Diagnosis, falls, early treatment and looking after yourself have all been up for discussion at the biggest Alzheimer’s event of the year.
Over the last week scientists from around the world have gathered in Paris to share news and research and discuss the future of a disease that directly affects 750,000 of us in the UK alone. At the moment Alzheimer’s disease is hard to detect at its early stages, and as yet there is no cure for it. So is there anything positive to say?
“The good news out of the Alzheimer’s International Conference this year is that we are making advances towards earlier detection of Alzheimer’s,” said William Thies, PhD, Alzheimer’s Association Chief Medical and Scientific Officer.
“These advances are critical to helping people live longer, healthier lives free of the disability and death caused by Alzheimer’s. Identifying the disease early in its process – even before symptoms start to become evident – and treating it early is how we will accomplish that.”
Falling is one potential early sign of Alzheimer’s disease. Research carried out at Washington University, St Louis, USA, found that people with the earliest signs of this disease are more likely to have a fall. The study looked at a group of older people with healthy cognitive (thinking) ability, some of whom had preclinical Alzheimer’s. (This was measured using positron emission tomography (PET).) The results showed that those with the highest marker for Alzheimer’s had twice the risk of falling.
“Understanding the traditional hallmarks of Alzheimer’s, including cognitive impairment and memory loss are important; however, these study results also illustrate the significance of understanding that, in some people, changes in gait and balance may appear before cognitive impairment,” said Maria Carrillo, PhD, Alzheimer’s Association Senior Director of Medical and Scientific Relations.
Two studies carried out on different continents indicate that tests on blood and spinal fluid could be vital in new methods to detect Alzheimer’s disease before symptoms appear. The first study, from Perth in Australia, looked at blood samples and brain scans from 273 Alzheimer’s patients. It found nine markers in the blood which, when combined, were able to predict with an 88 % success rate whether someone would have a significant build-up of the protein amyloid in their brains, a sign of Alzheimer’s.
In the second study from Sweden, researchers checked the spinal fluid of 137 people with mild cognitive impairment (MCI), for the presence of two proteins (amyloid and tau). Their results showed that 90 % who had MCI and levels of these proteins that were high enough to detect, went on to develop Alzheimer’s within 10 years or less.
Up to 60% of dementia sufferers never receive a diagnosis. It means that they miss out on the treatments that could slow down the development of their symptoms. It also means that they – and their families – may not connect with vital services and may not get the help they need.
“This year’s conference had a big focus on diagnosis,” said Dr Anne Corbett, Research Manager, Alzheimer’s Society. “For example, some early research showed that people who have memory loss were more likely to go on to develop dementia, especially when they also had a history of depression. People with other types of cognitive impairment – from mood changes to difficulties with cognition, were less likely to go on to have dementia.
“With the new NICE guidance that has come out, there are now treatments for every stage of Alzheimer’s, which is a lot better than the position we were in a year or so ago,” said Dr Corbett. “It’s really important to get a diagnosis as early as possible. The earlier you can start treatment, the earlier you can start to slow those symptoms down, and the longer you can then give people for independent living, time spent with their family, time to plan and all those really important aspects of dealing with dementia.
“The goal, eventually, is to find a cure. We are moving forward in our understanding of what we might be able to target with a drug or a cure, but a lot more research is needed before we’re going to be at that stage.
“It’s difficult to say when we might find a cure, because it relies on a kind of Eureka moment from someone working on an aspect of dementia research. We know that it can take up to 20 years to put a new drug through clinical trials. So it means that we are looking at quite a long time-scale.
“So in the meantime we are looking for treatments that are better than what we have at the moment. We’re looking for treatments that could actually affect those underlying diseases, rather than just the symptoms, and treatments that will have a longer-lasting effect as well, so will buy people more time,” said Dr Corbett.
Meanwhile, as another study showed, there may be steps we can take to help ourselves. Research published in The Lancet Neurology studied a number of risk factors, including depression, mid-life hypertension, mid-life obesity, smoking, physical inactivity, diabetes and low education. By studying how strongly these factors are associated with Alzheimer’s, the study showed that by reducing our risk factors by 25 % we could cut the number of Alzheimer’s cases worldwide by three million.
“There is good evidence for exercise in particular, that it can reduce risk by up to 50 %,” says Dr Anne Corbett. “Another aspect which is important is making sure that you get diagnosis and good treatment for the other conditions that increase your risk. Those include depression, high blood pressure and high cholesterol and diabetes. There’s good evidence for all of these – make sure they’re managed well.”