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.
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