An accumulation of small lifestyle factors can make a big difference in quality of life for people with dementia. On World Alzheimer’s Day, Dr Anthony Martyr, from the University of Exeter, summarises the evidence on how you can best support friends or loved ones.

It is estimated that more than 850,000 people in the UK have dementia, a number set to increase to 2 million by 2051. This year alone, 225,000 people will develop dementia – that’s one every three minutes. It’s therefore critical that our research efforts don’t focus exclusively on finding a cure. Even if it could be identified now, any treatment would only be likely to benefit people currently in mid life.

Dementia is now the most feared condition in the UK, but it is possible to optimise quality of life and support people to live as well as possible. Many people don’t know how to react when they hear an acquaintance or loved one has dementia.  I hope my research helps give people confidence to try ways to support those with dementia, as well as informing policy.

As part of the University of Exeter-led IDEAL study, a large-scale approach to identifying which factors can support people to live as well as possible with dementia, I recently led a review of all the available evidence in the field. It involved the four year task of analysing 198 studies worldwide, encompassing information on nearly 38,000 people with dementia.

Amid this mound of data, one of the key factors that emerged as making a real difference was how socially active people were. Too often older people can be socially isolated, and we know this contributes to dementia risk. Maintaining social activity and being included and involved in social activities were both lined to better quality of life.

Family, friends and neighbours can all contribute here, and many organisations run excellent initiatives such as memory cafes and day centres to meet this need. One arm of the IDEAL study is the A Life More Ordinary project where, photographer Ian Beesley, cartoonist Tony Husband and poet Ian McMillan worked with people with dementia who were involved in Age UK Exeter’s Budding Friends allotment group. The group itself is an outstanding example of social interaction with real purpose, and the artists’ project saw them produce works that will be on display outside Mothercare in Exeter’s Guildhall Shopping Centre today.

People with dementia also valued being able to manage everyday activities. The GREAT Trial, which along with the IDEAL study is led by Professor Linda Clare at the University of Exeter, recently found that an approach called cognitive rehabilitation therapy can help people with early stage dementia significantly improve their ability to engage in important everyday activities and tasks.

It involves working together to establish personalised everyday goals, which could range from cooking food without burning it to successfully going to the shops or remembering neighbours’ names. Therapists worked with family carers and people with dementia to establish ways to meet the goals that suited people’s individual needs and abilities.

Good relationships with friends and family was another key element to higher quality of life. Interestingly, certain factors that can be seen as “life goals” had no bearing on differences in people’s quality of life – particularly education level, marital status and income.

We also identified factors that were linked to poorer quality of life. People with dementia who had poor mental or physical health, who had unmet needs, who experienced pain, or whose carer experienced low well-being were more likely to have poor quality of life. We also found that quality of care and support was important. For instance, where a person with dementia is supported by a family member, quality of life is better where the family member feels more positive and better able to cope. Professor Clive Ballard, at the University of Exeter, has led studies concluding that people with dementia in residential care, receiving specialist person-centred care, which involves the individual in their own care plan, is linked to better quality of life, when combined with just ten minutes a day of social interaction. The average amount of social interaction in care homes is as low as two minutes a day, so even a brief daily visit could increase a resident’s quality of life.

Unsurprisingly, our findings did not identify a “silver bullet” for supporting people to optimise their quality of life. As individual as we all are throughout our lives, so are our preferences on how we want to live in older age. However, our research did identify that a number of factors can combine in small ways to make a real difference to the extent to which people enjoy their lives. I hope this encourages people that making their own small difference can contribute to a real overall benefit.  This could be through engaging someone in conversation or an activity they enjoy like a jigsaw, perusing a photo album or some gentle gardening. The key factor is taking the time and care to ensure that it is individualised to what the person enjoys in life.

To find out more about dementia research at Exeter, visit http://www.exeter.ac.uk/dementia/ or follow #ExeterDementia on Twitter.

Dr Byron Creese chose to pursue a career in dementia research after studying Psychology at University. His work focuses on the often under-recognised neuropsychiatric symptoms, such as hallucinations, which can cause huge distress in Alzheimer’s disease and other dementias. Around two thirds of people with Alzheimer’s disease experience these kinds of symptoms.

Byron’s work focuses on neuropsychiatric symptoms as risk factors for dementia, and aims to identify links between the disease and our genes.

Can you give us an overview of the work you do?

When people think of Alzheimer’s disease or other dementias, most think of symptoms to do with memory, thinking, planning and reasoning. However, a significant number of people with dementia also experience symptoms like hallucinations, suspicious thoughts, agitation and depression.

Examples of these would be thinking that their food has been poisoned, or that their relatives aren’t who they say they are, seeing people, animals or objects, or being very tearful or agitated. We refer to these as neuropsychiatric symptoms, and they can be hugely distressing and have a major impact on a person’s quality of life.

A major challenge of these symptoms is that we don’t have many effective treatments. This is a particular problem in treating psychosis, where there isn’t much evidence for non-pharmacological (non-drug) interventions, and the drug treatments we have are only slightly effective. These drug treatments also cause numerous severe side effects, such as Parkinsonism (shaking and unsteadiness). They also increase the risk of falls, triple the risk of stroke, and double the risk of death.

To develop new treatments, we need to understand more about the biology of these symptoms, and how they present clinically. To do this we have gathered a very large database of Alzheimer’s disease cases which have accompanying genetic data.

How did you get into dementia research?

I studied Psychology to Masters level until 2006. After university, I took a break from Science and worked in Finance for a few years. During that time, my Nan developed Alzheimer’s disease, which I suppose brought a career in science and research back to my attention.

In 2009, I began a PhD with Professor Clive Ballard, which was focused on psychosis in Alzheimer’s disease. A lot of the work we did at that time involved building up a big cohort of DNA samples from people with Alzheimer’s disease who had experienced symptoms like psychosis, depression and agitation, as well as those who did not experience any of these symptoms.

The kind of genetic research we do requires a large sample size – many thousands of samples really – so no single group can do this on their own and we are still busy setting up new collaborations to get more data.

Could you explain your Genetics research in more detail?

The first thing to highlight is that this is a highly collaborative project.  We have data from many thousands of people with Alzheimer’s disease from largely from the UK and Norway but also from Italy, USA, Greece, Poland, Finland, France…I think that’s all!

We take DNA samples from people with Alzheimer’s disease who have particular symptoms we’re interested in – these neuropsychiatric symptoms. We look across the person’s genome – the genetic blueprint for who we are – for variation. Variation across the genome is what gives rise to differences like hair or eye colour. We already know that certain variations are associated with an increased risk of disease and we want to know if there are any which are associated with neuropsychiatric symptoms. This could give us a clue as to why some people develop these symptoms and some don’t.

If there are any, we can work out if they’re nearby a gene. If that gene is of interest, we can do more work to investigate that, which could give us new research avenues.

We also use genes to look at shared genetic risk factors between disorders and conditions across the lifespan.

For example, in younger adults, you can have a condition like schizophrenia which is associated with psychosis, and then we see psychosis in older adults, and in dementia. One question we’re trying to answer is: is there any biological similarity between those symptoms? Are these symptoms caused by common mechanisms? What we discover about connections between Alzheimer’s disease and other conditions will also raise the possibility of developing new treatment options for people with Alzheimer’s disease and psychosis.

Are there any other projects you’re excited to be working on?

I’m currently involved in the PROTECT study – there we have a group of 25,000 cognitively healthy adults aged 50 and over. They’re assessed for these types of symptoms – depression, hallucinations, and we’re also conducting work to evaluate the significance of those symptoms in the development of later cognitive problems. The types of questions we’re asking are hallucinations in a cognitively healthy population associated with any sorts of memory impairments? And will that be useful in helping us predict who’s going to develop dementia? We can then integrate that info with genetics as well, to see if that can enhance the predictive value of genetics. This can helps us to predict more accurately who will develop symptoms, and at what point we can intervene. Examples of interventions could be social interventions, personalised care, or keeping people healthy for longer.

How do you feel dementia research is progressing?

There’s an increasing focus on neuropsychiatric symptoms in dementia. Soon we should have some new consensus criteria for psychosis in Alzheimer’s disease which will help establish a commonly accepted definition of what psychotic symptoms in the disease look like. Prof Ballard and I will be working on this as part of a group led by colleagues in Canada and the USA.

We’re seeing new treatments in the drug development pipeline, but I think there is an urgent need to develop treatments targeting novel disease mechanisms. What that means it that most drugs in development at the moment are ones that target biology of the disease that we already know about.  There are also a number of drugs in development for agitation and psychosis in AD which have shown efficacy in schizophrenia which brings those trans-diagnostic links I mentioned earlier into focus.

Non-drug treatments are also emerging, so things like exercise and social interaction. That’s definitely a good thing, as the side effects of commonly used anti-psychotics are quite severe.

Hopefully we’re getting to a position now where we can start to answer some questions about diseases mechanisms. Collaboration really is the key here and luckily we’ve found a lot of researchers willing to team up on this.

Next year we’ll have been gathering DNA samples from people with Alzheimer’s disease for 10 years – the collection we have now is one of the largest in the world. We’re on target hopefully in the next couple of years to get up to 10,000 samples which should allow us to take some big steps forward in this field. It’s quite unusual to have such a high number of samples with high quality clinical data, so we’re very lucky in that respect.

Follow Byron on Twitter @byron_creese to keep up to date. To read more about dementia research at Exeter, please visit our website, or follow #ExeterDementia.

Dr David Llewellyn is a Senior Research Fellow in Clinical Epidemiology

Artificial Intelligence (AI) – human intelligence exhibited by machines – in healthcare is developing rapidly, with many applications currently in use or in development in the UK and worldwide.

We speak to Dr David Llewellyn, a Senior Research Fellow in Clinical Epidemiology at the University of Exeter Medical School, about the impact of AI on dementia diagnosis. David’s research focuses on how data science and AI can improve the way in which we conceptualise neurocognitive disorders in order to improve diagnosis, treatment and prevention.

How do you define AI as it relates to healthcare and what are some of the biggest transformations that it will bring to the field?
In its broadest sense, artificial intelligence is the creation of generalisable intelligence. At the moment the majority of progress is being made with machine learning, where we’re teaching machines to learn patterns in real clinical data. We’re taking techniques that have been developed for a wide range of purposes, for example, self-driving cars and search engines, and applying this to real clinical data. This gives us a massive advantage in that we’re able to handle a much richer range of data than we were able to do so before with traditional statistical methods. We’re developing pieces of software which can be used by clinicians or patients to improve healthcare efficiency, patient safety, and patient outcomes.

How close are we to a world where AI are used to diagnose and treat patients?
I think that AI is already used to diagnose and treat patients but in limited ways. For example, before patients come and see their GP, they’re increasingly using the internet. They’re using AI through search engines to work out what their symptoms might mean. Doctors are also increasingly using various forms of AI and we’re seeing the growth in decision-making aid. It’s very much that the doctor is still in control, but they’re getting more targeted information about individual patients.

Do you foresee a future where AI technologies can operate autonomously in healthcare?
We’re much further away from systems that can actually make decisions autonomously without the doctor and without any clinical oversight. If we think about autonomous cars as an analogy, we’ve got cruise control. Similarly with AI in healthcare, we’ve got aids to decision-making. What we don’t have are ‘robot doctors’ that can diagnose and treat patients without any human oversight. I think that will come, but we’re a long way from that.

The biggest question at the moment is how we are going to regulate that process. If it’s an aid for doctors but the doctor is still in control, then you can regulate it as a medical device. But if it’s autonomous, then actually what it’s doing is practicing medicine, not supporting a doctor who practices medicine. Medical societies regulate people who practice medicine but who exactly is going to regulate machines that have the capacity to practice medicine? I don’t think we’re anywhere near to reaching a solution for that and there is certainly no way which we can effectively regulate that at the moment.

Are there any common misconceptions or general misunderstandings about AI that you believe could use some clarity?
When we think about how AI can influence medicine, there’s often the misconception that it’s going to deskill the workforce and put people out of a job. However, when you bear in mind the immense pressures that the NHS is under, I think AI technologies in healthcare should be seen as a massive opportunity to improve patient outcomes and to make the jobs themselves better for clinicians. Particularly things that are routine – they can be taken away from a clinician’s job. It will become less about whether AI will replace clinicians, but more about how clinicians will use the technology to enhance their own abilities. That’s a tremendous opportunity if you can empower clinicians to think in that way. It will allow them to focus on the human side of medicine, which for most medical professionals is the most interesting bit!

DECODE dementia enables GPs to identify patients with dementia more effectively

Identifying people with dementia is clinically challenging given the non-specific pattern of symptoms associated with it. You’ve recently developed a computerised decision support system called DECODE to help address this. Can you tell us more about it?
It’s a very difficult clinical challenge assessing patients who you may not know well and who are concerned about their memory and thinking, and trying to work out whether they are just ageing normally as no two cases of dementia are exactly alike. If you’re a non-specialist, you may not have seen a patient with a particular combination of signs and symptoms before. So one of the advantages of DECODE, a machine learning-driven system, is that it can learn to recognise patterns in hundreds, thousands, potentially millions of dementia cases and work out what needs to happen clinically to benefit that patient. So it’s the idea it doesn’t get tired or distracted and it’s very consistent. It’s not a completely objective system though, as it captures the human expert decision-making that we used to train it in the first place.

To find out more about the DECODE project, follow David (@DrDJLlewellyn) on Twitter. To read more about dementia research at Exeter, please visit our website, or follow #ExeterDementia.

Hello and thank you for visiting our new Exeter dementia blog!

We will be using this blog space to keep you in touch with all the latest dementia research happening at the University of Exeter Medical School.

Over the next couple of months we’ll be inviting our dementia researchers to contribute to our blog – watch this space for an exciting insight into the work we do on dementia!