack of success, there is a sense of urgency in the broader Alzheimer’s community of NGOs, researchers and industry, and the pressure to deliver is on. Researchers know that for the pharmaceutical industry to increase investment in neuroscience, there need to be signs that a ground-breaking discovery is just around the corner. That discovery, however, is still out of reach as study after study ends with non-conclusive results as to where and how Alzheimer’s begins or what can be done to stop it from developing.

Researchers know that data from small studies cannot usually be extrapolated to any significant portion of the population and that because of the pronounced difference in glia expression, what works in mice might not work in humans, as is the case, for example, in tumour research. Yet the hurdles don’t end with the question of moving from lab specimens to human trials, but also with the scope of the research. While there are many layers to each thread of research, the majority of projects have focused on beta-amyloid, glia cells, and tau. Beta-amyloids are a protein that can build up and is thought to have a detrimental impact on neurological function. Glia, already mentioned above, have a housekeeping role that has long been thought to contribute to plaque build-up. Tau proteins, when collapsed, create tangles that may disrupt the flow of nutrients and other ‘supplies’. All three may be related to Alzheimer’s and one another, but while researchers agree that there is a relationship, it does not necessarily indicate correlation, and that makes treatment and prevention options difficult to research, with questions arising faster than answers.

Unfortunately for the G7-imposed deadline of finding a modifying treatment for Alzheimer’s by 2025, researchers can’t let go of the few options that they have and with funding – despite the investment from pharmaceutical companies – still lagging far behind that of cancer research, studies can’t always afford to try something completely new. So how long until there is a possibility of identifying biomarker changes before there are noticeable cognitive changes in patient behaviour? Or, more importantly, is such a discovery even possible?

Researchers across the UK, from Alzheimer’s Research UK, Alzheimer’s Society and academia to those in industry-led studies, remain optimistic. They remind us that before the discovery of HER2 and the development of Herceptin, breast cancer diagnosis meant something completely different than it does today and the same may be true of dementia in the future. In twenty years, each of us may be able to go to the doctor and say, ‘Tests show that I’m at risk of developing dementia. Given my profile, what is my personalised prevention plan?’ Until then, however, researchers estimate that keeping your brain active can reduce your chances of developing dementia by 35% and that, for many, is reason enough to finally learn French, master chess, or take up a musical instrument.