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Understanding and Analysing Alzheimer’s: Can we unlock the brain?

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Memories, they say that’s all we’ll have in our elder years, but what if our memory begins to fail us? Memory problems are commonly linked with aging and are largely expected. However, misplacing our keys the odd time is nothing like misplacing core memories. Alzheimer’s disease consumes precious life moments, threatening older adults and seizing many. A progressive disease with no set cure, and a 60% chance of developing dementia (the decline of remembering, thinking and decision-making abilities) from it, the outlook after an Alzheimer’s diagnosis feels bleak. As though a sand timer has been flipped over and there is nothing to be done to catch the slipping grains containing thoughts, feelings and memories. 

In 2017, the World Health Assembly launched a Global action plan on public health response to dementia from 2017 to 2025. In 2020 Alzheimer’s Society forecast that:

“The numbers of people living with dementia worldwide is expected to double every 20 years. By 2050 it is projected there will be 115 million people with dementia worldwide, 71 per cent of whom will live in developing countries. There are over 6 million people with dementia in Europe.” 

71% of dementia patients will be in developing countries in the 2050 projection. South Asia is home to many developing countries and many of these countries still maintain a stigma toward Alzheimer’s and dementia. In some South Asian languages, there is no word for ‘dementia’ which can lead to mistrust and speculation as to what it is. Superstition and religion also come into play with finding reason as to why a person has developed the disease, often attributed to being condemned by God, or punished for past actions. In Punjabi for example, the word “pagal”, meaning “crazy” remains, reportedly commonly used when referring to those with dementia. Instead of being offered support and guidance when experiencing symptoms or getting diagnosed, a person is made to feel as though they are to blame for having the disease, which is entirely not the case.

In the World Alzheimer’s Report in 2019  63% of people in South East Asia, said their dementia symptoms were joked about by others. The significant lack of knowledge about and therefore empathy towards those living with dementia can lead to delayed diagnosis and potentially a lack of correct medical and emotional care. 

This stigma is not unique to South Asia. The World Alzheimer’s Report also reported that 35% of carers across the world have hidden the dementia diagnosis of a family member. Connected to this is the fear of dementia patients being ‘dangerous’. This most likely stems from dementia sufferers sometimes being unpredictable and changeable in mood and behaviour. At times those affected by dementia can become agitated and react as such, which is difficult for them, those caring for them and the person’s loved ones. 

Below is a bar chart showing the percentage of people who believed dementia patients are perceived as dangerous, country by country in 2019:

The outstanding result was Thailand, in South-East Asia, voting a huge 76.4% in agreement. This checks out with the World Alzheimer’s report finding that 45% of those in South-East Asia and 48% of healthcare practitioners feel that people with dementia are dangerous.

Considering the scale of dementia patients within the region of South Asia and the universal nature of Alzheimer’s disease, mass education on the condition could not be more vital at this time. Millions of patients around the globe will continue to increase every year, and the world needs to play catch up with its views on Alzheimer’s and dementia to have any hope of having an understanding as heightened as the case numbers.

Education and accurate awareness may be pending in terms of Alzheimer’s disease and dementia, but, thankfully, many studies, treatments and trials have been and continue to be developed despite this fact. 

China remains to be the largest developing country in eastern Asia and has also happened to have one of the highest numbers of dementia cases in recent years. In 2019 China’s National Medical Products Administration approved GV-971 (an experimental drug called sodium oligomannate) for treating mild to moderate Alzheimer’s disease. The medicine derives from brown algae, a natural source. In initial trials the medicine worked in the gut, regulating microbes there to reduce inflammation. Neuroinflammation can lead to Alzheimer’s, so reducing inflammation could reduce the risk of Alzheimer’s. GV-971 is now known to bind itself to amyloid-beta (the main component of amyloid plaques found in the brains of Alzheimer’s patients) and limits its deposition in the brain. 

Results of the phase-III trial of GV-971 found it had significantly improved cognitive function in patients. Following this, in 2020 the global trial was approved by approximately ten countries including Canada, Australia, France etc. This has been the latest update this year on the progress of GV-971, and the positive results are very encouraging as the trial is scheduled to be completed by 2025. Improving symptoms and potentially delaying the progression of Alzheimer’s disease, all from analysing brown algae, really is an unexpectedly remarkable breakthrough and could well be set to be the everyday treatment for Alzheimer’s patients in the next decade or two.  

Since amyloid-beta causes amyloid plaques to form in the brain, could clearing the amyloid-beta prevent Alzheimer’s altogether? That is exactly what the makers of the new drug aducanumab in Massachusetts are betting on. Approved by the US Food and Drug Administration (FDA) in June 2021, a lot of controversies have sounded over the green light being given to experimental medicine. Fears have been expressed about the safety and reasoning behind eradicating amyloid-beta from the brain. Aducanumab targets and removes amyloid-beta and therefore the risk of amyloid plaques, but as prevalent as amyloid plaques are in Alzheimer’s patients, it is still not known if they are the root cause of the disease. Some researchers have expressed uncertainty over the approval of this medicine and the hope invested in it. Many were concerned that the FDA has lapsed in its decision-making standards and people reading about the new drug believe bigger trials are needed. However, larger trials will be held and the FDA named aducanumab as the first treatment that affects the (believed) biological cause of the disease. A medicine aiming to stop Alzheimer’s altogether instead of treating symptoms is a huge development in the search for finding a cure. The FDA approved three other drugs (shown in early trials to clear plaques) for fast track reviews.  

On the fourth of April this year, researchers announced that they have found 42 new risk genes for Alzheimer’s. These genes had never been previously linked to the disease so this is a significant find. The study involved the UK and eight partner countries, the UK Dementia Research Institute leading the UK segment of the study. The genetic make-up of over 100,000 Alzheimer’s patients was compared with 600,000 healthy people and the unexpected risk genes were found along with the expected indication of amyloid proteins. We have entered a new stage of Alzheimer’s disease and Dementia treatment and prevention this year. From gaining knowledge of the warning signs that lead to amyloid plaques and through recognising risk genes for developing Alzheimer’s, healthy people with risk genes are now in a position to undergo experimental treatment for Alzheimer’s before they’ve even developed the disease. That seems to be the latest focus with medicinal trials, to not only attempt to treat symptoms and slow development of Alzheimer’s disease in patients but to also potentially remove all risk of the disease before it has even begun to form. 

Recent research breakthroughs have come about in Alzheimer’s diagnosis methods as well as treatments. Scientists based in Edinburgh have developed a pen that can provide an early diagnosis of Alzheimer’s. Being far more straightforward than the usual struggle of receiving an Alzheimer’s diagnosis, this pen could accelerate the speed at which Alzheimer’s can be recognised and diagnosed. After diagnosis, patients can receive the right kind of care, treatment and information on potential trials that could make a vital impact on their experience of the disease. Time is of the essence when it comes to Alzheimer’s disease, and although this pen cannot provide a cure for the disease or improve symptoms, the key to early treatment is early diagnosis. Such an advance in technology would have been truly unimaginable twenty years ago. 

The stubborn knot of Alzheimer’s has finally begun to loosen its grip on the world and could well be on the way to unravelling if our technology and research discoveries continue to develop at the speed they have over the last three years. 

References:

https://www.alzheimers.org.uk/about-us/policy-and-influencing/what-we-think/demography 





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