Professor Martin Rossor
Like cancer and HIV decades before, the solution to stopping dementia in its tracks has remained stubbornly intransigent. But there is hope.
This Dementia Awareness Week, the Alzheimer's Society is encouraging people to find out more about dementia and 'remember the person' by looking beyond someone's diagnosis and engaging with them.
The race to find a cure for dementia has never been more critical: within ten years there will be around one million people in the UK with this devastating condition – many of whom will spend their last few years severely impaired and dependent on others for care.
The NHNN and UCL Institute of Neurology are at the research epicentre and have recently been awarded grants totalling over £30 million.
Clinical researchers are faced with a dual challenge: they must develop new treatments to prevent, slow or stop the disease – and identify as early as possible those who will benefit from these treatments. Ideally before symptoms start showing.
Professor Nick Fox, consultant neurologist, has been instrumental in developing and refining a method of identifying dementia at the very earliest stages. The MRI-based image analysis system accurately measures brain tissue loss and can be used to assess the effects of particular treatments on the brain over a period of time, not only for Alzheimer’s but other neurological conditions too.
“Seeing parts of the brain actually shrinking and the loss of brain cells is a very powerful image,” said Professor Fox. “Dementia is often difficult to diagnose and can be mistaken for other conditions. This technique helps us make a more accurate clinical diagnosis and to determine which patients would be most suitable for research trials. “
He added: “At present, existing therapies help manage the symptoms but we desperately want to be able to offer something that really slows down or halts the disease. There is increasing recognition that the most effective therapies will be those offered to patients in the very earliest stages of disease and this idea is at the heart of our research work.”
The images demonstrate widespread brain shrinkage (brain loss shown in blue/green and increases in fluid space in red/yellow) progressing at a rapid rate in patient with Alzheimer’s disease (right image). The left image is that of a control patient.
For example, as part of an international trial UCLH/UCL is analysing brain scan images sent from around the world. The aim of the study is to see if an infusion of antibodies slows the disease’s progression by attacking Beta Amyloid, protein deposits which are one of the hallmarks of Alzheimer’s.
Up to 400 new dementia patients are referred to the NHNN each year, many are in their 50s and 60s and some even younger.
Professor Fox said: “It’s a cruel, and increasingly common, condition but these numbers are probably the tip of the iceberg, with many more remaining undiagnosed. It’s a dreadful disease yet I am always impressed with the way patients and their families cope. It is both humbling and inspiring.”
Meanwhile, in his office at 8-11 Queen Square, Professor Martin Rossor, recalls his first “Eureka” moment in 1991. He was working with Professor John Hardy, when they identified the first Alzheimer gene. “At the time it was a massive problem, an interesting problem, but people didn’t seem to be focusing on it.”
If you are unlucky enough to be born with the gene, you have a one in two chance of succumbing at a relatively early age.
Prof Rossor had the privilege of talking about his work to Prime Minister David Cameron during a recent visit to the NHNN.
Shortly before, the Prime Minister had announced a new target to recruit at least 10% of dementia patients on research trials. As director of the National Institute for Health Research (NIHR) dementia and neurodegenerative research network (DeNDRoN), Professor Rossor has that target firmly in his sight.
Professor Nick Fox
“We must rise to the challenge. It’s an empowering challenge and demonstrates real political support. In the past, dementia research has been under-funded but that is now beginning to change.”
On the NIHR Queen Square biomedical research unit programme, clinicians and scientists are adopting a four-pronged attack to investigate causes and possible treatments: research into molecular mechanism (Professor John Collinge), signatures of disease (Professor John Hardy) and biomarkers of change (Professor Nick Fox). Professor Rossor will concentrate on experimental treatments such as the new drug CPHPC which has been developed by Professor Sir Mark Pepys at UCL.
“In the past dementia was not talked about. But in the past 30 years of research, there have been dramatic changes. We are beginning to understand so much more.”