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Dementia on the front pages

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There seems little doubt that dementia sells newspapers these days. Barely a week goes past without a new sensation – Miracle Cure! ….Eat This, Eat That!... XXX gives you Alzheimers’!! What is an ordinary person supposed to make of this barrage? How good is the science? Let’s consider a couple of recent examples.

Solanezumab hit the airwaves late in July when findings from a drug trial were presented at the Alzheimer’s Association International Conference in Miami. It was claimed that the drug reduced the progression of Alzheimer’s disease by one-third, and the word ‘breakthrough’ went into overdrive. Solanezumab is a monoclonal antibody aimed at amyloid and amyloid is an insoluble substance that is deposited in increased quantities in the brains of people with Alzheimer’s disease. Indeed, the hypothesis that amyloid is at the basis of causing Alzheimer’s has been a strong theme for several decades now, though it is also possible that the deposits of amyloid are the result rather than the cause of the disease. So, if solanezumab dissolves amyloid and slows down Alzheimer’s disease, that would be very good news. However, what wasn’t quite so obvious was that this wasn’t an ordinary clinical trial against a placebo – indeed, when that was done with solanezumab, the effects weren’t significant – it was instead a special sort of analysis known as a delayed-start analysis, which is not currently accepted by drug regulators as robust enough to show that a drug works.

Are we experiencing an epidemic of neurodegenerative diseases, especially causing a wave of young onset cases of dementia? This has recently been claimed, the causes being something to do with our lifestyles, maybe heavy metals or maybe just too many computers and mobile phones. The claim was based on comparing causes of death recorded in 20 countries in two periods about 20 years apart. There are several problems here, the main one being that causes of death data (death certificates) are notorious for under-reporting disorders like dementia. However, recording that someone had dementia when they died has become more common in recent years, though still patchy, so of course it would appear that dementia is getting more common. To say nothing of the fact that other causes of death, cardiovascular disease and cancer, have become a bit less common. It is, however, possible that dementia in middle age is becoming commoner but we can’t exclude the possibility that we have got better at diagnosis and more likely to detect it in the last 20 years.

How can research in Nottingham help? The Centre for Dementia at the Institute of Mental Health takes a broad view across the whole picture of dementia. One of our jobs, I believe, is to comment and put things in perspective, for instance through our IDEA (Improving Dementia Education and Awareness) website, which includes our Dementia Day to Day blog. Research across the University includes molecular genetics, neuroimaging and biomarker work on Alzheimer’s disease and other forms of dementia. Through the National Institute of Health Research Clinical Research Network, we have clinical leadership for mental health, dementia and neurodegeneration treatment trials across the East Midlands. This also includes helping to deliver the research side of the Prime Minister’s Dementia Challenge and to engage people with dementia and their carers through an initiative called Join Dementia Research. It is also important to realise that there are around three-quarters of a million people with dementia in the UK now, so the care and services that they receive and the activities that they are involved in are at least as important as any future treatments. Therefore, our research encompasses psychological and social aspects of dementia, such as arts experiences, use of technology, and support to people in care homes.

In all of these enterprises, it is necessary to build hope and a sense of purpose, but to avoid sensationalism and inflating the issues. We think there’s a role to be critical yet positive about how progress can be made with dementia.

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Alistair Burns

Only a few years ago it would have been a real challenge to get a room full of people interested in dementia, to garner excitement and a real sense of possibility for what could be done.

Tom Dening

We’re just getting going on a project about hearing loss, dementia and care homes. As research projects do, it has a short title, ORCHARD, which is a contraction of Optimising Hearing Related Communication for Residents with Dementia.

Neil Chadborn

Academics are generally discreet about how their initial ideas for a research project develop. There are lots of reasons for this - some are rational, other reasons can seem a little 'paranoid'.