Today is World Alzheimer’s Day, an awareness raising campaign that will grow in significance as we face up to an increase in cases amongst an ageing population.
Alzheimer’s is a truly horrific disease, one that robs people of their memories and individuality. Families can face years of emotional pain as their loved ones lose the ability to care for themselves and sometimes transform into someone unrecognisable. The cost of caring for people with dementia places an immense burden on healthcare systems.
There is a major obstacle in the way of those of us who have dedicated our professional lives to battling Alzheimer’s– fundamentally, we still don’t fully understand the disease.
Alzheimer’s is a heterogenous and complicated disease with most patients presenting with different clinical features, something that complicates the diagnosis process. Although there is a fairly well-defined progression, the experience of each individual will still differ.
Problems with navigation can be an early sign of something going wrong, but we don’t know which memories will be lost or which other symptoms – such as behavioural changes or language impairment – will be experienced.
Across the world, scientists are trying to piece together the puzzle of what exactly Alzheimer’s is and what it does to the brain. Research is taking place into all aspects of Alzheimer’s, from studies into its causes to clinical trials of potential new drugs. A cure eludes us at the moment, and while recent clinical trials have raised hopes that a disease-modifying drug may one day help to slow the progress of Alzheimer’s, the only treatments currently available target symptoms.
My colleagues and I are investigating the loss of connections between brain cells, called synapses. There are trillions of these connections in our brains and these tiny structures are critical for normal brain function.
Our research involves examining brain tissue 1/1000th the thickness of a human hair to try and understand where and why these connections are being lost. In Alzheimer’s, these synapses start dying off before brain cells do. Ultimately, we hope that by gaining a greater understanding of this process then it raises the possibility of developing drugs that prevent these synapses from breaking down and possibly even impairing progress of the disease.
Being able to predict in advance of who is likely to develop the disease is the Holy Grail of Alzheimer’s research. Billions of pounds are being invested into biomarkers – tests able to detect who is about to develop Alzheimer’s or who is in the early stage of the disease from their blood or saliva. This type of diagnostic tool will also be vital for identifying people with dementia suitable for clinical trials of potential treatments.
I fervently wish there was a more positive story to tell on World Alzheimer’s Day. Indeed, given that depression, social isolation and cognitive inactivity have been identified as risk factors, the impact of the pandemic and lockdowns is something to be concerned about.
This is not a challenge that either myself or the thousands of brilliant researchers and clinicians working on this disease around the world are willing to duck, however. The answer will not come today, or tomorrow, but we will not stop fighting for it and we have hope that a disease modifying drug will soon be available for people living with the disease.
In the meantime, the World Health Organisation recommends that anyone can reduce their risk by being physically active, not smoking, avoiding harmful use of alcohol, controlling their weight, eating a healthy diet, and maintaining healthy blood pressure, cholesterol and blood sugar levels.
(The author is a Principal Investigator (Tenure Track), Systems Medicine, at School of Medicine, University of Dundee)
