The battle against dementia in 2016: here’s the good news

There are two problems for understanding dementia in human beings. One is that disease progression can be very slow. The earliest chemical changes in Alzheimer’s, for example, probably occur in your 40s. Therefore, experiments to capture what is going on will take a long time. The other problem is that our brain – the most complex structure we know of in the universe – is encased in a thick layer of bone. MRI or PET scans aren’t detailed enough to really see what is happening and we can’t put imaging fibres in the brain like we might with other organs – it’s too risky.

These problems will take time to overcome. In other ways, though, 2016 has been a year of progress. Here are the key areas of breakthrough.

1. Trials
We have had big fanfares for potential drugs — the holy grail when it comes to dementia research. Specifically, there was the trumpeting of a possible drug by TauRx which sought to clear the intracellular tangles of Alzheimer’s disease. Unfortunately, when further scientific rigour was applied, the results were not as promising as had been initially suggested.

More recently, we have had disappointing news from Eli Lilly, reported to have spent an eye-watering $3 billion so far on potential drugs. Its latest, solanezumab, failed at the last stage before it would have been rolled out. The company’s share value dropped, and the public is deflated, but in the scientific world we do see the positive in these results. They guides us about where to go next. In science, the saying goes, nothing is ever proven, only disproven.

The latest setback appeared to suggest that using an antibody (which is revolutionising treatments in cancer) may not be the best approach for dementia. But is this true? It turns out that there is hope for modified versions of these antibody-based-drugs. Specifically, a potential drug called aducanumab which, according to a trial reported in August, seemed to clear amyloid in the brain and alleviate memory loss.

This antibody approach came from a new way of thinking: rather than asking why people get dementia, researchers looked at why other people, so-called ‘super-agers’, don’t get dementia. The drug was developed from naturally occurring antibodies that attack the Alzheimer’s plaques.

2. Numbers going down?
Is the proportion of people who are developing dementia dropping? It seems that dementia prevalence is falling even as absolute numbers are going up as more of us reach old age. Various reasons have been mooted, in particular the fact that education has improved in the last 50 years. This effect is most apparent in countries that have increased their education of young women; for example, in some countries, the average of state education of women 50 years ago was only one year, whereas now, even in well-established economies, people are staying in education longer.

The axiom ‘use it or lose it’ is true: the brain needs to be exercised. Our brain works the hardest when we are interacting as human beings and not playing computer games — which, despite this, seems to be the zeitgeist for do-it-yourself improvement.

Intriguingly, there is a possibility that we are all currently running a giant experiment on testing our cognitive reserve. These days when we want to know something, we look it up online, rather than trying to recall the information from our memory. As forming memories are what human brains are essentially all about, in the future we will know if this out-sourcing of our memories will also affect dementia prevalence.

3. A new £250m research institute
The director of a new £250 million Dementia Research Institute will be announced very soon. The institute, promised by David Cameron, will be the dementia equivalent of the Francis Crick Institute.

Thankfully, the money is not being focussed solely in one location. There will be one hub but various centres around the country. As I numb many a politician’s ear: although politicians like shiny new buildings, it is networks of people that solve problems.

The institute is truly a new starting point for dementia research in the UK. It will shape the dementia science community and influence the focus of our research for many years to come.

It also shows just how much has changed. Eight years ago 11 of my neuroscience colleagues published an open letter to the Health Secretary in the Times saying that the situation had become critical. Now, it seems, politicians have finally woken up to the crisis.

Professor Frank Gunn-Moore is Director of Research in the School of Biology, University of St Andrews

  • davidofkent

    ‘The axiom ‘use it or lose it’ is true: the brain needs to be exercised. ‘

    The evidence is there, is it not? If on retirement, a person merely puts his feet up, the brain gives up trying. Do we not see this all the time? Men and women in their 70s who learn new things such as foreign languages stay pretty bright and compos mentis, do they not? Am I also correct in thinking that many people stop using the little grey cells quite early in life and show that they really know little except how to manage bodily functions? The problem, as I see it, is how to keep the memory active later in life. Memories of early life come flooding back but trying to memorise the Imperfect tense of Italian irregular verbs is a struggle!

    • MurdoMcSponge

      Heaven help me! I don’t even know the Imperfect Tense of English regular verbs. I’m doooooomed!

      • davidofkent

        I expect you “used to learn” them at school.

        • MurdoMcSponge

          How kind of you to give me an example. I expect, at school, I did learn what they are and how to use them. I hope so, because my education cost my parents a small fortune. However, I can’t see that I am any worse off for not being able to remember what they were or how to recognise them. To a student of the English Language I am sure they are very important, but to one merely attempting to make himself understood in his native language, knowing about them hardly matters. But thank you.

  • Suzy61

    My husband developed dementia at age 58 – at least by then it was noticeable, by everyone, not just me and the children.

    He was running his own company, played sport three times a week and played golf at weekends. Nothing wrong with his golf – except that he would leave his clubs on the last green, or forget the time of play-off.

    He never attempted a crossword in his life. By the time he was advised to try ‘brain training’ exercises – he couldn’t distinguish 4 x 4 from 4 + 4. Blue from yellow. By age 60 he had forgotten almost every noun – he called everything ‘that thing’. It was only at this stage that he was diagnosed. We were living abroad – and told the only ‘treatment’ was to take him home and look after him.

    By age 62 he had completely lost the ability to communicate at all. He became violent with me and acted inappropriately with our daughter. It was not unlike looking after a strong-willed, naughty, 62-year-old toddler. The death of his brother and the birth of our first grand-child were welcomed with the same indifferent shrug. He was already in a world of his own.

    Now, he has no idea who I am and even less our children.

    He had a healthy diet (I saw to that), he was active and played sport, he was still running a successful business when the signs became clear.

    I fear we are grasping at straws.

    • Poor you. What a nightmare. In those circs, I would have had to leave him to the care of a home for the sake of my own sanity — and happiness.

  • when we want to know something, we look it up online, rather than trying to recall the information from our memory
    That’s a silly statement really, isn’t it? I don’t look up things online that I already know, just because I’m supposedly too lazy to recall it. No: I look things up because I don’t know about them at all. I also buy books which I then read on Kindle or paper, and so I become better informed or more opinionated or some combination of the two. The Internet is a fabulous resource: but as with a beautifully stocked pantry and full fridge, it is up to us to make the most of it.