Alzheimer’s in the newsfear and fascination

www.nhs.uk/newsA Behind the Headlines special report

Contents

Introduction 1

TheimpactofAlzheimer’s 2

Alzheimer’sinthemedia 3

Causesandriskfactors 4

Genes 5

Lifestyle 5

Otherfactors 7

Prevention 7

RCTSofdementiaprevention 9

Testsanddiagnosis 10

Memorytests 10

Brainscans 11

Bloodtests 12

Potentialtreatments 12

Randomisedcontrolledtrialsoftreatments 13

OtherRCTsofdementiatreatments 14

Tomorrow’sheadlines 14

Generesearch 14

Earlydiagnosisanddetection 15

Newdrugs 16

AvaccineagainstAlzheimer’s? 17

FindoutmoreaboutdementiaandAlzheimer’s 17

Version1.02011

Alzheim

er’s in the news

Alzheimer’sdiseaseisamodernmedicalbogeyman,

fearedbymanyandneverfarfromtheheadlines.

Ifthereisonehealthworrythatseemstoeclipse

allothersaspeoplegetolder,itisfallingpreyto

Alzheimer’sorsomeotherformofdementia.

Researchshowshowdeepthisfearruns.A2011

surveyfoundthat31%ofpeoplefeareddementia

morethandeathorcancer.Thestudy,byAlzheimer’s

ResearchUK,alsofoundthatfearofdementiadidn’t

justaffectolderpeople.

Overhalf(52%)ofUKadultsaged30to50were

afraidtheirparentswoulddevelopdementia,

comparedto42%whofearedtheywouldgetcancer

and33%aheartattack.

Thisanxietybothfuelsandisfedbyaconstant

streamofstoriesinthepress,chartingthelatest

developmentsinunderstanding,treatingor

preventingthecondition.

Since2007,BehindtheHeadlineshascoveredovera

hundrednewsstoriesondementia,abouttwo-thirds

ofwhichwererelatedtoAlzheimer’sdisease

insomeway.

Thisreportlooksathowthemainstreammedia

hasreportedAlzheimer’sdiseaseoverthelastfour

years,andassesseswhichofthemanyheadlines

werejustifiedandwhichwerewideofthemark.It

identifieskeythemesandcommonproblemsinthe

newsreportsand,hopefully,willhelpreadersjudge

forthemselvesthevalueoffuturenewsreports.

Finally,weaskedleadingexpertstopredict

whatwillbemakingheadlinesinthemonthsand

yearstocome.

Thisreportdiscussesthemediacoverageofresearch

intodementiaandAlzheimer’sdisease,examining

someoftheindividualstudiesthathavebeen

reported,andtheaccuracyofthosereports.This

articleisnotadefinitiveguidetothediseaseor

treatment.Peoplewantingmoreinformationshould

visittheNHSChoicesHealthA-ZpageonDementia.

Introduction

1

Alzheim

er’s in the news

TheimpactofAlzheimer’s

IntheUK,it’sestimatedthatover

750,000peoplehavesome

formofdementia,mostof

themover65.Ofthese,nearly

two-thirds–around465,000–

haveAlzheimer’s.

Theriskofdementiarises

dramaticallyinoldage.Currently,

dementiaaffectsabout10in

1,000peopleaged65to69,about

40in1,000peopleaged70to79,

andabout170in1,000people

aged80andabove.

Asourpopulationagesrapidly,

thenumberofpeoplewith

Alzheimer’sandotherformsof

dementiaissettogrowapace.

IntheUK,thenumberofpeople

withsomeformofdementia

ispredictedtorisetojustover

940,000by2021andto

1.7millionby2051.

However,thesefiguresinclude

onlythosepeoplewithdementia,

whiletheburdenofcopingwith

theconditionisshoulderedbya

muchlargergroup.

AsSimonLovestone,professor

ofoldagepsychiatryat

King’sCollegeLondon,says:

“Alzheimer’sdiseaseisaterrible

problem,bothforpeoplewho

suffertheconditionandtheir

families,whoarethemaincarers.

Sufferersofthediseaselosea

littlebitaboutwhatitistobe

themselves,whilemanyfamilies

sayitisalivingbereavement.”

Dementiaalsohasahuge

financialimpact.TheAlzheimer’s

Societyestimatesthatthecurrent

costtotheUKis£20billiona

year.In2008,healththinktank

TheKing’sFundpredictedthat

thecostofdementiainEngland

alonewouldriseto£34.8billion

by2026.

Youcanfindoutmoreabout

Alzheimer’sdiseaseandits

symptoms,diagnosisand

treatmentontheNHSChoices

website.

Thementaldeclineseen

withagehasbeendescribed

throughouthistory,butit

wasn’tuntil1906thatDrAlois

Alzheimeridentifiedthefirst

publishedcaseofthedisease.

DrAlzheimerwasworkingata

mentalasyluminFrankfurtin

1901,whenhemeta51-year-

oldpatientcalledAuguste

Deter.Deterhadmanyofthe

symptomswenowassociate

withAlzheimer’s,including

“reducedcomprehension

andmemory,aswellas

aphasia[languageproblems],

disorientation,unpredictable

behaviour,paranoia,auditory

hallucinations,andpronounced

psychosocialimpairment”.

DrAlzheimercontinuedto

followDeter’scaseuntilshe

diedfiveyearslaterin1906,

atwhichtimeheaskedto

studyherrecordsandbrain.

Hisexaminationsrevealedfor

thefirsttimetheclumpsof

proteins,knownasplaquesand

tangles,inthebrainthatarea

characteristicofthedisease.

DrAlzheimer’scasenotesfor

Deterwerefoundin1995,

almost90yearsafterherdeath,

andtheresearcherswhofound

themconcludedthatthey

fulfilledthesamecriteriafor

diagnosingAlzheimer’s

asweusetoday.Dr Alois Alzheimer was the first to document the disease

Whatisdementia?Dementiaisnotadiseasein

itself,butisthetermused

todescribeacollectionof

symptomsthatfollowalossor

declineinsomeone’smental

(cognitive)ability,caused

bythedeathorpoor

functioningofbraincells.

Typesofdementiainclude

Alzheimer’sdiseaseand

vasculardementiaandother

rarertypessuchasdementia

withLewybodies,andfronto-

temporaldementia.

WhatisAlzheimer’s?Alzheimer’sdiseaseisthemost

commontypeofdementia,

accountingfornearlytwo

thirdsofcases.Alzheimer’s

isaphysicaldiseaseofthe

brain,resultinginthedeath

ofbraincells.Alzheimer’sis

atthemomentincurableand

progressive.Thismeans

thatovertime,morepartsof

thebrainbecomedamaged

andthesymptomsbecome

moresevere.

2

Alzheim

er’s in the news

Alzheimer’sinthemedia

Giventhisalarmingpictureand

agrowingnumberofhigh-

profilepeoplewithAlzheimer’s

–includingauthorTerryPratchett

andthelateformerUSpresident

RonaldReagan–it’snotsurprising

thatdementiaisbignews.

Alargeamountofmedia

coverageisdevotedtonew

developmentsinourscientific

understandingofAlzheimer’s–

whatmaycauseit,whatwecan

dotoavoidit,newteststospot

earlysignsofthediseaseand

potentialnewtreatments.

However,aswithallhealth

sciencereporting,noteverything

youreadinthepapersis

accurateorreliable.

ThisiswhereBehindthe

Headlinesstepsin,checking

theevidencebehindthenews

reportsandprovidingano-

nonsenseappraisalofeachstory’s

significance.

Since2007,wehavepublished

appraisalsofmorethan2,000

studiesandover100ofthese

havefocusedondementiaand

Alzheimer’s.Thesesamestudies

havebeenreportedinaround300

newsstoriesinmainstreamdaily

newspapersandevenmorewidely

acrosstheinternet.

Table1showswhatpercentage

ofstoriescoveredbyBehind

theHeadlinesfromeachnews

sourcewereaboutdementia

andAlzheimer’s.Foralmostall

newspapers,thisaccountsfor

atleastoneinevery20stories

covered–asignificantproportion

oftheirhealthnewsoutput.

Somesimpleanalysisofthese

storiesoverthepastfouryears

providesaninsightintotheway

themediareportsondementia

andAlzheimer’s.

Almostallthedementiastorieswe

havecoveredfallintooneofthe

followingcategories:

• Causesandriskfactors

• Prevention

• Testsanddiagnosis

• Potentialnewtreatments

Thechartshowshowstoriesare

dividedamongthesecategories.

Thestoriesarecategorised

accordingtothefocusofthenews

reporting,andsomefallintomore

thanonecategory.Thearticlesin

the‘other’categoryincludethose

ondementiacareinhospitals,

updatestoNICEguidelinesand

researchinvestigatingthebiology

andanatomyofAlzheimer’s.

Thisanalysissuggeststhat

newspapersfocusmainlyonways

ofpreventingdementia,suchas

lifestylechoices.

Table1:Dementiareportsasaproportionofallhealthstories

coveredbyBehindtheHeadlines.

Table 1 shows what proportion of stories covered by Behind the Headlines from each news source were about dementia and Alzheimer’s, from July 4 2007 to July 19 2011.

Ronald Reagan lived with Alzheimer’s

Chart 1 Dementia stories by category

Chartshowing

theproportion

ofeachtypeof

dementiastory

coveredinthe

press

3

Alzheim

er’s in the news

Thewordcloud,showingwhich

termsaremostcommonlyused

inmediaheadlines,illustrates

hownewspaperspresentthis

information,with‘risk’,‘drug’,

‘test’,‘help’and‘prevent’all

prominent.Emotivewordssuch

as‘breakthrough’,‘hope’and

‘warning’arealsocommon,but

theappearanceof‘early’among

themostpopularheadlinewords

mayreflecttheuncertainty

overtheimpactofmanyofthe

findingsbeingpresented.

Thefollowingsectionsofthis

reportlookateachofthe

keycategorieslistedabove,

highlightingwhatwedoand

don’tknowandillustratingsome

oftheproblemsthatariseinthe

media’sreportingofthiscomplex

areaofmedicine.

Causesandriskfactors

Findingoutwhatcausescomplex

diseasessuchasAlzheimer’s

takesalotofresearch.Itusually

requiresthegradualbuild-up

ofabodyofdifferenttypesof

evidence.Therefore,ifanews

storyannouncesthatthecauses

ofsuchdiseaseshavebeen

‘cracked’basedononepieceof

newresearch,itisgenerally

overstatingthefacts.

Studiesthatinvestigaterisk

factorswouldideallyassessa

largegroupofpeoplewithout

Alzheimer’stoseewhichofthem

hadbeenexposedtoapossible

riskfactor.Itwouldthenfollow

themupovertimetoseewho

developsthediseaseandif

theriskofgettingAlzheimer’s

differsinpeoplewithdifferent

exposures.Thisisknownasa

prospectivecohortstudy.With

Alzheimer’sdisease,itmaybe

necessarytofollowpeoplefor

alongtime,whichmakessuch

studiesexpensive.

Alternatively,studiesmay

comparepeoplewithandwithout

Alzheimer’sdiseasetoseehow

exposuretoapossibleriskfactor

inthepastdiffersbetweenthe

twogroups.Thisisknownasa

case-controlstudy.Geneticstudies

tendtousethisapproach.For

non-geneticriskfactors,this

typeofstudymaynotbeable

toensurethattheparticipants

remembertheirpastexposures

accurately,orthatexposure

toriskfactorsoccurredbefore

Alzheimer’sdeveloped.

Ifonestudyfindsalinkbetween

anexposureandanoutcomesuch

asAlzheimer’sdisease,thisneeds

tobeconfirmedbyfindingsfrom

similarstudiesandothertypes

ofevidencebeforewecansay

thattheexposureislikelytohave

causedtheoutcome.

Sometimes,newspapersreport

newrisksforAlzheimer’sbased

onlyonanimalorlaboratory

studies.Withoutconfirmingthe

resultsofthesestudiesinpeople,

itisnotpossibletoconclude

thatthefactorstheyidentified

definitelyincreasetheriskof

Alzheimer’s.Forexample,in

2007,manynewspapersreported

thatgettingcoldsoresincreases

Alzheimer’srisk.

Whilethismaybeaninteresting

WordcloudshowingthemostcommonlyusedtermsinnewsheadlinesondementiaandAlzheimer’sdisease

4

Alzheim

er’s in the news

theory,itwasbasedonastudy

inmicethatweregiventhe

herpessimplexvirus,whichcauses

coldsores.Itfoundthatlarge

quantitiesofamyloidprotein

builtupinthemice’sbrains,which

issimilartowhathappensinthe

brainsofpeoplewithAlzheimer’s.

However,asyetthereisn’t

anyconvincingevidencethatthe

coldsoreviruscausesAlzheimer’s

inhumans.

Themediahascoverednumerous

studiesintobothknownand

suspectedriskfactors.What

followsisaselectionofthestories

thatwehaverespondedtoover

thepastfouryears.

Genes

Whilestudiessuchasthecold

sorestudyaboveneedmuch

moreresearchtoestablishtheir

importance,othershavebeen

morerobust.Advancesinour

understandingofthegenetic

factorsthatcontributeto

Alzheimer’sdiseasehavegrabbed

theheadlinesrecently.

InApril2011,manynewspapers

reportedthatfivenewgenetic

variantsassociatedwiththe

diseasehadbeenidentified.

Thisbroughtthenumberof

variantslinkedwithlate-onset

Alzheimer’sto10.Thelatest

geneticlinkswereidentifiedin

twostudies,knownasgenome-

wideassociationstudies,which

lookedfordifferencesinthe

geneticprofileofpeoplewith

Alzheimer’sdiseasecomparedto

peoplewithoutthecondition.

Thefindingsweremajornews,

andtheresearchersreportedthat

togetherthese10variantsappear

tocountformuchofthegenetic

riskofAlzheimer’s.Atthetime,

oneoftheresearchersinvolvedin

thisdiscoverytoldtheBBC:“Ifthe

effectsofall10[variants]couldbe

eliminatedtheriskofdeveloping

thediseasecouldbecutby60%.”

Generally,thisresearchreceived

high-profilecoverage,andthe

mediagavehelpfulexplanations

ofwhatisverycomplexscience.

However,thenewspaperscould

haveemphasisedthefactthat

apracticalapplicationforthese

findingsislikelytobeatleast10

to15yearsaway.

Lifestyle

Themediaregularlyreports

thatcertainbehaviourmight

increasetheriskofdementia.

Potentiallymodifiable‘lifestyle’

risksreportedinthenewsstories

thatweassessedinclude:heavy

smoking,passivesmoking,having

apotbellyinmiddleage,being

obese,havingan‘apple’body

shape,highbodyfat,obesityin

mid-life,omega-6fattyacids,

bingedrinking,alcoholabuseand

workinglonghours.

Notalltheresearchcovered

byBehindtheHeadlinesisas

significantasthegeneticsstudies.

Somestudies,suchasthosethat

lookedatomega-6fattyacidsand

longworkinghours,were

early-stageresearchthatneed

morestudy.

Otherstudieshavehadresults

that,ontheirown,maynot

presentparticularlystrong

evidence,butwhichconfirmwhat

hasbeenfoundinotherresearch.

Thisaddstotheevidencefor

dementiarisks,andincreasesour

knowledgeofhowmodifiable

lifestylefactors,suchassmoking,

obesityandexcessivealcohol

consumption,affectourrisk.

Smoking

InOctober2010,The Independent

reportedthatalargestudyof

21,000middle-agedmenfound

thatthosewhosmokedmore

thantwopacksofcigarettesaday

weremorethantwiceaslikely

todevelopAlzheimer’saspeople

whohadneversmoked.Wefound

thatwhilethestudyhadsome

strengths,italsohadlimitations

andideallyitsfindingsshould

beconfirmedinotherstudies.

TheNationalInstituteforHealth

andClinicalExcellence(NICE)lists

smokingasariskfactorforboth

Alzheimer’sdiseaseandanother

typeofdementiacalledvascular

dementia(whereproblemswith

bloodcirculationmeanthat

Vegetable oils are a source of omega-6

Claims for human health based on animal research should be treated with caution

5

Alzheim

er’s in the news

partsofthebraindonotreceive

enoughbloodandoxygen).

Obesity

Obesityisanotherfactorthatis

thoughttopotentiallyincrease

theriskofAlzheimer’s.The Daily

ExpressreportedinMay2008that

areviewofstudiessupported

apossiblelinkbetweenobesity

andAlzheimer’srisk.Italsofound

anincreasedriskofdementiain

peoplewhowereunderweight.

Weconcludedthatfurther

researchwasneededtoclearly

establishalinkbetweenweight

anddementia.

Alcohol

InNovember2008,theDaily

Mailwarned:“Bingedrinkers

areputtingthemselvesatriskof

Alzheimer’sinlaterlife.”Itsaid

therecouldbean“epidemic”

inthenumberofpeoplewith

alcohol-relateddementiainthe

nearfuture.

Wesaidthatthenewsstory

largelyreflectedtheeditorialin

theBritishJournalofPsychiatryon

whichitwasbased.Thiseditorial

statedthatalcohol-related

dementiaisunder-recognised

andmayaccountforupto10%

ofalldementiacases–around

70,000peopleintheUK.However,

theeditorialwasaboutalcohol-

relateddementia,whichisnotthe

sameasAlzheimer’s,astheMail

andDaily Mirrorbothsuggested.

Depression

Since2007,severalnewsstories

havereportedthelinkbetween

depressionandAlzheimer’s.

A17-yearstudy,coveredbythe

BBCinJuly2010,confirmedthat

thetwoarelinkedwhenitfound

elderlypeoplewithdepression

hadalmostdoubletheriskof

developingdementialaterinlife.

However,aswereportedatthe

time:“Thisdoesnotnecessarily

meanthatdepressioncauses

dementiaandthereasonforthe

associationbetweenthetwo

conditionsisstillunclear.

Itisunknownifdepressionis

ariskfactorfordementia,

whetheritisanearlysignof

cognitivedeclineorifcertain

changesinthebrainare

associatedwithbothconditions.”

Twoyearsearlier,The Daily

Telegraphcoveredastudy

thattriedtoshedsomelight

ontherelationshipbetween

depressionandAlzheimer’s.This

researchfollowedmorethan

900membersoftheCatholic

clergyforupto13years.It

foundthat,althoughpeople

whodevelopedAlzheimer’shad

moresymptomsofdepression

whenthestudybegan,these

symptomsdidnotincreaseinthe

timeleadinguptotheonsetof

Alzheimer’ssymptoms,norafter

thesymptomsdeveloped.The

researcherstookthistomean

thatdepressionisnotanearly

signofthesameprocessesthat

causedementia.Ifitwas,the

symptomsofdepressionmight

beexpectedtogetworseasthe

Alzheimer’ssymptomsprogressed.

Theresearcherssuggestedthat

depressivesymptomsmaybearisk

factorforAlzheimer’s.

Wedidn’tcompletelyagreewith

thisconclusion,however,asthe

studyhadseverallimitations

thatcloudedtherelationship.

Weadvisedthat,untilfurther

researchprovidedaclearer

picture,peoplewithdepression

shouldnotbeoverlyconcerned

aboutbeingatgreaterriskof

developingdementia.

Binge drinking may increase your risk

Obesity may increase risk of Alzheimer’s

NICE advises that smoking can increase the risk of developing Alzheimer’s

6

Alzheim

er’s in the news

Thereisanestablishedlink

betweendepressionand

dementia,buttherelationship

iscomplex.Depressionmaybea

riskfactorfordementia.However,

notonlydothesymptomsof

depressionresemblethoseof

dementia,butthetwoconditions

canalsooccuratthesame

time.Whiledepressioncould

beanearlysignofthebrain

changesthateventuallyleadto

Alzheimer’s,somestudies,suchas

theonedescribedabove,suggest

thatthismaynotbethecase.

Initsguidelineondementia,NICE

notesthatnoprospectivestudies

haveexaminedwhetherreducing

depressionsubsequentlyreduces

dementiarisk.

Otherfactors

Otherstudieshavelookedat

otherdiseasesorconditionsthat

mayincreaseAlzheimer’srisk.

Forinstance,The Guardian

coveredastudyinAugust2007

thatlookedatwhetherawoman

havingherovariesremoved

increasedherriskofdementia

inoldage.Wefoundthat,

althoughtheriskofdementia

wasalmost50%higherinwomen

whohadtheirovariesremoved

atarelativelyyoungage,the

totalnumberofwomenwho

developeddementiain

thestudywaslow(268women

outof3,000).

Environmentalfactors

Ithasbeensuggestedthat

severalenvironmentalfactors

maycontributetotheriskof

Alzheimer’s.However,none

ofthesehasbeenconclusively

proventohaveaneffect.For

example,inthepast,scientists

noticedthatsomepeople

withAlzheimer’sdiseasehad

aluminiumintheclumpsof

proteins–calledplaquesand

tangles–intheirbrainswhen

theydied.However,it’snot

possibletosaythatthealuminium

causedAlzheimer’sasthe

accumulationofaluminium

mayhaveoccurredasaresult

ofthedisease.Thecurrent

medicalandscientificconsensus

isthatthereisnoconvincing

evidencethataluminiumcauses

Alzheimer’sdisease.

NICEsaysthatwhileitisclearthat

consumingaluminiumcanhave

atoxiceffectonnervecells,itis

unclearwhetheritisresponsible

forthedeteriorationofbraincells

inAlzheimer’sdisease.

Severalstudiesonpossible

environmentalriskfactorshave

madethenewsinrecentyears.

However,noneoftheoneswe

analysedprovidedclearevidence

thatthesefactorshavearolein

causingAlzheimer’s.

Copperpipes

InJanuary2010,theTelegraph

reportedthatareviewofresearch

oncopperpipesfoundthatthey

couldcauseheartdiseaseand

Alzheimer’s.Wefoundthatthis

reviewonlylookedatasmall

sampleofstudies,andmostof

theevidenceitpresentedwas

basedonstudiesinanimalsand

cells.Noneofthestudiesdirectly

assessedwhetherwaterfrom

copperpipescontributesto

Alzheimer’sdisease.

Pesticides

Meanwhile,astudyinDecember2010,whichwasreportedinThe

Independent,appeared

toshowanassociationbetween

long-termexposuretopesticides

andaslightlygreaterriskof

declineinmentalabilityin1,000

Frenchvineyardworkers.Behind

theHeadlinesconcludedthat

whiletheincreasedexposureof

farmworkerstopesticides

isanimportantissue,thestudy

didnotshowthatpesticides

causeAlzheimer’s.

Prevention

Anotherfavouritemediatopic

ishowtoreducethechances

ofgettingAlzheimer’sand

dementia.It’sanimportant

issue,butstudyfindingsare

There is no convincing evidence that aluminium raises risk

The review we covered mainly presented studies on copper in animals

The study we covered did not assess the effect of pesticides on risk of dementia

7

Alzheim

er’s in the news

oftenwildlyoverstatedbythe

newspapers.Theproblemisthat

manynewsstoriesonhowto

preventAlzheimer’sarebased

onobservationalstudies,which

haveidentifiedanassociation

betweenaparticularfactorand

areducedriskofAlzheimer’s.

Othernewsstoriesarebasedon

animalorlaboratorystudies,or

onshort-termstudiesthatlookat

substitutemeasures,suchaspoor

performanceonmemorytestsor

brainshrinkage,neitherofwhich

isthesameashavingAlzheimer’s.

Arandomisedcontrolledtrial

(RCT)wouldbenecessaryto

showwhetheranintervention

cantrulypreventAlzheimer’s.

Studiesofthistyperandomly

splitparticipantsintotwogroups

–agroupthatreceivesadrug

orintervention,anda‘control’

groupthatreceivesanexisting

preventativemeasure,aninactive

placeboornointerventionatall.

Randomlyallocatingpeopleinto

groupsinanRCTmeansthatthe

groupsshouldbeverysimilarto

eachother.Thismeansthatany

differencesinoutcomeare

likelytobedirectlydueto

differencesintheinterventions

theparticipantsreceive.

However,becauseAlzheimer’s

usuallydevelopslateinlife,and

thediseaseprocessisbelieved

tostart10to20yearsbefore

symptomsarise,suchatrialmight

needtobedecadeslongtoshow

aneffect.Therefore,trialsoften

useintermediatemeasures,such

asbrainshrinkageormental

ability,ratherthanlooking

atAlzheimer’sitself.

Severalinterventionshavebeen

studiedorsuggestedaspossible

waysofreducingtheriskof

WhataretheknownrisksfordementiaandAlzheimer’s?

Intheir2007guidelineon

dementia,theNational

InstituteforHealthandClinical

Excellence(NICE)andSocial

CareInstituteforExcellence

(SCIE)mentionthefollowing

riskfactorsfordementia

andAlzheimer’s.

Theysaythatestablished

non-modifiableriskfactors

fordementiaingeneraland

Alzheimer’sdiseaseinparticular

includebeingolder,your

geneticmake-up,beingfemale

andhavingalearningdisability.

Establishedriskfactorsthat

maybemodifiableinclude

highbloodpressure,excessive

alcoholconsumption,diabetes,

depressionandheadinjury.

Otherpotentiallymodifiable

riskfactorsmayincludeobesity,

raisedlevelsofanaminoacid

calledhomocysteine

inthebloodandraised

cholesterollevels.

Riskfactorsforvascular

dementiaoverlapwith

Alzheimer’sdiseaseandinclude

age,vascularriskfactors(stroke,

highbloodpressure,diabetes

andsmoking)andcarryingthe

E4formoftheApoEgene.

IsthereanythingIcandotoreducemyriskofAlzheimer’s?

Studieshavenotyetconclusively

identifiedanyinterventions

thatcanreduceourriskof

Alzheimer’s.Intheabsence

ofthistypeofevidence,the

bestadvicethatcancurrently

beofferedisbasedonwhat

weknowaboutthepossible

modifiableriskfactorsfor

Alzheimer’s.Thatlargelymeans

followingahealthylifestyle,

ideallynotjustinoldage.

AccordingtotheNational

InstituteforHealthandClinical

Excellence(NICE),factorsthat

mayhelpprotectagainst

dementiaincludelong-term

useofnon-steroidalanti-

inflammatorydrugs(NSAIDs),

controlofvascularriskfactors,

regularexercise,anddoing

activitiesthatstimulate

thebrain.

However,sofar,studieshave

notclearlyshownthatadopting

anyofthesechangesleadstoa

reductionindementiarates.For

example,fourtrialsoftherapy

totreathighbloodpressure

showedanon-significanttrend

towardsreduceddementia

ratesinpeoplewhoreceived

thetreatment,twotrialsof

statins(cholesterol-lowering

drugs)foundnoeffect,andone

studyofhormonereplacement

therapyunexpectedlyfound

increaseddementiaratesin

peoplewhoreceivedtreatment.

Duetothelackofconvincing

evidencethatspecificdrugscan

reducetheriskofdeveloping

dementia,NICErecommends

thatthefollowingshouldnot

beusedtoreducedementiarisk:

statins,hormonereplacement

therapy,vitaminEorNSAIDs.

8

Staying active is important

Alzheim

er’s in the news

dementia,basedonwhatis

knownaboutthediseaseand

possiblemodifiableriskfactors.

Intheirguidelinesfrom2007,

NICEnotedthattheevidencefor

preventingdementiawaslargely

restrictedtotypesofstudy(called

observationalstudies)thatoffer

muchlessrobustevidencethan

RCTs.TheavailableRCTevidence

onpreventionatthattimehad

eitherfoundnosignificanteffect

(aswasthecasewithstatinsand

highbloodpressuredrugs),oran

increasedriskofdementiawith

treatment(forexample,with

hormonereplacementtherapy).

Basedonthis,NICErecommended

againsttheuseofstatins,

hormonereplacementtherapy,

vitaminEornon-steroidalanti-

inflammatorydrugsspecificallyfor

thepreventionofdementia.

Keepingyourbrainactivehas

alsobeensuggestedasaway

topreventAlzheimer’s.NICE

guidelinessaythatfurtherstudies

areneededtoassesswhether

keepingthebrainactivecan

protectagainstAlzheimer’s.

RCTsofdementiaprevention

BehindtheHeadlineshascovered

severalRCTsthatlookedat

thepreventionofdementia

(thoughnotnecessarily

Alzheimer’sspecifically).

Ginkgobiloba

ThemostrelevantRCTonthe

preventionofdementiathatwe

coveredassesseduseoftheherbal

supplementginkgobilobain

3,000elderlypeopleoversixyears.

Thiswell-conductedstudyfound

thatginkgobilobahadnoeffect

ontheriskofdementia.

TheotherRCTsintopreventing

dementiathatwecoveredeither

lookedatsubstituteoutcomes

(ratherthandementiaitself),

orhadotherlimitationswhich

meantwecouldnotdrawfirm

conclusionsabouttheeffectsof

theirinterventionson

Alzheimer’sdisease.

VitaminB

VitaminBisarecurringfocusof

Alzheimer’sresearchandhasbeen

studiedinboththeprevention

andtreatmentofthedisease.This

maybepartlybecausevitaminB

deficiencycancausesymptoms

similartothoseofdementia.

InSeptember2010,theTelegraph

reportedthatparticipantsin

anRCT,whohadmildmental

impairment,weregiveneither

vitaminBsupplements(containing

folicacidandvitaminsB12and

B6)oraplacebofortwoyears.

Peoplewithmildcognitive

impairmentwhotookvitaminB

showedlessbrainshrinkagethan

peoplewhotooktheplacebo.

However,brainshrinkagedoes

notguaranteethataperson

willdevelopAlzheimer’s,and

somebrainshrinkageisanormal

partofageinginpeoplewho

donotdevelopthedisease.

Therefore,itisnotpossibletosay

conclusivelywhetherthepeople

whotookvitaminBwereless

likelytodevelopAlzheimer’s.

Moreinformationonthestudy

ofvitaminBandtreatmentof

dementiacanbefoundlater

inthisreport.

Exercise

AstudyinFebruary2011was

pickedupbytheExpress.

Thisresearchfoundthatthe

volumeofapartofthebrain

calledthehippocampusincreased

by2%inolderadultswhodid

aerobicwalking,whilethesame

areadecreasedinvolumeby1.4%

inacontrolgroupwhodid

mildstretchingexercises.

DespitetheExpress’headline,

thisstudyalonecouldnottellus

thataerobicwalkingcan“help

beatdementia”.

Bloodpressuredrugs

AnRCTreportedintheMail

inFebruary2009testedanew

bloodpressuremedication(called

indapine)againstaplacebo.

Aftertheyassessedtheeffectof

thedrugonbloodpressure,the

researcherslookedatwhether

thedrugwouldcuttheriskof

dementiainveryelderlypeople.

Thetrialfoundnodifferencein

theriskofdementiabetweenthe

drugandtheplacebo.However,

whentheresearcherspooledtheir

resultswiththoseofothersimilar

studiesofhighbloodpressure

treatments,theyfoundthatthese

drugsofferedamodestreduction

intheriskofdementia.It is important to get aerobic exercise but whether it helps dementia is unproven

9

The leaf of the ginkgo biloba tree

Alzheim

er’s in the news

Asthisstudydidnotspecifically

lookatAlzheimer’s,wecannotbe

surewhattheeffectonthistype

ofdementiawouldbe.Also,the

studywassetuptoassessblood

pressureanddidnotprimarily

lookatdementia.Inaddition,itis

notclearwhethertheresearchers

identifiedalltherelevantstudies

toincludeintheirpooledanalysis.

Therefore,theseresultsshouldbe

interpretedverycautiously.

Severalnon-RCTstudieshavealso

claimedtoidentifyinterventions

thatcanprotectagainst

Alzheimer’s.Manyofthesehave

notevenreachedtestingin

humans,andarestillatthestage

ofcelloranimalresearch.These

studiesshouldbeconsidered

asverypreliminaryandnotas

conclusiveevidencethatthe

interventionshaveaneffect.They

shouldcertainlynotbeseenas

definitelyformingthebasisofa

newpreventionortreatment,as

newspaperreportsoftensuggest.

Testsanddiagnosis

Currently,thereisnowaytotest

peopleforAlzheimer’sbeforethe

symptomsappear,eventhough

theprocessesbehindthedisease

startsometimebeforethese

symptomsbecomeapparent.This

meansthatbythetimesomeone

isdiagnosed,thediseaseprocess

islikelytobequiteadvancedand

theirbrainwillhavealreadybeen

subjecttosignificantchanges.

Developingnewdiagnostic

techniques,particularlythose

thatallowearlierdiagnosis,isa

keyareaofAlzheimer’sresearch.

Earlierdiagnosiswouldallow

ustouseexistingtreatmentsat

anearlierstage.However,the

availabletreatmentscannot

reverseexistingdamageorstop

thediseasefromprogressing

altogether.Thehopeisthat,ifwe

canidentifythediseaseearlier

initsdevelopment,thiswill

helpusstudyanddevelopnew

treatmentstohalttheprogression

ofAlzheimer’sdiseasebeforethe

damageitcausesisadvanced.

Mostdiagnostictechniques

currentlybeingdeveloped

concentrateonthreedifferent

aspectsofAlzheimer’sdisease:

• changesinaperson’smemory

andmentalfunctioning

• physicalandstructural

changesinthebrain

• changesinthechemical

balanceinthebodyandblood

Somestudiesthatmadeit

intothepaperswerewell

designedandmayeventually

leadtoimproveddetectionof

Alzheimer’s.However,sometimes

newspapersgivetoomuch

significancetofindingsfromvery

preliminaryresearch.

Memorytests

Testsofmemoryandmental

functioningarealreadyusedto

diagnoseAlzheimer’sdiseaseand

dementia.Forexample,oneof

themostwidelyusedtestsisthe

mini-mentalstateexam(MMSE),a

validatedtestingtechniquethatis

recognisedbyNICEandnumerous

medicalbodiesaroundtheworld.

Researchintohoningexistingtests

aswellasdevelopingnewones

isongoing.

Forexample,somestudieshave

lookedatdevelopingteststohelp

identifypeoplewhomightneed

furtherassessmenttodetermine

iftheyhavedementia.Onesuch

testistheself-administeredTest

YourMemory(TYM)method,

whichBehindtheHeadlines

lookedatinJune2009.The

Independent saidthatthetest,

whichfeaturedsimpletaskssuch

asdrawingthetimeonaclock,

coulddetect93%ofAlzheimer’s

cases.Thenewswasbasedona

trialthatcomparedTYMwith

theMMSEin139peoplewith

Alzheimer’sdiseaseorothertypes

ofdementia,aswellas540people

withoutdementia.

Thetrialfoundthatthe

newassessmentwasmore

accuratethantheMMSEalone

foridentifyingpeoplewith

Alzheimer’s.However,thetest

wronglyidentifiedarelatively

highproportionofhealthy

participantsashavingdementia.

Weconcludedthatthetesthad

potential,butthatitneeded

Brain scans identify changes in the brain

Earlier diagnosis would allow care to be given earlier

10

Alzheim

er’s in the news

tobeassessedinfurthertrials,

forexampletoverifytheexact

scorethatwouldbeconsidered

asindicatingpotentialdementia.

Inaddition,peoplewithmore

severecognitionproblemsmight

struggletocarryoutthetest

themselves,althoughthisis

unlikelytobeamajorissueif

thetestwastobeusedas

ascreeningtooltoidentify

Alzheimer’sthathasnotyetbeen

detected,whichwouldprobably

beatanearlystage.

Overall,iffuturestudiesare

favourable,thistestcould

potentiallybeusedbynon-

specialistdoctorsasaninitial

screeningtoolforAlzheimer’s.

Aswithcurrentmethods,

suspectedcasesofAlzheimer’s

wouldstillneedtobefollowed

upwithfurthertestingand

assessmentbyspecialiststomake

afirmdiagnosis.

TheTestYourMemorytestis

availabletoviewonline

(PDF4kb).

Brainscans

Brainscansarehardertocarryout

thanmemorytests,buttheycan

helpidentifyimportantchanges

inthestructureofthebrain,such

asshrinking(atrophy),aswellas

areaswithreducedfunctioningor

unusualpatternsofbloodflow.

Althoughnotestsareavailable

tomakeadefinitediagnosis

ofAlzheimer’sdiseaseinliving

patients,thesescanscanhelp

ruleoutconditionssuchasstroke

ortumoursthatproducesimilar

symptomstoAlzheimer’s.Itisonly

afterrulingoutconditionssuchas

thesethatdoctorswilldiagnose

Alzheimer’sdisease.

Asscanningtechnologycontinues

todevelopandimprove,scientists

areresearchingnewwaysto

detecttheearliestbrainchanges

inAlzheimer’sdisease.

InApril2011,theDaily Mail

announcedatechniquethat

“couldhelpdetectchanges

leadingtoAlzheimer’sdiseaseup

toadecadebeforethesymptoms

develop”.Thestudybehind

thisnewsstoryinvolvedthe

developmentofamethodbased

onusingMRI(magneticresonance

imaging)scanstoexaminethe

thicknessofninedifferentbrain

regions,dubbed“Alzheimer’s

signatureareas”byresearchers.

Thestudyfollowed65people

withoutAlzheimer’sdiseasewith

anaverageageofabout70.

Researchersusedscanstoidentify

thedimensionsofthevolunteers’

signaturebrainareasand

followedthemforupto11years

toseewhichofthemdeveloped

thedisease.Theyfoundthat

55%ofvolunteerswhosebrains

werethinnerinthesenineareas

developedAlzheimer’s,compared

to20%ofthosewithsignature

areasofaveragethicknessand

noneofthosewiththe

thickestsignatureareas.

Althoughtheseresultssuggest

alinkbetweenthethicknessof

thesebrainregionsandlater

riskofAlzheimer’s,thiswasa

preliminarystudyinarelatively

smallnumberofpeople.Having

greaternumbersofparticipants

generallyincreasesthereliability

ofstudiesasitreducesthe

chanceofanomaliesdistorting

theresults.However,thestudy’s

design–whichinvolvedtesting

peoplebeforetheywereknown

todevelopAlzheimer’sand

followingthemupoverseveral

yearstoseewhodevelopedthe

disease,usingacceptedcriteria

fordiagnosis–isthebestwayto

tellwhetheranewtestmightbe

agoodearlydetectionmethod.

Repeatingthestudyinlarger

numbersofparticipantsshould

giveaclearerindicationof

whetherAlzheimer’ssignature

areascanhelppredictwhoisat

riskofdevelopingthedisease

inthenextdecade.

Whilethisresearchlookedatthe

riskofdevelopingAlzheimer’sin

elderlypeople,somenewspaper

reportssuggestedthatbrainscans

canbeusedtopredictwhether

someonewouldgetthedisease

decadesbeforesymptomswould

typicallyappear.Forexample,in

November2010,astoryinthe

Daily Mailannounced“aninstant

testat40topredictAlzheimer’s.”

Thestory,whichsaidthata

“30secondtest”toscreenfor

Alzheimer’scouldbeavailable

inaslittleastwoyears,was

unfortunatelyoverlyoptimistic.

Theresearchlookedathow

thepresenceofbrainlesions

waslinkedtoaperson’scurrent

mentalfunction.Itexamined428

healthypeopleintheir40swho

didnothavedementiaandfound

thatchangesintheextentofone

typeofchangeinthewhite

matterofthebrainwerelinked

topoorerperformancesinmental

abilitytests.Brain scans showing white matter lesions

11

Alzheim

er’s in the news

However,asthestudydid

notfollowthepeopleupto

seewhethertheydeveloped

Alzheimer’s,wecannotbesure

thatbrainscanslookingatwhite

matterlesionscanpredictwho

developsAlzheimer’s.Infact,

whiletheMailsuggestedthis

researchcouldleadtoatestin

twoyears,itwillprobablytake

severaldecadestotellwhichof

theparticipants,ifany,develop

Alzheimer’sdisease.Theresearch

shouldbeseenasprovidingclues

tothedisease,ratherthananew

diagnosismethod.

Bloodtests

Bloodtestsarenotcurrently

usedtodetectAlzheimer’s,

althoughtheymaybeusedto

helpruleoutotherpotential

causesofmemoryloss.

Researchintothepossibleuse

ofbloodteststohelpdetect

Alzheimer’sisataveryearly

stage,andthereisstillsomeway

togobeforeweknowifsuchtests

couldhavearoleindetecting

Alzheimer’s.Severalnewsstories

havecoveredtheseearlystudies.

InJuly2011,theTelegraph

reportedthatabloodtest

maysoonbeableto“predict

Alzheimer’sdiseaseupto10years

beforesymptomsappear”.

Thereportwasbasedonastudy

thatexaminedarangeofproteins

inthebloodtoseewhether

peoplewhodevelopAlzheimer’s

havedifferentlevelsofthese

proteinscomparedtopeople

withoutthedisease.Thestudy

foundthatthelevelsofa

proteincalledclusterinwas

linkedtomentaldecline,the

severityofdiseaseinpeoplewith

Alzheimer’sandtherateatwhich

Alzheimer’sprogressed.

However,theresearchers

werelookingatproteinsinan

experimentalwayanddidnot

suggestthatthisproteinmaybe

usedtodiagnoseAlzheimer’s,at

leastnotyet.Infact,theysaid

thattheirfindingsdidnotsupport

usingclusterinlevelsaloneto

predictAlzheimer’sdisease.

Potentialtreatments

Unfortunately,currenttreatments

forAlzheimer’sdiseaseonly

temporarilyslowthedeclineof

brainfunctionordealwithcertain

symptomsofthedisease.They

cannotstopthediseasefrom

progressingaltogether,orreverse

thedamagethathasalreadybeen

donetothebrain.

Studieslookingatpotential

‘cures’forAlzheimer’s–bethey

coffee,magnettherapyoreven

anAlzheimer’s‘milkshake’–are

frequentlytalkedupbythe

media.It’softenignoredthat

whiletheresultsofsomeofthese

trialslookpromising,developing

safeandeffectivenewdrugs

foranydiseaseisaslowand

painstakingprocessthatrequires

severalstagesofresearchandcan

takemanyyears.

Alargeproportionofthestudies

ofpotentialtreatmentsreported

inthepapersarepreliminary

studies,oftencarriedoutincells

inthelaboratoryorinanimals.

Anytreatmentforhumansthat

mightbedevelopedfromthese

studiesremainsmanyyearsaway.

However,thisdoesn’tdiscourage

headlineswriters,whoadmittedly

mighthavetroublefittinginthis

caveatwhilekeepingthereaders’

interest.Manyheadlinesabout

thesestudieshaveexaggerated

theirsignificance,oftenreferring

tothemasa‘holygrail’,‘fresh

hope’or‘cure’fordementia.

Forexample,inNovember2010,

BBCNewsreportedthatthe

diabetesdrugmetforminmight

offer“Alzheimer’shope”.

Thisearly-stagestudyonmouse

cellsfoundthatmetformin

increasedtheactivityofan

enzymethatcancounteractthe

developmentoftauprotein

tangles,whicharecharacteristic

ofthedisease.Asmetforminis

alreadyusedindiabetes,it

It is hoped that blood tests might one day detect early stage Alzheimer’s

Can “special milkshakes” slow Alzheimer’s?

Results from lab studies are often just the first step in a lengthy research process

12

Alzheim

er’s in the news

couldpotentiallyreachthe

stageofhumantestingfor

Alzheimers’diseasemorequickly

thananewdrug.However,more

laboratoryandanimalresearch

wouldprobablybeneeded

beforethestartoftestingin

peoplewithAlzheimer’s.

Earlystudiesliketheseare

essentialfirststepsinidentifying

drugsthatcouldeventuallybe

usedintreatingAlzheimer’s

diseaseinhumans.However,they

needtobeseenaspreliminary.

Manyofthedrugsinthese

earlystudiesdonotproveto

beeffectiveorsafeenoughfor

humantesting.Forthosethatdo,

itcanstilltakemanyyearsbefore

weknowifthedrugworks

andissafe.

Randomisedcontrolledtrialsoftreatments

Thebestwaytoinvestigatethe

effectsofatreatmentiswith

arandomisedcontrolledtrial

(RCT).Ofthe100orsostudieson

Alzheimer’sanddementiathatwe

havecoveredoverthepastfour

years,justunderathirdlookedat

currentorpotentialtreatments.

Ofthese,onlysixwereRCTs

thatlookedattheeffectsof

treatmentsforAlzheimer’sor

dementiainhumans.

TheseRCTslookedattheuseof

theherbalsupplementginkgo

biloba,vitaminB,amultinutrient

milkshake,atypeofmagnetic

therapyandtwodrugtreatments.

Ginkgobiloba

Thestudiesthattestedginkgo

bilobaandvitaminBinhumans

suggestedthattheydonothelp

peoplewithdementia.

InJune2008,BBCNewsreported

that“Ginkgo‘doesnottreat

dementia’”.

TheRCTbehindthisstory

comparedtheeffectsofginkgo

bilobaextractin176peoplewith

mildtomoderatedementia.

Itfoundthatginkgodidnot

improvementalperformance

comparedtoplacebooversix

months.Weconcludedthatthe

studywaswellconductedand

providedgoodevidencethat

ginkgodoesnotimprovebrain

functionorqualityoflifein

peoplewithmildtomoderate

dementia.Thefindingsofthis

studyaresupportedbyareview

oftheevidence,publishedby

theCochraneCollaborationthe

followingyear,whichconcluded

thattherewasnoconvincing

evidencethatginkgobilobais

effectivefordementiaandmental

impairmentingeneral.

Bvitamins

Bvitaminsarearecurringstoryin

thetreatmentandpreventionof

dementia.Theyarealsoagood

exampleofhowsomethingcanbe

reportedtobehelpfulonemonth

anduselessthenext.Peopleare

clearlyinterestedinthesubject,

assomeofBehindtheHeadlines’

mostpopulararticlesareonB

vitamins.The Timesreportedin

2008thatAlzheimer’spatients

were“wastingtheirtime”taking

vitaminBsupplementsintheir

attemptstoslowtheprogressof

thedisease.

TheRCTbehindthisstorylooked

attheeffectsofadailyhigh-dose

vitaminBsupplement(containing

folicacidandvitaminsB6and

B12)over18monthsin409people

withmildtomoderateprobable

Alzheimer’sdisease.Itfoundthat

thevitaminBsupplementdidnot

slowmentaldeclineanymore

thanaplacebodid.

VitaminBwasbackinthenews

inSeptember2010,whenthe

Telegraphreported:“Vitamin

Btabletscouldslowandeven

haltthedevastatingmarchof

Alzheimer’sdisease.”Thestudy

inquestionwasawell-conducted

trialin271elderlypeoplewhodid

nothavedementiabutwhodid

havemildmemoryproblems.The

studyfoundthatthosewhowere

givenvitaminBexperiencedbrain

shrinkage(atrophy)30%slower

thanthosegiveninactivetablets.

Despitebeingpromising,the

resultscouldnotshowthat

vitaminBcanpreventdementia

becausethestudycannottellus

NICE says that vitamin B supplements offer no clear overall benefit in dementia

WhatdoesNICEsayaboutvitaminB?

Inits2007guidanceon

dementia,NICEconcluded

thattherewasinsufficient

evidencefromRCTsto

determinewhethervitamin

B12hasbenefitsthat

outweighedtheriskof

adverseeffectsinpeoplewith

dementia.Italsoconcluded

thattheincreasedriskof

adverseeffectswithfolicacid

supplementationoutweighed

anypotentialbenefitsin

peoplewithdementia.

13

Alzheim

er’s in the news

whetherthisreductioninbrain

shrinkagewouldhavebenefitsfor

peoplewithdementia.

OtherRCTsofdementiatreatments

TheotherRCTswecoveredthat

assessedpotentialAlzheimer’s

treatmentshadmorepromising

initialresults.However,these

studiesalsohadsomelimitations,

suchastheirsmallsizeornot

beingfullypublishedatthetime

theywerereported.

Rembertrials

TheDaily Mailreportedin2008

thatthefindingsfromanearly

humantrialofadrugcalled

methylthioniniumchloride

(Rember)was“thebiggest

breakthroughagainstbrain

diseasefor100years”.The

drugreportedlytargetedthe

tauprotein–whichformsthe

characteristictanglesinbrainsof

peoplewithAlzheimer’sdisease

–andreducedmentaldeclineby

81%overayearinpeoplewith

mildtomoderateAlzheimer’s.

However,thefindingshadonly

beenpresentedataconference.

Whiletheymaylookencouraging,

resultspresentedatconferences

shouldbeinterpretedwith

cautionuntiltheyhavebeen

fullypublishedinapeer-reviewed

journal.Withoutbeingable

tolookatthestudy’smethods

orresultsindetail,itisdifficult

todrawfirmconclusionsabout

thesefindings.

Theanti-Alzheimer’smilkshake

Thestoryofamilkshakethat

couldtreatAlzheimer’s,reported

bytheDaily Mailin2010,isnotas

unlikelyasitsounds.However,the

researchonwhichitwasbased

isstillatanearlystageandthe

findingswereexaggeratedbythe

newspaper,whichsaidthatthe

“once-a-daymiracledrink”could

beavailablewithintwoyears.

TheRCTcomparedadaily

multinutrientmilkshake

(containing‘phosphatide

precursorsandcofactors’)witha

placebodrinkin225peoplewith

mildAlzheimer’sover12weeks.

Themilkshakewasfoundto

improveparticipants’verbalrecall

morethantheplacebodrink,but

didnothavethesameeffecton

othermentalfunctions.

Hayfeverpill

In2008,The Sunreportedthat

ahayfeverpillcalleddimebon

can“combatmemorylossin

patientswiththebraindisease”

AnRCTlookedat183Russian

patientswithmildtomoderate

Alzheimer’sandfoundthat

dimebonimprovedsymptoms

comparedtoaplaceboover26

weeks.Althoughthestudywas

smallandlimitedtoonecountry,

ithighlightsthatdimebon

mayhavepotentialintreating

Alzheimer’s.However,thiswas

earlyresearchandfurtherstudies

arerequired.

Magnettherapy

The Independentreportedin

2010that:“Applyingmagnets

tothebrainsofAlzheimer’s

diseasesufferershelpsthem

understandwhatissaidtothem.”

ThisverysmallRCTassessedthe

effectsofrepetitivetranscranial

magneticstimulation(rTMS)in10

peoplewithmoderatelysevere

Alzheimer’sdisease.Participants’

performanceimprovedina

sentencecomprehensiontestafter

twoweeksofrTMSbutnotafter

ashamtreatment.However,this

trialwastoosmallandshortto

telluswhetheranyimportant

long-termbenefitscanbe

expectedwiththistreatment.

Youcanfindoutwhattreatments

arecurrentlyavailableonthe

NHSfordementiainNHSChoices

HealthA-Z.

Tomorrow’sheadlines

Trialsoftreatmentsthatmake

thenews,suchasRemberand

dimebon,areonlyonearea

ofresearch.

Overthepastfewyears,scientists

havemadesomekeyadvances,

notablyinthefieldofgenetics,in

progresstowardsearlierdiagnosis

andindevelopingdrugsthatmay

onedaypreventAlzheimer’sfrom

progressing.Weaskedresearchers

inthefieldwhatareasof

Alzheimer’sresearchtheyexpect

tohittheheadlinesinthefuture.

Generesearch

Nineofthe10geneticvariants

associatedwithlate-onset

Alzheimer’shavebeendiscovered

inthelasttwoyears.Research

thatuncoveredthelastfivewas

publishedin2011inthejournal

Hayfever medication

14

Alzheim

er’s in the news

NatureGeneticsandwascovered

inBehindtheHeadlines.

ProfessorJulieWilliamsofthe

departmentofpsychological

medicineandneurologyat

CardiffUniversity,andchairof

thescientificadvisoryboardat

Alzheimer’sResearchUK,seesthis

asanexcitingbreakthrough.

“Themoregeneswecanidentify

thatincreaseriskofthedisease,

themoreweunderstandwhatis

goingwrongbiologicallyinthe

brain,”saysProfessorWilliams.

“Eventuallythatwillleadto

newtreatments.”

Whatisveryexciting,shesays,

isthattheidentifiedgenesare

clusteringinpatterns,whichpoint

topossiblediseasepathwaysthat

infuturecouldbetargetedfor

treatment.Forexample,several

genessuggestthattheimmune

orinflammatoryresponseof

peoplewhodevelopAlzheimer’sis

somehowdifferentfromnormal.

Othergenesthathavebeen

identifiedareinvolvedwithhow

weprocessfattysubstancessuch

ascholesterol,whichindicates

thatthisprocessmaydifferin

peoplewithAlzheimer’s.“The

brainmakesitsowncholesterol

andthereseemstobeaproblem

withthewaypeoplewith

Alzheimer’sprocessthis,”says

ProfessorWilliams.

Themostrecentandexciting

breakthroughconcernsa

processcalledendocytosis.Thisis

basicallyhowabraincell

bringsin‘bigmolecules’from

outsideandhowtheyare

processed.“Wenowhaveseveral

genesthatsuggestthatproblems

withthisprocessareplayinga

strongroleinthedevelopmentof

Alzheimer’sdisease.”

Thefindingssuggestthat

scientistsarebeginningtopiece

togetherthejigsawofhowand

whythediseasedevelops.

“Ifwewereabletodevelop

treatmentstoremovethe

detrimentaleffectsofthese

genevariations,weshouldbe

abletoreducethenumbersof

peopledevelopingAlzheimer’s

diseaseinthelongterm,”says

ProfessorWilliams.

Howthesemorerecently

discoveredfactorsrelatetothe

plaquesandtanglesfoundinthe

brainsofpeoplewithAlzheimer’s

isnotyetknown.However,itis

possible,shesays,thattheplaques

couldbesideeffectsofamore

fundamentaldiseaseprocess.

“I’mexcitedbythesefindingsand

Iknowthateventuallytheywill

makeadifference.Wehavelots

ofquestionsstilltoanswerabout

geneticsandweknowtheycan

resultinpotentialtherapies,”says

ProfessorWilliams.

EarlydiagnosisanddetectionEarlydetectionofAlzheimer’s

disease,yearsbeforesymptoms

firstappear,iscrucialifnew

drugsaretostopthedisease

developing,saysSimonLovestone,

professorofoldagepsychiatryat

King’sCollegeLondon.

“Oneofthethingsweknowis

thatAlzheimer’sstarts10to20

yearsbeforeclinicalsymptoms

appear,”hesays.“Soanydrugs

targetingthediseaseareunlikely

tobehelpfulaftertheclinical

diseasehasstarted.I’mreally

interestedinwhetherwecan

potentiallyreversethisdisease.

Buttobesuccessful,evento

setupclinicaltrialsofnew

treatments,weneedtobeableto

diagnoseitalotearlier.”

Overthelast10years,promising

developmentsindetectioninclude

theuseoflumbarpuncturesto

lookforlevelsofcertainproteins

incerebrospinalfluid(which

surroundsthebrainandspinal

cord)andhighlyspecialisedscans,

calledPETscans,todetectprotein

depositsinthebrain.Bothof

thesearebeingtestedinclinical

trialsonearlydiagnosis.However,

theyareexpensiveandrequire

specialistskillstoadministerthem.

Therefore,researchersarelooking

atthepotentialoftwoother

methodsforearlydetectionof

dementia,includingAlzheimer’s:

MRIscansandbloodtests.

“SofarMRIscanshaveonly

beenusedtoruleoutconditions

otherthanAlzheimer’s.We

haven’tbeenabletousethem

todiagnosethedisease,”says

ProfessorLovestone.“Butwe

havenowdevelopedacomplex

Our genes appear to play an important role in development of dementia

A lumbar puncture to sample spinal fluid

15

Alzheim

er’s in the news

analysisofwhattheyshow,which

meanswecanusethemtomake

apositivediagnosisofdementia.

Infact,MRIsarenowbeingused

todiagnosedementiainroutine

clinicalpractice.

“WithMRIs,digitaldataare

collectedandturnedintoaphoto

toseeiftherehasbeenbrain

shrinkage.Inouranalysis,weare

abletolookatdifferentvolumes

ofatrophyindifferentregionsof

thebrainandcomparethistoa

largedatabaseofnormalMRIs.

Asyet,wecannotdifferentiate

betweenAlzheimer’sandother

dementias,butweknowthat

regionalpatternsofatrophyare

differentindifferentdisorders,so

wehopetobeabletodothisin

future.Wearealsohopingtouse

thisanalysisearly–inthepre-

dementiaphase–inpeoplewho

havemildcognitiveimpairment,

topredictwhichofthemarelikely

togoontodevelopdementia.”

Thesecondareathatisinteresting

researchersisthedevelopmentof

abloodtesttolookforprotein

“fingerprints”forAlzheimer’s.

Usingacomplexarrayof

technologies,researcherscan

identifyindividualproteinsin

bloodsamplesandcomparethe

levelsinpeoplewithAlzheimer’s

andthosewithoutthedisease.

Inthefuture,itishopedthat

bloodtestsmaybeableto

identifyproteindepositsin

thebrainearlyinthedisease,

some10to20yearsbefore

symptomsappear.

“Levelsofcertainproteinsinthe

bloodmayreflecttheamountof

amyloidproteininthebrainwell

beforeclinicalsymptoms,”says

ProfessorLovestone.“Soablood

testcouldeventuallybeusedon

peopleveryearlyinthedisease.

“We’vediscovered30proteins

whichareatdifferentlevelsinthe

bloodofpeoplewithAlzheimer’s

disease.Wearenowdoinga

Europe-wideclinicalstudywith

samplesfromcontrolgroupsand

fromthosewithAlzheimer’s,to

pinpointthedifferencesfurther.

Withinthenextyear,wewill

knowhowthenewtestswe’ve

developedarefunctioningand

afterthisweneedtosetup

clinicaltrials,totrythemonlarge

numbersofpatients.”

Onebloodproteinthathasbeen

linkedtothedevelopmentof

Alzheimer’sisclusterin,

whichintriguinglyhasbeen

foundinhigherlevelsinthe

bloodasmuchas10yearsbefore

thefirstsignsofthedisease

appearinthebrain.“Atthe

sametimeaswediscoveredthis,

scientistsworkingingenomics

foundthatageneforclusterin

isassociatedwithAlzheimer’s–

anamazingcoincidence,”says

ProfessorLovestone.

Earlydiagnosisisvaluableto

patientsandfamiliesbecause

itenablesthemtoplanahead,

hesays.“Buttheunderlying

assumptionisthatonedaywe

willhavethetreatmenttohalt

theprogression.”

Newdrugs

Developingdrugsisalengthy

andpainstakingprocess.Froma

keydiscoveryaboutthedisease

process,itcantake20yearsto

developadrugtotargetthat

processandenteritinclinical

trials,andanother10yearsbefore

thedrugwillbeusedinpractice.

Therefore,discoveriesmadeabout

Alzheimer’s20to30yearsagoare

onlynowcomingtofruition.

Thirtyyearsago,thebeta-amyloid

proteinthatformsplaques

inthebrainwasdiscovered.

Followingthis,20yearsago,

twoenzymesthatgeneratethe

protein,calledgamma-secretase

andbeta-secretase(orBACE).

Scientiststhensetouttofind

drugstostopthatactivity.Itis

onlynowthatthesedrugs,called

gamma-secretaseinhibitorsand

BACEinhibitors,areinclinical

trials,withresultsexpectedin

thenextyearortwo.Iftheyare

foundtobeeffective,theycould

bereadyforusesoonafter.

Inthefuture,saysProfessor

Lovestone,anotherenzyme,

calledGSK3,couldalsobeatarget

fordrugs.GSK3addsphosphate

Scientists are studying differences in proteins in the blood of people with Alzheimer’s

MRI scan of the brain

16

Alzheim

er’s in the news

tothetauproteinwhichforms

thecharacteristictanglesseenin

Alzheimer’s,anddrugstotarget

thisenzymearenowentering

phase2clinicaltrials,hesays.

Heisalsotryingtounderstand

moreaboutthebasicprocesses

involvedinthediseaseto

identifypossiblenewtreatments,

inparticularhowthetwo

abnormalitiescharacteristicof

Alzheimer’s–amyloidplaquesand

tautangles–arerelated.

AvaccineagainstAlzheimer’s?

Anotherexcitingdevelopment

accordingtoCliveBallard,

professorofage-relateddisorders

attheInstituteofPsychiatry

inKing’sCollegeLondon,and

directorofresearchforthe

Alzheimer’sSociety,isapotential

vaccineagainstAlzheimer’s,

currentlybeingtrialled.Although

notavaccineintheusualsense

oftheword,itishopedthat

thedrugcanclearamyloid

plaquesfromthebrain.“We

haveevidencefrominitialstudies

thatthevaccinecandothis.The

questioniswhetherthatisof

benefittopatients–whetherit

willhelpthemindailylife,”says

ProfessorBallard.“Clinicaltrialsof

thevaccineonpatientswithmild

tomoderateAlzheimer’sdisease

arenowatthefinishingstage.We

willknowwithintwoyearsifthe

vaccineworksornot.Itwouldbe

veryexcitingbutalsobringlots

ofchallenges,sincethisapproach

dependsonhavinginfusionsin

hospital,isexpensiveandrequires

specialistskills.”

Developing drugs is a lengthy process

Is an Alzheimer’s vaccine a possibility?

17

FindoutmoreaboutdementiaandAlzheimer’s

OnNHSChoices

Worriedaboutdementia?-learnthebasicsaboutdementia

HealthA-Z:Alzheimer’sdisease-astraightforwardguidetothecauses,symptomsandtreatments

forAlzheimer’sdisease

HealthA-Z:Dementia–readaboutthedifferenttypesofdementiaandhowtheyaretreated

CarersDirect–adviceonthepracticalandfinancialsupportavailableifyoucareforsomeonewith

dementia

Officialguidelineondementiatreatment

NICEGuidanceonDementia–medicalguidelinesdetailingthebestpracticefortreatingdementia

andAlzheimer’sdisease

NICE:DementiaQualityStandard–achecklistexplainingwhathigh-qualitydementiacareshould

providetopatients

NationalDementiaStrategy–theDepartmentofHealth’splanforimprovingdementiacareand

treatmentacrosstheUK