When we think of future clinical trials and new treatments for dementia, we often think of new drugs. However, such disease-modifying treatments are only one of many avenues, and another big hope for future generations is dementia prevention.The goal of dementia prevention is to identify those at risk of developing dementia, and provide interventions as early as possible.
Two weeks ago, on November 29th, Pooja and I attended an event about dementia prevention organised by the University of Edinburgh. The evening was opened by Professor Tara Spire-Jones, who is the Chair of Neurodegeneration at the University of Edinburgh, followed by a discussion that also involved Professor Craig Ritchie (Director of the Centre for Dementia Prevention) and Henry Simmons (Chief Executive of Alzheimer’s Scotland). They outlined how we have already seen a decrease in the number of people with dementia over the last 10 to 20 years, especially men. This is thought to be related to better cardiovascular health, and shows how powerful even inadvertent prevention can be. The next step is to encourage purposeful, individualized prevention. We need to deconstruct the concept that there is nothing we can do about dementia, and empower individuals to do something about their own health. This does not mean we should blame people for their brain health deteriorating. Although there are some aspects of our health that we can influence, there are genetic predispositions that may make it impossible to prevent us from developing dementia. For those people that cannot use prevention, we will need interventions (i.e. disease-modifying treatments). At this stage one of the challenges to overcome to drive dementia prevention is getting valid and credible evidence to the people.
Various strands of research support the idea that there are risk factors of dementia that we can modify. There is about one third of dementia cases, where the exact causes remain unexplained. Part of this may be due to environmental risk factors. In a recent study a number of environmental factors was found to be associated with an increased risk of developing dementia. These include a lack of vitamin D, exposure to air pollution, and occupational exposure to some types of pesticides. However, it is important to remember that association does not imply causation. This means we cannot say at this stage whether any of the listed factors actually cause dementia, and we have to await future results. The PREVENT study is looking to identify early indicators of dementia risk in middle-aged people. In preliminary analyses, researchers have found that high cardiovascular risk impacts on a person’s dementia risk already in mid-life. These early results should however not be considered ready for clinical use and formal risk prediction.
Hope for the Future
In the final talk of the evening Hilary Evans, Chief Executive of Alzheimer’s Research UK, outlined how she views the future of dementia, and what the world will look life for children growing up now. Although there will be an increase in the number of people living with dementia, it is estimated that 35% of dementia may be prevented. To date 9 risk factors have been identified, and 93 treatments are in clinical developments for Alzheimer’s disease.
In 2021 several drug trials are expected to finish. One of these is the Aducanumab trial that lots of hope has been placed on. The Chief Executive of Alzheimer’s Research UK hopes that by then new approaches to research will be taken, and NHS GP health checks for people in their midlife will be rolled out. These health checks will involve talks about brain health and how to reduce the risk of dementia. At the same time, campaigns about dementia awareness will be in full swing. These aim to challenge some of the stigmas associated with dementia, talk about the fact that dementia is caused by a number of different disease, and make people think about it differently in terms of prevention. Her hope is that by 2025 life-changing treatments to be given to people in the early stages of the disease will be available. Overall, Hilary Evans gives a very positive outlook for the future, providing hope to those affected by dementia.
If you are interested in finding out more about what clinical trials for dementia are currently going on, then there are various online tools that can help you navigate through your options. One tool to try and help people find trials that might be relevant to them is TrialMatch. This is an individualised trial matching service for people with Alzheimer’s disease and related dementias. It is designed by the Alzheimer’s Association to be easy to use with web and phone support. Other websites that include details of clinical trials include the UK NHS website and the clinical trials registry platform run by the World Health Organisation.
Throughout the evening it was highlighted that healthcare systems all around the world need to start preparing for when these new treatments are brought to the market. In a Consensus statement led by Professor Craig Ritchie, Tom Russ, Martin Rossor and Alistari Burns, explain how services such as the NHS can prepare to keep pace with scientific breakthroughs, and what governments need to focus on now, to provide hope for the future.