A Marathon Effort to PREVENT Dementia

Athletes ready at the starting line
Athletes ready at the starting line

This weekend sees our fantastic CDP runners take on the streets of Edinburgh once more for the Edinburgh Marathon Festival 2018. Following the brilliant success of our marathon relay teams last year we are again out in force and are thrilled to be represented in the 5k, 10k and relay marathon runs.

Our team comprises a great mix of participants, supporters and researchers, all dedicated to raise funds for the PREVENT dementia programme. PREVENT Dementia is a globally significant study that seeks to understand the origin and progression of brain changes eventually leading to the development of dementia. The study will assess detailed biological and cognitive markers from 700 volunteers between the ages of 40-59. PREVENT aims to provide a novel insight into these very early disease indicators that occur in the brain prior to the onset of dementia to improve our understanding of dementia risk. We hope that, in the future, we can empower people to protect their brain health and, if necessary, intervene with targeted drugs or other therapies to tackle dementia as early as possible.

We have received fantastic support for our runners so far and the funds raised from all their hard work will help us to grow the PREVENT project and improve our understanding of dementia risk and strategies for prevention.

We have been incredibly honoured to receive such great public backing for the project so far and we could not have achieved all our progress to date without the selfless donations of our supporters. To learn more about this year’s runners and to back the team please visit our JustGiving page where we would be extremely grateful for any donation no matter how small.

We are working hard to achieve our ultimate goal of a world without dementia. The road to success in this endeavour will prove a marathon, not a sprint and with your support we can get there.

Watch: Highlights from ‘‘Preventing Dementia: Advice and Advances’’ Winter Conference

Preventing dementia cover for the conference 29/12/2017
Preventing dementia cover for the conference 29/12/2017

The Centre for Dementia Prevention held its inaugural winter conference, ‘‘Preventing Dementia: Advice and Advances’’ at the end of 2017. Hosted in the beautiful surroundings of Edinburgh University’s Playfair Library, the sold-out event was a fantastic success. Thank you to all who joined us! Below are video highlights from a range of talks delivered on the night by our excellent expert speakers.

Welcome and Introduction

Our chair for the evening, Professor Tara Spires Jones, begins by outlining the scale of the challenge we currently face, with an estimated 45 million people living globally with dementia.

Current Priorities in Dementia Prevention Research

Professor Craig Ritchie, Director of the Centre for Dementia Prevention, and Henry Simmons, Chief Executive of Alzheimer Scotland, answer questions submitted by research participants and the wider community. Topics discussed include; How close are we to preventing dementia? How does the NHS prepare now for future disease-modifying medications? And what will your job role involve ten years from now?

How Lifestyle Choices May Reduce Your Risk

With a recent report suggesting a third of overall dementia risk is potentially modifiable,  what lifestyle changes can we all make to improve our brain health? From greater understanding of environmental influences to designing better drug trials to harnessing the powerful technology within smartphones. In this clip Professor Craig Ritchie, Dr Tom Russ (both University of Edinburgh) and Dr Ivan Koychev (University of Oxford) discuss some of the key factors to target for dementia risk reduction.

In Their Lifetime: Can Today’s Youth hope for a Future without Dementia?

The Keynote speech of the evening was delivered by Hilary Evans, Chief Executive of Alzheimer’s Research UK. Hilary’s talk drew inspiration from the recent birth of her son George. Looking to the future, what developments will he be likely to see in his lifetime? Will the first disease modifying treatments be available by his 10th birthday? By George’s teenage years will preventative medications for at-risk individuals be routine? And when George reaches mid-life, will tailored risk factor management strategies for dementia be as commonplace as blood pressure monitoring for cardiovascular risk is today? Watch Hilary’s fascinating talk to share in her many reasons for optimism for the youth of today.

‘‘Preventing Dementia: Advice and Advances’’ Your Questions Answered

The panel at the Preventing Dementia conference
The panel at the Preventing Dementia conference

On the 29th of November 2017, The Centre for Dementia Prevention hosted its annual winter conference ‘‘Preventing Dementia: Advice and Advances’’ at Edinburgh’s Playfair Library. We were delighted the conference was sold out and that so many joined us in discussing how we can all manage our risk of dementia. Our speakers received some great questions from the audience and many who attended expressed an interest in engaging with our research. As promised, here we have summarised some more of the main topics discussed on the night in a Q&A format.

A  summary of key points from the from the night can be found here

Video highlights of the evening’s presentations and panel discussions are also available here

I have a parent with dementia and I am worried about my own and my daughter’s dementia risk. How can we make sure we are first in line to try newly available drugs to prevent dementia?

There currently aren’t any known treatments which can prevent dementia. The Centre for Dementia Prevention and other research institutions are working very hard to find interventions that can prevent or reduce someone’s risk of dementia by exploring the contributing risk factors. Finding treatments for the prevention of dementia is highly dependent on people’s willingness to take part in research. Participating in research studies will therefore help researchers improve their understanding of dementia and will increase their chances of finding an effective treatment which may benefit you in the future.

You should, however, not expect to clinically benefit from participating in a drug trial. The very reason why drugs are tested, is because we do not yet know if they have the required effect.  Additionally, researchers want to know if there is a change in the disease pathway that would not have occurred if someone had received a different drug or treatment, or no drug at all. For this reason, a drug is always tested against another treatment or a placebo, a substance with no active or therapeutic effect. When participating in a drug trial, there is always a chance of receiving a non-active substance. You may, however, derive benefits from receiving clinical assessments and consultations above your standard clinical care.

If you wish to contribute to dementia research, we suggest you sign up to our research register by contacting us here. Entering onto the register means that we can keep you informed of research we carry out and contact you to ask you if you might be interested in volunteering for specific research studies.

Which drug treatments are currently available for Alzheimer’s Dementia?

Disease-modifying treatments, or treatments which can prevent the development of dementia, don’t currently exist. Researchers – including those in the Centre for Dementia Prevention in Edinburgh – are working very hard to gain a better understanding of how disease underlying dementia develops and are designing trials to test existing and new drugs. For further information see our recent article published here

There currently are a number of symptomatic treatments available for Alzheimer’s disease, which aim to reduce dementia symptoms. The most common symptomatic treatment is provided by a group of drugs called cholinesterase inhibitors. We now know that people with Alzheimer’s disease have lower levels of acetylcholine, a neurotransmitter in the brain that is thought to promote memory and learning. Cholinesterase inhibitors, such as Rivastigmine, Galantamine, and Donepezil – Donepezil is also known by its brand name Aricept – slow the breakdown of acetylcholine in the brain, thereby increasing levels of the neurotransmitter. Research from various randomised controlled trials shows that 6 months of treatment with one of these drugs can improve cognitive function in people with mild to moderate Alzheimer’s disease. A small number of these studies further demonstrate a positive effect on activities of daily living and behavioural outcomes and suggests the effects of cholinesterase inhibitors may be similar for those with severe Alzheimer’s disease.

How can we use technology to ensure timely diagnosis and treatment of dementia?

 Timely diagnosis of dementia is essential in ensuring effective treatment and care provision. In line with advances in research, healthcare services must equally evolve to keep pace – as outlined in the recent Edinburgh Consensus. Current cognitive assessments used by GPs and memory clinics may not be adequately sensitive to detect very early changes in more complex activities or tasks (e.g. financial transactions, use of appliances, etc.) which are undertaken outside of clinical settings. We would ideally want to test people frequently on sensitive and specific, home-based measures.

Ivan Koychev, lecturer at the University of Oxford’s Department of Psychiatry, hopes that this type of data can in the future be provided by our smart phones. Current generations are inseparable from their mobile devices, which could generate a large number of potentially useful data.  Our phones could, for example, track the average speed at which we send a message or use an application, or the locations which we attend on daily or weekly basis. It can then also detect if we behave in a way that is consistently and significantly different from one’s usual recorded behaviour (e.g. if we are slower at sending messages or fail to visit our usual locations). Cognitive assessments could additionally be administered via our mobile phones at frequent intervals, thereby providing a more reliable and stable image of one’s cognition.

I have heard contrasting reports on the number of people living with dementia. Have dementia rates really gone up or down?

Quantifying disease is not easy. There are a number of different things that we can measure to try to understand disease frequency, the most important measures being disease prevalence and disease incidence. Disease prevalence refers to the number of people with a certain disease at a given time and therefore indicates how widespread the disease is. This measure is important to understand the number of people who are going to need health and social care now and in the near future.  Disease incidence refers to the number of new cases of a disease over a specified time period. This measure can help us understand whether or not we are successfully minimising risk factors for dementia.

It has been widely reported that the number of people living with dementia has grown over the past decades and will continue to grow rapidly in the future. There are a number of reasons why dementia prevalence has increased. Firstly, the Baby Boom generation is ageing. The more elderly people there are, the higher the number of dementia cases. Secondly, people in the UK live longer as a result of better health profiles, improved living conditions, advanced care systems, etc. Since the risk of developing dementia is higher at an older age, more people will live on to develop dementia symptoms. Because more people will develop dementia, health and social care demands will increase.

Dementia incidence rate provides an alternative measure, as it indicates the number of new cases per population in a given time period. A large UK study recently identified a 20 per cent reduction in dementia incidence in the population above 65 years of age. This age-specific drop was largely observed in men, but a small reduction was also seen for women. This means that dementia incidence overall has stayed relatively stable. Although it is difficult to say what exactly explains this drop, the authors note that it may be linked to a change in dementia risk factors. The past decades have seen a reduction in cardiovascular disease, but also an increase in education; improved cognition is thought to be a neuroprotective (brain-protecting) factor.

In summary, while dementia is more widespread than it was two decades ago, research suggests the true number of new dementia cases has remained relatively stable overall. There has been a drop in new dementia cases in people over 65 years of age, largely seen in men.

New report summarises evidence-based approaches to dementia prevention, intervention and care

The Lancet Commissions
The Lancet Commissions

A new report from the Lancet Commission has summarised key points around dementia prevention, intervention and care. We are delighted Prof Karen Ritchie based at the Centre for Dementia Prevention was one of the co-authors of this paper.

While scientists have looked into possible treatments for dementia for decades, the prevention aspect of the disease has so far been less researched. We know that Alzheimer’s disease starts developing decades before dementia occurs – in effect, making dementia an illness of midlife that manifests in later life. It is therefore crucial to study a younger, midlife population in order to be able to identify these early risk factors that contribute towards eventual dementia. This is the aim of the UK wide PREVENT Dementia study and the European Prevention of Alzheimer’s Dementia (EPAD) project, both led from the Centre for Dementia Prevention.

The Lancet Commission results suggest that around 35% of dementia is attributable to a combination of the following nine risk factors: education to a maximum of age 11–12 years, mid-life high blood pressure, mid-life obesity, hearing loss, late-life depression, diabetes, physical inactivity, smoking, and social isolation. Interestingly, social isolation is thought to be a risk factor for dementia because it increases the risk of high blood pressure, coronary heart disease, and depression. The most beneficial diet to brain health is again suggested to be Mediterranean diet.

Possible treatments for dementia have not been developed and progress in research has not led to disease modifying drugs but to improvements in symptom management, treatment of associated pathology and protection of the person. The commission report concludes that we currently extend life expectancy and therefore, paradoxically, disease duration and dementia prevalence. On the assumption that dementia is neither treatable nor preventable care policy is currently largely based on a crisis-intervention model. The Lancet commission has extended the definition of care beyond crisis intervention to a life course approach, emphasising potential windows for early interventions such as starting prevention efforts in a normal healthy populations in their mid-life. Leading research in dementia prevention was covered in BBC Radio 4 (from 17 min 10 sec) and BBC news (from 19 min 50 sec) yesterday, focusing on the work Centre for Dementia Prevention does around identifying risk factors in mid-life.

There are multiple examples in the history of epidemiology of risk factor removal leading to significant decreases in disease incidence although the etiology remains unknown. The Lancet report drew on an earlier paper by one of the co-authors Karen Ritchie and colleagues where a potential 25% reduction of dementias was shown with elimination of cardiovascular risk factors and depression but only a 7% reduction with elimination of ApoE e4 gene. A significant finding in epidemiological evidence is the suggestion that risk factor elimination will be the most effective in mid-life.

Major collaboration will provide a better look inside the ageing brain

Tribeka logo
Tribeka logo

We are hugely excited to launch the TriBEKa consortium today at the Alzheimer’s Association International Conference in London. The Centre for Dementia Prevention is one of the three pillars that form the TriBEKa consortium – a collaboration between three world leading academic and research centres for dementia prevention.

The TriBEKa (Tri BarcelonaEdinburgh and Karolinska) Imaging Platform builds upon large scale projects led by the University of Edinburgh’s Centre for Dementia Prevention in the UK, the Barcelonaβeta Brain Research Center in Spain and Sweden’s Karolinska Institute. The imaging platform will be closely linked with the flagship studies in each centre: PREVENT Dementia (Edinburgh) ALFA study (Barcelona) and FINGER (Karolinska).

The TriBEKa consortium is set up to understand the specific brain changes that take place during the middle age of an individual’s life course – we know that it is during the middle age where the earliest phases of neurodegenerative diseases start. The consortium is delighted to have received £1.9m from the US based Alzheimer’s Association and an anonymous international charitable foundation. TriBEKa will generate an open access neuroimaging platform that will use novel techniques to identify the very early preclinical changes and pre-amyloid deposition in the Alzheimer’s disease continuum and other neurodegenerative conditions.

The TriBEKa platform is designed to deliver the largest and best characterised data for understanding neurodegenerative disease and related clinical models in mid-life that is ever assembled globally. The project will include data from more than 1000 participants. The TriBEKa imaging platform will involve younger, middle aged participants, and therefore bring empirical data and knowledge to an earlier stage of the life course. The large scale projects TriBEKa is aligned with already collect vast amounts of data from people in their mid-life so the collaboration will enable a deeper analysis and discovery of risk factors in mid-life.

The consortium aims to offer the academic and drug development community evidence upon which to base drug development and other interventions. These drug developments will benefit from new insights, biomarker discovery, patient stratification and novel clinical and neuropsychological outcome measures. The participants are followed longitudinally to incorporate any changes in outcomes into the modeling of how neurodegenerative diseases develop starting in the earliest stages.

TriBEKa will therefore be a facilitator for evidence based interventions for dementia prevention, with the ultimate purpose of playing a significant part in the advancement of neuroscience to secure prevention of dementia by 2025.

The TriBEKa press release can be found here.

Mapping out specific cognitive abilities in midlife might predict future dementia risk

Karen Ritchie
Prof Karen Ritchie

We are thrilled that the PREVENT Dementia study has reached a point where the study follow-up visits are on-going and preliminary results from the baseline assessments have just been published in Alzheimer’s & Dementia. The PREVENT Dementia study is looking to identify early indicators of dementia in middle aged people that may appear decades before any dementia symptoms occur. The authors analysed the cross-sectional data to begin mapping out cognitive profiles of adults who are at high risk of late-onset Alzheimer’s disease. We are delighted to explain these preliminary findings in more detail.

A recent review of innovation in the field of dementia identified prevention and risk reduction as one of the key themes in finding a solution to a growing global dementia problem. We know from existing research that the underlying pathology to Alzheimer’s dementia might start developing decades earlier when a person is outwardly healthy. Risk factors for the development of Alzheimer’s disease include diseases affecting heart and blood vessels and problems involving the breakdown and build-up of substances in the body. As people get exposed to these – cardiovascular and metabolic – risk factors particularly in midlife then this period is a critical window to prevent the disease progression.

Traditional memory tests not sensitive to very early cognitive changes

Alzheimer’s disease studies with people who are in the stage just before they develop dementia commonly use similar tests to assess memory performance. The lead author of the paper and the co-lead of the PREVENT Dementia study, Prof Karen Ritchie (pictured) from the Centre for Dementia Prevention, explained that looking at their study group, people in their midlife, then overall these traditional tests did not show an association between cognitive performance and later-life dementia risk. However, there was some evidence that the people at higher risk performed worse on tasks that measured specifically spatial awareness. These results from the first wave of the PREVENT data highlight the need to include tests that focus more on spatial and navigational tasks in future dementia prevention studies in order to accurately identify people at higher risk.

There is emerging evidence that the accumulation of certain proteins such as amyloid-beta precedes cognitive decline by decades. Prof Ritchie and colleagues argue that cognitive changes may not only appear at the same time but also interact with these biological changes. This is vital as cognitive functioning is a central clinical concern and something that is monitored closely in dementia studies. The nuance in detecting cognitive decline at such an early time point, decades before a person would be showing signs of dementia, comes from looking at an appropriate much more specific part of the brain. Many of the current studies, therefore, use brain scanning methods that are not sensitive enough to the truly subtle brain changes that occur so long before dementia onset.

Focusing on spatial awareness

In the current paper, the authors aimed to examine associations between cognitive performance at mid-life and various indicators of dementia risk. While these early findings cannot be used to explain the underlying causes between the associations, then the authors found that a higher dementia risk score was associated with a small number of specific tests which have a strong spatial component – such as linking a person’s photo with their name. It is also noteworthy that dementia risk factors change over time. Looking at genetics, while APOE ε4 allele is generally considered a higher risk factor for developing dementia then in the PREVENT study, participants with an APOE ε4 allele performed better on a specific visuospatial task matching geometric figures. The authors conclude that while APOE ε4 allele is associated with a number of poorer health outcomes in old age, it may have a positive effect earlier in life as it is associated with higher intelligence.

For the PREVENT study sample, a high cardiovascular risk score was found to be associated with poorer visual association learning as well as a decrease in both brain volume and smaller size of specific regions in the brain such as hippocampus which is associated with spatial navigation, spatial memory and the combining of spatial location with personal memories. It is an important finding that a high cardiovascular risk score impacts on a person’s dementia risk already in midlife – emphasising the critical role of cardiovascular health in longer-term outcomes.

First results in the context of longitudinal follow-up data still to come

The authors emphasise that the spatial and navigational tests that are highlighted in the paper as potential avenues for cognitive testing should, at this early stage, be used in dementia research and not to inform individual risk statuses. The current findings from the PREVENT Dementia study are preliminary as they are based on 210 people enrolled in the study so far – half of whom have a family history of dementia and half of whom do not. The study is on going and will aim to recruit 700 participants in order to follow an even larger number of people over time and get a more in depth understanding of dementia risk factors. Nevertheless, the findings of this paper serve as a vital contribution to the prevention and risk reduction work that is globally recognised as a key part of tackling dementia.

Ritchie K, Carrière I, Su L, O’Brien JT, Lovestone S, Wells K, Ritchie CW. (2017). The mid-life cognitive profiles of adults at high risk of late-onset Alzheimer’s disease: the PREVENT Study. Alzheimer’s and Dementia