Developing Alzheimer’s or another form of dementia is many Britons’ worst fear when it comes to ageing, according to a recent survey by YouGov.
And it’s easy to see why. Outside the pandemic years, when Covid deaths slightly outnumbered dementia deaths (by 0.6 per cent), dementia and Alzheimer’s disease have been the leading cause of mortality in the UK. In care homes it’s to blame for more than 65 per cent of deaths, data from the Office for National Statistics show.
But would you like to know, 10 years in advance, that you were going to die from dementia?
How would that devastating news change your life, especially when there may be little you can do to delay its onset and science has repeatedly failed to come up with drugs to cure — or even radically slow — its progress?
These difficult questions no longer remain hypothetical.
Developing Alzheimer’s or another form of dementia is many Britons’ worst fear when it comes to ageing, according to a recent survey by YouGov
In Britain, a University of Cambridge spin-off company, called Cognetivity Neurosciences, is beginning NHS trials of a simple, five-minute diagnostic test that, the firm claims, will instantly and accurately predict your risk of Alzheimer’s in up to 15 years’ time.
The timing of this is significant as Britain faces an epidemic of Alzheimer’s disease and dementia owing to its ageing population. The number of affected is expected to rise from 800,000 to more that 1.2 million in England by 2040.
Yet most people are only diagnosed once symptoms — such as severe memory loss, confusion, forgetting words or becoming anxious and withdrawn — start to appear.
James Medcalf is the commercial director of Cognetivity Neurosciences. He says that the new test works well.
‘In the test you are shown quickly — only for about 100 milliseconds — pictures that feature either an animal or no animal. You are asked to respond quickly by pressing “yes” or “no”, depending on whether you see an animal,’ he says.
‘In evolutionary terms, spotting an animal very quickly was vital for our survival. The task involves some of the most basic structures of our brains, such as the amygdala, which helps to regulate our fight-or-flight responses.’
As the test relies purely on instinctive responses, we don’t consciously learn how to perform it, so practice cannot improve a person’s scores over time.
This is why this reaction is important for predicting dementia risk.
‘In the earliest stages of Alzheimer’s, it is not memory that gets affected,’ says Mr Medcalf.
‘Research shows instead that it is your brain’s processing speed that starts to slow, and this is what the new test shows.’
It was designed to work with screens such as the Apple iPad. The company claims the test is so easy that it plans on selling an abbreviated 2-minute form to anyone who would like to use it at their home.
‘You could use it every day, to track how you’re doing over the weeks,’ adds Mr Medcalf.
Three NHS trusts in Staffordshire and Sussex, as well as two care homes, are currently running pilot projects to identify signs of mild cognitive disability (MCI). These include people who forget their names, have trouble planning or organizing, or become easily distracted.
Would you like to know, more then a decade ahead, that your fate was dementia? How would that devastating news change your life, especially when there may be little you can do to delay its onset and science has repeatedly failed to come up with drugs to cure — or even radically slow — its progress?
One in ten people with MCI will develop dementia. Scientists at the Centre for Neurodegenerative Diseases (Bonn, Germany) are currently working on a more complex test that will predict if someone will develop dementia up to five-years before they do.
They have identified three molecules in the blood, called microRNAs, that may indicate Alzheimer’s risk. MicroRNAs are chemical messengers that transport instructions between cells. They can be used to help build new proteins, or other important functions.
In research published in the journal EMBO Molecular Medicine, the scientists described how 90 per cent of older people with very raised levels of the three molecules developed Alzheimer’s within two years.
Andre Fischer, a professor of psychiatry who led the research, says: ‘An increased blood level of these three microRNAs can indicate that Alzheimer’s symptoms will begin about two to five years later.’ Researchers now hope to develop a simple blood test that can be applied in routine medical care to assess dementia risk.
They say it may also be possible to develop drugs that can reverse the increase in these microRNAs — potentially undoing some of the damage.
It is a great help to be able to predict years ahead if you are going to get an incurable condition.
Hannah Churchill, research communications manager at the Alzheimer’s Society, told Good Health: ‘There is no sure-fire way to prevent the onset of dementia. Research suggests that around 40% of dementia cases can be prevented by addressing risk factors like hearing loss, obesity, excessive drinking, and smoking. The other 60% of dementia cases could not be linked to modifiable risks factors. Our age and genetics will also play a role and are outside our control.’
However, not everyone believes this makes risk-testing ineffective. ‘There has always been this argument in dementia care: should we bother doing something if we can’t do anything about it?’ says Mr Medcalf. ‘I say yes — at the very least you can put your affairs in order and give legal power of attorney to your loved ones in good time.’
Research shows that people don’t want to know their dementia risk.
The Social Care Institute for Excellence, a UK charity, says many people with early signs of dementia ‘choose not to seek a diagnosis’ because of concerns about the effect on their jobs, social lives and ability to drive.
In May 2020, psychiatrists at Yale University in the U.S. reported that adults aged over 65 who had recently been diagnosed with Alzheimer’s or other types of dementia were twice as likely to die from suicide compared with those who didn’t have dementia.
Authors of the study, published in the journal Alzheimer’s & Dementia, said all patients should be given ‘suicide risk screening and additional support at the time of receiving a dementia diagnosis’.
The Alzheimer’s Society agrees that patients and loved ones should receive this support, including, says Hannah Churchill, access to peer support groups, education for carers and care planning.
It could also mean starting medicines that might help the person cope with their symptoms — such as Aricept, a drug which helps nerve cells damaged by dementia to keep communicating with each other.
It can temporarily relieve some symptoms, but it cannot stop the disease from getting worsened.
‘For many, a dementia diagnosis may be a relief — an explanation for the changes they’ve been experiencing, especially if they have lived with symptoms for years,’ says Hannah Churchill.
‘And early diagnosis means better access to personalised care and support, such as occupational therapy, which means people with dementia can live well for longer.’
So is there any prospect of a drug that could stop Alzheimer’s in its tracks?
Scientists at Durham University last week revealed they had developed a futuristic £7,000 helmet that might be able to reverse dementia by zapping the brain with pulses of infrared light to boost memory and processing skills.
Secrets to an A-List body
How to achieve the star-like physiques. This week: Denise van Outen’s calf muscles
Denise’S toned calf muscles took centre stage when she wore a thigh-skimming dress recently. 47-year-old Denise, a TV presenter and actress, keeps fit by cycling and walking.
‘I try to do a little bit of exercise every day,’ she has said. ‘I don’t do a lot, maybe half an hour, but it’s enough to get the blood pumping.’
Try the inward-outward calves raise. This exercise targets the lower leg muscles. Start by standing with your feet shoulder-width apart and your toes facing inwards. Engage your core muscles, then push the heels of your feet up to the ceiling. Keep your knees straight, but not locked. To squeeze your calf muscles, pause at the top of this move. Next, lower your heels.
Do 12 repetitions, then start over with your toes pointed outwards and your heels slightly inwards. That’s one set. Do three sets of three sets three times per week.
However, the technology is still years away from being routinely used.
Hopes of a breakthrough in the search for a pharmaceutical solution were raised earlier this year by the fast-track approval in the U.S. of aducanumab, a drug that could slow or halt Alzheimer’s by reducing the build-up of a toxic protein — called amyloid — in the brain.
But the approval caused huge controversy, with some critics accusing the U.S. Food and Drug Administration — which gave it the green light — of ignoring the unanimous verdict by its expert advisory committee that trial evidence failed to show that aducanumab is effective.
The injectable drug, which costs £42,000 per patient per year, is not available here. The UK regulators have done a rigorous assessment to determine whether the clinical benefits are worth granting a licence.
The National Institute for Health and Care Excellence would then assess the drug for cost effectiveness.
According to the charity Alzheimer’s Research UK, that process is unlikely to be completed until ‘the middle of 2022 at the earliest’.