Professor Clive Ballard, Executive Dean of the University of Exeter Medical School and internationally-renowned dementia researcher, updates on the latest from the Alzheimer’s Association International Conference
It’s an incredibly exciting time in dementia research. I’m part of a team from the University of Exeter who have just returned from the Alzheimer’s Association International Conference in Chicago– one of the largest showcases of worldwide dementia research. It’s where the cutting-edge of dementia research is shared, often for the first time. It’s really on the front line of discovery. We presented our own research in a range of areas around improving prevention, treatment and care in dementia, and we spoke to the research teams behind the latest innovations. I’m feeling inspired and optimistic about a number of promising developments.
Hope in Alzheimer’s therapeutics
There’s an urgent need for more and better research in dementia, a disease which affects 40 million people worldwide. Our own research highlighted that there are only 29 clinical trials with the potential to modify Alzheimer’s disease that have passed the first phase of testing – compared to more than 1,000 in cancer, for example. We’ve seen a number of high-profile failures in dementia clinical trials, and we urgently need more and better-designed trials to make an impact.
We finally got the positive news we’ve been craving at the conference. A compound called BAN2401 is showing real promise in treating Alzheimer’s disease. In a trial of 800 people, it reduced levels of amyloid – a protein linked to dementia – by more than 90 per cent. The trial was conducted in people who already had some amyloid build-up in the brain. Particularly excitingly, more than 80 per cent of them saw levels reduce to normal over the 18 month trial, and the rate of cognitive decline was reduced by 50 per cent.
It’s early days yet, but these figures are stunning – the most promising results we’ve ever seen in a clinical trial at this stage. We need a larger trial, which will take at least three years, to see if the results are confirmed. If so it will be a really significant breakthrough.
Reduction of “chemical cosh” prescribing
Our research revealed that people with dementia are being harmed by medication designed to ease their symptoms. An opioid-based painkiller called buprenorphine and a class of sleeping pill called Z-drugs both increase harms such as falls in people with dementia, and in turn falls lead to a significant rise in death rates.
It makes sense – these drugs have a sedative effect. We have to stop sedating elderly, frail people with dementia and look for non-drug options to help them more effectively.
Our research uncovered the harms caused by antipsychotics to people with dementia. It provided the evidence base to persuade everyone involved in dementia research and care to make a concerted effort to find alternatives, which led to a 50 per cent reduction in prescribing. We now need this approach with other medications – and to ensure that the alternatives we use are not harmful in themselves.
Personalising care improves lives
Care homes are really challenging environments, both for people with dementia and for carers. Our previous research has shown that the average person with dementia experiences just two minutes of social interaction each day. Imagine that! It’s no wonder that levels of agitation and apathy are very high. Residents have complex needs and staff need training in techniques that really work. Incredibly, only three of 170 care home staff training programmes are evidence-based, and none of those improved quality of life.
Our WHELD staff training programme incorporates ten minutes of social interaction each day and a programme of personalised care, designed around the needs and interests of the individual resident. It brings people with dementia and their carers together, resulting in improved wellbeing and more positive staff attitudes to care. We found these outcomes when the programme is delivered as e-learning, supported by Skype. It’s now time this rolls out to care homes to improve people’s lives.
Take action to prevent dementia
Our previous research has found that dementia risk could be reduced by a third, if people took action from mid-life onwards. Factors including diet, exercise, education, social interaction and effectively managing health issues such as hearing loss and depression all play a role in dementia risk. There’s an increasing body of evidence around links to blood pressure and dementia risk. Previously this has focussed around high blood pressure, but research at the conference has found compelling evidence that orthostatic hypotension – or unusually high drops in blood pressure – is also linked to increased dementia risk. We need to understand this better, but it does add further weight to the advice to look after your heart to protect your brain.
The conference included interesting updates on the benefits of sleep – a deep night’s sleep means the amyloid levels in the body are lower the next morning. We also saw some interesting research on food products such as green tea, ginseng and omega 3 fatty acids, and on curcumin, contained in turmeric, and how they activate different parts of the brain that are implicated in dementia. We’ll be putting these to the test in our online PROMOTE platform, which has 25,000 people aged 50 or over signed up. Watch this space to find out what really works!
Keep updated on our dementia research by following #ExeterDementia on Twitter or visiting: http://www.exeter.ac.uk/dementia/