Research Update: The Challenges of Treating Dementia

With 46.8 million people currently living with dementia and the world’s aging population, there is an urgent need for a treatment to prevent or cure dementia. However, finding a cure for neurodegenerative diseases is very challenging, because these illnesses are hard to diagnose due to the gradual and slow progression of symptoms, as well as the fact that dementia is a complex health problem that can stem from over 50 underlying causes.

Today, most research about potential drug treatments target Alzheimer’s disease, which is the most common form of dementia, accounting for 60 – 70% of all cases. In spite of the high prevalence of Alzheimer’s, we still don’t know enough about the disease’s underlying biology to develop a successful treatment. For instance, it is unknown why the progression of the disease varies between people, or what regulates the toxic build-up of beta-amyloid plaques and tau tangles responsible for Alzheimer’s in the brain. Moreover, patients may have Alzheimer’s disease in addition to other forms of dementia too. Secondly, the blood-brain barrier prevents drugs from reaching the brain through the bloodstream.

Due to these obstacles, some research and clinical trials involving potential dementia drugs have had disappointing results and thus, several companies have stepped away from dementia research. Most recently, pharmaceutical giant Pfizer announced at the beginning of January that it will stop Alzheimer’s research, after costly failed attempts to develop a drug treatment over the past decade.

Nevertheless, there seems to be steps in the right direction for dementia research, as other pharmaceutical companies have continued to test new drugs with modest but promising results. New treatments are targeting the underlying biology of dementia to slow or reverse the disease progression itself. One such approach is called immunotherapy, where antibodies are created to bind to abnormal proteins in the brain – such as the beta-amyloid plaques or tau tangles. These antibodies then expose these abnormal proteins for the body to destroy them.

Non-drug therapies are also being actively investigated – including exercise, focused ultrasound, electrical and magnetic brain stimulation techniques, and cognitive remediation. These techniques, with and without drug therapy, may eventually be shown to be effective at significantly delaying the onset of the disease. Although these may not be “cures”, delaying the onset of Alzheimer’s disease by 5 years can lower the prevalence of the illness by almost 50%.

While it is no easy task to develop a cure for dementia, all dementia research and clinical trials will contribute to our current knowledge of the disease, allowing scientists to create and test new drugs. With perseverance and continued investment in research, we can restore some of what dementia takes away.  

For more information on the challenges and current progress of dementia research, visit https://www.cnn.com/2018/01/18/health/dementia-alzheimers-drug-treatment-partner/index.html

Ask the Expert: Do patients with dementia who live with their family members have better outcomes, compared to those who live alone?

This is a really good question, but allow me to broaden the question a bit.

First of all, does living with a spouse or family prevent dementia? The answer is yes - married adults (and likely those living with family) have a reduced risk of developing dementia. Unfortunately, this protection disappears for widows and widowers who actually have a higher risk of dementia. Although the exact reasons for these relationships are unknown, it is likely that marriage and living with someone enriches their environment and increases social interactions and conversation which are mentally stimulating activities, and known to reduce the risk of dementia. On the other hand, grief and bereavement are stressors that are known to have negative effects on health, especially immune function, and therefore may contribute to an increased risk of developing dementia.

Once someone develops dementia, their ability to perform everyday activities inevitably becomes affected. By the time someone has moderately severe dementia, it is impossible for them to live on their own because they will require help with things like food preparation, shopping, grooming and personal hygiene. So, to answer the question, living with a family will definitely allow them to live longer in their own home, as they require more and more help with activities of daily living. This will significantly increase the time before considering moving to an institution like a nursing home is necessary. Living with family also contributes to a richer environment and more mental stimulation, and this may slow the deterioration of the disease.

Professor Nathan Herrmann

Nathan Herrmann MD FRCPC

Professor, Faculty of Medicine, University of Toronto

Lewar Chair in Geriatric Psychiatry

Head, Division of Geriatric Psychiatry

Sunnybrook Health Sciences Centre

Research Update: Post-Traumatic Stress Disorder and Dementia

In the January 2018 issue of the Alzheimer’s Association Journal, an article discussed the relationship between Post-traumatic stress disorder (PTSD) and the risk of dementia. The study was conducted in affiliation with the Kaiser Permanente Division of Research in Oakland, California, the Department of Epidemiology and Biostatistics from the University of California, and the Institute for Health & Aging from the University of California. The study examined many potential direct and indirect links between PTSD and dementia outlined below.

Post-traumatic stress disorder or PTSD is a mental health condition that is caused by experiencing or witnessing an extremely traumatic event such as a car crash. People with the condition often suffer from symptoms such as anxiety, flashbacks, shame, and fear.

In American male and female civilians, it was found that PTSD greatly raised the risk for dementia. Older individuals with PTSD were more prone to dementia, whereas younger individuals with PTSD had a lower risk. It was also found that those with PTSD and depression were at even higher risks for developing dementia. These conclusions were drawn from collecting years of data from individuals across the Northern California region.

In American veterans and prisoners of war with PTSD, the risk for developing dementia is also higher. However, the risk was found to be higher in men than women. Although, there are few studies examining the relationship specifically between veterans with PTSD and dementia, thus more research is needed to further investigate.

There are many potential reasons for PTSD causing a higher risk of dementia. One may be due to the stress that PTSD causes. Studies also found that PTSD can decrease gray matter in areas of the brain that are responsible for memory. There may also be a link between PTSD causing a higher risk for illnesses such as stroke, cardiovascular disease, and diabetes, which in turn translate to a higher dementia risk.

This study is very unique as it is the first to investigate the link between PTSD and dementia, and to provide evidence that PTSD does in fact increase the risk of dementia. For more information, visit http://www.alzheimersanddementia.com/article/S1552-5260(17)30221-2/fulltext#ack0010.