Dr Susan Kohlhaas
Director of Research at Alzheimer’s Research UK
People with dementia have been disproportionately affected by the COVID-19 pandemic. In fact, according to the ONS, a quarter of people who have died from COVID-19 also had dementia.
Changes to the world have brought new challenges for people living with dementia and some of our scientists are exploring how social isolation has impacted mental health, wellbeing, physical health, and the use of social care.
Latest figures also show a worrying increase in prescription rates of antipsychotic medications for people with dementia. Typically, these are used for dealing with challenging behavioural symptoms that some people with dementia experience, but these drugs can have a powerful sedative effect and should only be used for these people where there is no alternative. It is possible that some of the increase in prescription is related to delirium management, but it is also possible that the increase was in response to worsened agitation and psychosis in relation to COVID-19 restrictions.
The pandemic has also had huge implications for medical research, with labs forced to close earlier in the year. Even now, many labs conducting vital dementia research are not open at 100% capacity. Social distancing in specialised lab environments is difficult and getting clinical trials up and running again with volunteers at high risk of COVID-19 is challenging.
Fixed-term contracts, all too common in biomedical research, mean that vital research staff do not have job security, and those in the early stages in their careers are at greatest risk of job losses. In fact, our recent survey revealed that one in three dementia researchers are considering leaving research because of COVID-19. At the same time, funders across the UK are struggling to make funding available for new research, meaning the challenge is compounded.
As the UK’s leading dementia research charity, we are facing up to a 45% shortfall in income because of COVID-19. The pandemic is not only affecting our ability to fund new research this year but has the potential to alter the landscape of dementia research for years to come.
What has not changed is our vision of a world without the fear, harm, and heartbreak of dementia.
And we are committed to redoubling our efforts.
Dementia is a progressive condition research for which we do not yet have a cure.
However, there is hope. We have seen a great deal of progress in research over the last 10 years and there are new treatments in our sights. We expect to see the outcomes of an FDA priority review of the potential Alzheimer’s drug, aducanumab in 2021. This will determine whether is the drug licensed in the US. For the UK we will have to wait longer to learn whether there is sufficient evidence that aducanumab is safe and clinically effective to receive regulatory approval.
While this would be a positive step forward, aducanumab is unlikely to be a silver bullet. Any new licensed drug still needs to be judged to be cost effective. As many of the experimental drugs in late stage clinical trials are thought to be most effective for people at the earliest stages of Alzheimer’s, a new diagnostic pathway would need to be developed. This would enable beneficiaries to be identified and treated to delay the progression of this devastating disease.
Therefore, it’s still imperative we fast-track the development of a wide range of new treatment options.
With the biology underpinning the diseases that cause dementia complex there is much to be done. The immune system, which is the body’s defence mechanism, safeguarding against damage and attack is one area that’s previously received less attention. It’s also an area where new treatments may arise. New start-up companies like AstronauTx, a spinout from Alzheimer’s Research UK’s Drug Discovery Alliance, will start to look to develop new medicines designed to reset the behaviour of crucial support cells in the brain.
It is likely that any new treatments in the pipeline will need to be given as early as possible to have the greatest effect. The diseases that cause dementia start in the brain decades before symptoms begin to show. Currently we can only diagnose these diseases once symptoms are apparent, which means treatments have a much harder job to do at this later stage.
Technology advances are providing huge opportunities to intervene decades earlier, when these diseases first start to take hold. That’s where Alzheimer’s Research UK’s Early Detection of Neurodegenerative diseases (EDoN) initiative comes in.
The project is pulling together a wealth of information from a huge number of studies that will ultimately allow us to develop and test a digital device designed to pick up subtle effects of diseases like Alzheimer’s in people who don’t yet have any obvious symptoms.
Identifying the very earliest changes in these diseases would transform research efforts today, giving us the best chance of treating or preventing these diseases before the symptoms start to get in the way of life.
Key support from the likes of philanthropist Bill Gates has allowed this project to ramp up even during the pandemic and researchers have been recruited to key positions.
In COVID-stricken world, research is at risk, but there is hope. This year a new report has estimated that the number of dementia cases worldwide could be reduced by 40% if 12 risk factors for the condition could be eliminated. More research needs to be done to fully understand dementia risk, and to unpick why some of these factors may impact the number of people living with dementia. But this report points to a number of actions we can take now, both as individuals and as a society, that could reduce the number of people developing the condition in the future.
The best advice for individuals is that what’s good for your heart is good for your head: that means eating a balanced diet with plenty of fruit and vegetables, staying mentally and physically active, and keeping blood pressure, weight and cholesterol in check.
Although it’s been a difficult year, progress in dementia research is still being made and there’s hope for what 2021 will bring.