Are we getting closer to a treatment?
New ways of working offer hope for a wave of insights into dementia that will eventually lead to more effective treatment.
Why don't we have a cure yet?
Since the first recorded discovery of Alzheimer's disease in 1906, there has been disappointingly slow progress in discovering drugs that prevent or even delay it. There are a few reasons why this could be:
1. By the time symptoms of dementia present themselves, a lot of damage has already been done to the brain. So far, drugs have been tested on and developed for patients whose dementia has progressed too far to give effective results.
2. Dementia affects the whole brain and involves lots of pathways, proteins and cells going wrong. This makes research a lot more complicated and reduces the likelihood of a single miracle cure, as there is no single 'thing' to target. That's why our name features dementias in the plural – because there are lots of different types, and lots of diseases that can cause it (such as Alzheimer's or Parkinson's).
3. Historically, dementia has been poorly understood, partially due to a lack of funding for research and drug development. Typically, areas that yield lots of promising results, and fields with a long-term payoff, get approved for funding, like physical conditions and childhood diseases. Because dementia most commonly affects older people and is a notoriously difficult condition to treat, it hasn't received as much funding in the past.
But all that's changing – thanks in part to DPUK and the wealth of information in our Data Portal.
Listen to our interview with DPUK's director, Professor John Gallacher, on the future of dementia research:
Better data offers hope
By bringing together what is known as 'cohort data', DPUK offers the chance for more specific drug trials that can be carried out earlier in the progression of the disease. Longitudinal cohort data is where information about thousands of people (who have volunteered for these studies) is collected over a large period of their lives.
"When researchers study the people for whom we have a lot of data – the people who take part in cohort studies – we are in a much stronger position to make the breakthroughs we need in the dementia treatment deadlock."
Professor John Gallacher, Director of Dementias Platform UK
The benefit of this cohort data is that researchers have information about people's lives before they went on to develop dementia. When these people are analysed, we can begin to see patterns in the data, such as similarities in people's genetics, early experiences or lifestyles, that could have increased their risk of getting dementia.
Once patterns have been identified, health professionals can begin to predict who may be at high risk of developing dementia. So, interventions like new treatments can be made in time to lower that risk and help stop them getting dementia.
Ultimately, we need to understand dementia better before we can develop those transformative new treatments, and data from cohorts helps make that possible.
The DPUK Data Portal is a free resource bringing together dozens of cohort studies and millions of health records that any researcher can apply to use in their work. This gives a unique opportunity for studies to be conducted cheaply, negating the need for big grants and funding. Plus, these cohorts can be analysed again and again with different research questions to get the most out of them.
Because the Data Portal is a virtual tool, it can be accessed by researchers from anywhere in the world. As well as making dementia research accessible, this also means great researchers from around the world can easily collaborate together. And we're bolstering this knowledge and understanding of dementia by running a series of new, cutting-edge experimental studies into the mechanisms behind dementia, and by helping match the right volunteers to studies and trials.
The best ideas and breakthroughs come when we work together – and that's what DPUK is all about.
While researchers across the world are working together on new treatments, there are some treatments already being used to reduce some symptoms of dementia.
These drugs are call symptomatic drugs because they target the symptoms rather than the underlying processes of dementia. In the UK, these drugs are licensed for treating Alzheimer's disease and Lewy body dementias. Read more about symptomatic treatments for dementia here.
Other drugs are sometimes prescribed for people with dementia, depending on their symptoms. Some people with Lewy body dementias experience symptoms that overlap with Parkinson's disease, so they may be given the Parkinson’s drug L-Dopa. If people with dementia experience a deterioration in their mental health, they may be prescribed anti-depressants.
Some people with dementia may get very agitated, in which case sedative drugs may be prescribed to calm them down. In some types of dementia, like dementia with Lewy bodies and sometimes Alzheimer's disease, people may experience hallucinations. If these hallucinations are distressing for the person with dementia, they may be given anti-psychotics to help them subside.
As well as all of these medication options, there are lots of non-medical things people with dementia can do to help slow the progression of their condition. Things like exercising and socialising more, eating healthily and quitting smoking can all help – read more about keeping your brain healthy here.
Even though we don't yet have the golden treatment for dementia, the drugs we do have available are helping people with dementia live well. Plus, revolutionary new ways of working bring us ever closer to an effective treatment to beat dementia.
Drugs in the pipeline
Aducanumab (referred to in science papers as BIIB037) is an antibody that binds to and clears amyloid-beta plaques. These plaques are formed when a protein called amyloid-beta accumulates and clumps together. This happens in the brains of people with Alzheimer's disease, and the plaques block their brain cells from communicating with each other.
Drug development is a lengthy process, and human clinical trials of aducanumab have been ongoing since 2012. The trials have shown a reduction in amyloid-beta plaques and reduced decline in scores on diagnostic measures of Alzheimer's disease, meaning people's memories remained fairly stable. However, side effects of headache, diarrhoea and confusion have been commonly reported.
The latest on aducanumab is that the Food and Drug Administration – the organisation in charge of licensing new drugs in the US – has approved the use of aducanumab to treat Alzheimer's disease. It becomes the first potentially disease-modifying treatment for Alzheimer's (that is, a therapy that doesn't simply tackle symptoms) and the first new treatment for Alzheimer's in almost two decades. The dementia research community will be keeping a close eye on its progress.
Donanemab is another antibody that binds to amyloid-beta plaques in a slightly different way to aducanumab. This drug has recently undergone a phase II clinical trial, which is where patients with Alzheimer's disease are given the drug to determine how effective it is, how safe it is, and the appropriate dose to give.
The phase II trial found a significant reduction in amyloid-beta plaques that translated to a reduced decline in memory and thinking skills. Unfortunately, nearly a third of participants stopped taking donanemab due to adverse side effects like nausea and tiny bleeds in their brains.
Another phase II trial is now under way to further investigate the safety and effectiveness of donanemab. After this, the final step will be for donanemab to enter a phase III trial, where the findings from phase II are confirmed and fine-tuned using a far larger sample of patients.