No one who has read the coverage around our Seasonal Appeal will doubt that dementia has emerged as one of the great medical challenges of our time. FT writers and readers have contributed powerful testimony about the devastation that Alzheimer’s and related diseases can wreak on the lives of those with dementia — around 50m now and 152m by 2050, according to the latest World Health Organization projections — and on the people who know, love and care for them.
Yet we have also heard of a resurgence of hope among scientists that they will find ways to prevent and in time reverse the biochemical processes that slowly but inexorably destroys the brain as dementia takes hold.
A herd mentality had unfortunately dominated research for two decades until about 2015: the idea that Alzheimer’s could be beaten by targeting the sticky plaques of amyloid protein that build up in patients’ brains. This led the pharmaceutical industry to spend billions developing amyloid-busting drugs that have failed clinical trials.
Now scientists, including those funded by our Appeal charity Alzheimer’s Research UK, are breaking free of the amyloid hypothesis and pursuing a plethora of new approaches, some of which are showing initial promise. One is to enlist the body’s immune system to treat Alzheimer’s, rather as immuno-oncology is becoming a powerful weapon against cancer.
Another recent advance is the demonstration that the toxic neurological changes leading to dementia begin at least 20 years before any overt symptoms appear. This has two important consequences. People who are likely to develop Alzheimer’s in their 70s may benefit from preventive treatment as early their 50s — and early diagnostic tests are needed to identify those at risk while they are pre-symptomatic.
To bring even a few of these lab developments to patients in the form of diagnostics and treatments will of course require resources. Although medical researchers in different areas are always competing for funding — and arguing that their field is the most deserving — a comparison of the human suffering and economic cost of dementia (an estimated $1tn in 2018) with other diseases makes the case that it is relatively underfunded.
The output from dementia research is certainly disproportionately low. As the WHO points out, the number of papers on dementia in peer-reviewed journals in 2016 was around 7,000, compared with more than 15,000 for diabetes and 99,000 for cancer.
The outlook for future funding is encouraging, as Alzheimer’s emerges from the shade of shame and ignorance under which it has hidden for too long. The record of other diseases, such as HIV/Aids and breast cancer, shows that greater public awareness, discussion and patient advocacy do attract more resources.
A contribution to Alzheimer’s Research UK will help to accelerate the flow of diagnostics and drugs into the clinic, though we should not expect too much too soon. The charity’s target is to have the first medicine that affects the underlying cause of the disease available to patients by 2025.
If that is to be achieved an effective drug must already exist in a research lab somewhere, given the timescales of pharmaceutical development, though we do not know its identity. It may not work very well but, as the history of other pharmaceutical fields shows, the first medicine with some proven efficacy provides a base on which to build better drugs. If all turns out well, the WHO projection of a tripling of dementia cases by 2050 will look in hindsight like a gross overestimate.
References: Financial Times