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Alzheimer’s in the news
fear and fascination
A Behind the Headlines special report www.nhs.uk/news
Contents
Introduction 1
The impact of Alzheimer’s 2
Alzheimer’s in the media 3
Causes and risk factors 4
Genes 5
Lifestyle 5
Other factors 7
Prevention 7
RCTS of dementia prevention 9
Tests and diagnosis 10
Memory tests 10
Brain scans 11
Blood tests 12
Potential treatments 12
Randomised controlled trials of treatments 13
Other RCTs of dementia treatments 14
Tomorrow’s headlines 14
Gene research 14
Early diagnosis and detection 15
New drugs 16
A vaccine against Alzheimer’s? 17
Find out more about dementia and Alzheimer’s 17
Version 1.0 2011
Introduction
Alzheimer’s disease is a modern medical bogeyman,
feared by many and never far from the headlines.
If there is one health worry that seems to eclipse
all others as people get older, it is falling prey to
Alzheimer’s or some other form of dementia.
Research shows how deep this fear runs. A 2011
survey found that 31% of people feared dementia
more than death or cancer. The study, by Alzheimer’s
Research UK, also found that fear of dementia didn’t
Alzheimer’s in the news
just affect older people.
Over half (52%) of UK adults aged 30 to 50 were
afraid their parents would develop dementia,
compared to 42% who feared they would get cancer
and 33% a heart attack. 1
This anxiety both fuels and is fed by a constant
stream of stories in the press, charting the latest
developments in understanding, treating or
preventing the condition.
for themselves the value of future news reports.
Since 2007, Behind the Headlines has covered over a Finally, we asked leading experts to predict
hundred news stories on dementia, about two-thirds what will be making headlines in the months and
of which were related to Alzheimer’s disease years to come.
in some way.
This report discusses the media coverage of research
This report looks at how the mainstream media into dementia and Alzheimer’s disease, examining
has reported Alzheimer’s disease over the last four some of the individual studies that have been
years, and assesses which of the many headlines reported, and the accuracy of those reports. This
were justified and which were wide of the mark. It article is not a definitive guide to the disease or
identifies key themes and common problems in the treatment. People wanting more information should
news reports and, hopefully, will help readers judge visit the NHS Choices Health A-Z page on Dementia.
The impact of is predicted to rise to just over cost to the UK is £20 billion a
940,000 by 2021 and to year. In 2008, health think tank
Alzheimer’s 1.7 million by 2051. The King’s Fund predicted that
the cost of dementia in England
In the UK, it’s estimated that over However, these figures include
alone would rise to £34.8 billion
750,000 people have some only those people with dementia,
by 2026.
form of dementia, most of while the burden of coping with
them over 65. Of these, nearly the condition is shouldered by a You can find out more about
two-thirds – around 465,000 – much larger group. Alzheimer’s disease and its
have Alzheimer’s. symptoms, diagnosis and
As Simon Lovestone, professor
treatment on the NHS Choices
The risk of dementia rises of old age psychiatry at
website.
dramatically in old age. Currently, King’s College London, says:
dementia affects about 10 in “Alzheimer’s disease is a terrible
1,000 people aged 65 to 69, about problem, both for people who What is dementia?
40 in 1,000 people aged 70 to 79, suffer the condition and their Dementia is not a disease in
and about 170 in 1,000 people families, who are the main carers. itself, but is the term used
aged 80 and above. Sufferers of the disease lose a to describe a collection of
little bit about what it is to be symptoms that follow a loss or
As our population ages rapidly,
Alzheimer’s in the news
themselves, while many families decline in someone’s mental
the number of people with (cognitive) ability, caused
say it is a living bereavement.”
Alzheimer’s and other forms of by the death or poor
dementia is set to grow apace. Dementia also has a huge functioning of brain cells.
In the UK, the number of people financial impact. The Alzheimer’s Types of dementia include
with some form of dementia Society estimates that the current Alzheimer’s disease and 2
vascular dementia and other
The mental decline seen “reduced comprehension rarer types such as dementia
with age has been described and memory, as well as with Lewy bodies, and fronto-
throughout history, but it aphasia [language problems], temporal dementia.
wasn’t until 1906 that Dr Alois disorientation, unpredictable
Alzheimer identified the first behaviour, paranoia, auditory What is Alzheimer’s?
published case of the disease. hallucinations, and pronounced Alzheimer’s disease is the most
psychosocial impairment”. common type of dementia,
Dr Alzheimer was working at a accounting for nearly two
Dr Alzheimer continued to
mental asylum in Frankfurt in thirds of cases. Alzheimer’s
follow Deter’s case until she
1901, when he met a 51-year- is a physical disease of the
died five years later in 1906,
old patient called Auguste brain, resulting in the death
at which time he asked to
Deter. Deter had many of the of brain cells. Alzheimer’s is
study her records and brain.
symptoms we now associate at the moment incurable and
His examinations revealed for
with Alzheimer’s, including progressive. This means
the first time the clumps of
proteins, known as plaques and that over time, more parts of
tangles, in the brain that are a the brain become damaged
characteristic of the disease. and the symptoms become
more severe.
Dr Alzheimer’s case notes for
Deter were found in 1995,
almost 90 years after her death,
and the researchers who found
them concluded that they
fulfilled the same criteria for
diagnosing Alzheimer’s
Dr Alois Alzheimer was the first to
document the disease as we use today.
Table 1: Dementia reports as a proportion of all health stories
covered by Behind the Headlines.
Ronald Reagan lived with Alzheimer’s
Alzheimer’s in the media
Given this alarming picture and
a growing number of high-
profile people with Alzheimer’s Table 1 shows what proportion of stories covered by Behind the Headlines
from each news source were about dementia and Alzheimer’s, from July 4
– including author Terry Pratchett 2007 to July 19 2011.
and the late former US president
Alzheimer’s in the news
Ronald Reagan – it’s not surprising
Table 1 shows what percentage • Tests and diagnosis
that dementia is big news.
of stories covered by Behind • Potential new treatments
A large amount of media the Headlines from each news
coverage is devoted to new The chart shows how stories are
source were about dementia
developments in our scientific divided among these categories. 3
and Alzheimer’s. For almost all
understanding of Alzheimer’s – The stories are categorised
newspapers, this accounts for
what may cause it, what we can according to the focus of the news
at least one in every 20 stories
do to avoid it, new tests to spot reporting, and some fall into more
covered – a significant proportion
early signs of the disease and than one category. The articles in
of their health news output.
potential new treatments. the ‘other’ category include those
Some simple analysis of these on dementia care in hospitals,
However, as with all health stories over the past four years updates to NICE guidelines and
science reporting, not everything provides an insight into the way research investigating the biology
you read in the papers is the media reports on dementia and anatomy of Alzheimer’s.
accurate or reliable. and Alzheimer’s.
This analysis suggests that
This is where Behind the Almost all the dementia stories we newspapers focus mainly on ways
Headlines steps in, checking have covered fall into one of the of preventing dementia, such as
the evidence behind the news following categories: lifestyle choices.
reports and providing a no- • Causes and risk factors
nonsense appraisal of each story’s • Prevention
significance.
Since 2007, we have published Chart showing
appraisals of more than 2,000 the proportion
studies and over 100 of these of each type of
have focused on dementia and dementia story
Alzheimer’s. These same studies covered in the
have been reported in around 300 press
news stories in mainstream daily
newspapers and even more widely
Chart 1 Dementia stories by
across the internet. category
Word cloud showing the most commonly used terms in news headlines on dementia and Alzheimer’s disease
Alzheimer’s in the news
The word cloud, showing which of a body of different types of tend to use this approach. For
terms are most commonly used evidence. Therefore, if a news non-genetic risk factors, this
in media headlines, illustrates story announces that the causes type of study may not be able
how newspapers present this of such diseases have been to ensure that the participants
information, with ‘risk’, ‘drug’, ‘cracked’ based on one piece of remember their past exposures 4
‘test’, ‘help’ and ‘prevent’ all new research, it is generally accurately, or that exposure
prominent. Emotive words such overstating the facts. to risk factors occurred before
as ‘breakthrough’, ‘hope’ and Alzheimer’s developed.
Studies that investigate risk
‘warning’ are also common, but
factors would ideally assess a If one study finds a link between
the appearance of ‘early’ among
large group of people without an exposure and an outcome such
the most popular headline words
Alzheimer’s to see which of them as Alzheimer’s disease, this needs
may reflect the uncertainty
had been exposed to a possible to be confirmed by findings from
over the impact of many of the
risk factor. It would then follow similar studies and other types
findings being presented.
them up over time to see who of evidence before we can say
The following sections of this develops the disease and if that the exposure is likely to have
report look at each of the the risk of getting Alzheimer’s caused the outcome.
key categories listed above, differs in people with different
Sometimes, newspapers report
highlighting what we do and exposures. This is known as a
new risks for Alzheimer’s based
don’t know and illustrating some prospective cohort study. With
only on animal or laboratory
of the problems that arise in the Alzheimer’s disease, it may be
studies. Without confirming the
media’s reporting of this complex necessary to follow people for
results of these studies in people,
area of medicine. a long time, which makes such
it is not possible to conclude
studies expensive.
that the factors they identified
Causes and risk Alternatively, studies may definitely increase the risk of
factors compare people with and without Alzheimer’s. For example, in
Alzheimer’s disease to see how 2007, many newspapers reported
Finding out what causes complex exposure to a possible risk factor that getting cold sores increases
diseases such as Alzheimer’s in the past differs between the Alzheimer’s risk.
takes a lot of research. It usually two groups. This is known as a
requires the gradual build-up case-control study. Genetic studies While this may be an interesting
theory, it was based on a study variants linked with late-onset
in mice that were given the Alzheimer’s to 10. The latest
herpes simplex virus, which causes genetic links were identified in
cold sores. It found that large two studies, known as genome-
quantities of amyloid protein wide association studies, which
built up in the mice’s brains, which looked for differences in the
is similar to what happens in the genetic profile of people with
brains of people with Alzheimer’s. Alzheimer’s disease compared to
However, as yet there isn’t people without the condition.
any convincing evidence that the The findings were major news,
cold sore virus causes Alzheimer’s and the researchers reported that
in humans. together these 10 variants appear
to count for much of the genetic
The media has covered numerous
risk of Alzheimer’s. At the time,
studies into both known and Vegetable oils are a source of omega-6
one of the researchers involved in
suspected risk factors. What
this discovery told the BBC: “If the
follows is a selection of the stories early-stage research that need
effects of all 10 [variants] could be
that we have responded to over more study.
eliminated the risk of developing
the past four years.
Alzheimer’s in the news
the disease could be cut by 60%.” Other studies have had results
that, on their own, may not
Genes Generally, this research received
present particularly strong
high-profile coverage, and the
evidence, but which confirm what
While studies such as the cold media gave helpful explanations
has been found in other research.
sore study above need much of what is very complex science.
This adds to the evidence for 5
more research to establish their However, the newspapers could
dementia risks, and increases our
importance, others have been have emphasised the fact that
knowledge of how modifiable
more robust. Advances in our a practical application for these
lifestyle factors, such as smoking,
understanding of the genetic findings is likely to be at least 10
obesity and excessive alcohol
factors that contribute to to 15 years away.
consumption, affect our risk.
Alzheimer’s disease have grabbed
the headlines recently. Lifestyle Smoking
In April 2011, many newspapers The media regularly reports
In October 2010, The Independent
reported that five new genetic that certain behaviour might
reported that a large study of
variants associated with the increase the risk of dementia.
21,000 middle-aged men found
disease had been identified. Potentially modifiable ‘lifestyle’
that those who smoked more
This brought the number of risks reported in the news stories
than two packs of cigarettes a day
that we assessed include: heavy
were more than twice as likely
smoking, passive smoking, having
to develop Alzheimer’s as people
a pot belly in middle age, being
who had never smoked. We found
obese, having an ‘apple’ body
that while the study had some
shape, high body fat, obesity in
strengths, it also had limitations
mid-life, omega-6 fatty acids,
and ideally its findings should
binge drinking, alcohol abuse and
be confirmed in other studies.
working long hours.
The National Institute for Health
Not all the research covered and Clinical Excellence (NICE) lists
by Behind the Headlines is as smoking as a risk factor for both
significant as the genetics studies. Alzheimer’s disease and another
Some studies, such as those that type of dementia called vascular
Claims for human health based on animal looked at omega-6 fatty acids and dementia (where problems with
research should be treated with caution
long working hours, were blood circulation mean that
Alcohol However, as we reported at the
time: “This does not necessarily
In November 2008, the Daily mean that depression causes
Mail warned: “Binge drinkers dementia and the reason for the
are putting themselves at risk of association between the two
Alzheimer’s in later life.” It said conditions is still unclear.
there could be an “epidemic” It is unknown if depression is
in the number of people with a risk factor for dementia,
alcohol-related dementia in the whether it is an early sign of
near future. cognitive decline or if certain
We said that the news story changes in the brain are
NICE advises that smoking can increase the largely reflected the editorial in associated with both conditions.”
risk of developing Alzheimer’s
the British Journal of Psychiatry on Two years earlier, The Daily
parts of the brain do not receive Telegraph covered a study
enough blood and oxygen). that tried to shed some light
on the relationship between
Obesity depression and Alzheimer’s. This
research followed more than
Alzheimer’s in the news
Obesity is another factor that is 900 members of the Catholic
thought to potentially increase clergy for up to 13 years. It
the risk of Alzheimer’s. The Daily found that, although people
Express reported in May 2008 that who developed Alzheimer’s had
a review of studies supported more symptoms of depression
6
a possible link between obesity when the study began, these
and Alzheimer’s risk. It also found symptoms did not increase in the
an increased risk of dementia in Binge drinking may increase your risk time leading up to the onset of
people who were underweight. Alzheimer’s symptoms, nor after
the symptoms developed. The
which it was based. This editorial researchers took this to mean
stated that alcohol-related that depression is not an early
dementia is under-recognised sign of the same processes that
and may account for up to 10% cause dementia. If it was, the
of all dementia cases – around symptoms of depression might
70,000 people in the UK. However, be expected to get worse as the
the editorial was about alcohol- Alzheimer’s symptoms progressed.
related dementia, which is not the The researchers suggested that
same as Alzheimer’s, as the Mail depressive symptoms may be a risk
and Daily Mirror both suggested. factor for Alzheimer’s.
Depression We didn’t completely agree with
this conclusion, however, as the
Since 2007, several news stories
study had several limitations
have reported the link between
that clouded the relationship.
depression and Alzheimer’s.
We advised that, until further
Obesity may increase risk of Alzheimer’s research provided a clearer
A 17-year study, covered by the
BBC in July 2010, confirmed that picture, people with depression
We concluded that further the two are linked when it found should not be overly concerned
research was needed to clearly elderly people with depression about being at greater risk of
establish a link between weight had almost double the risk of developing dementia.
and dementia. developing dementia later in life.
There is an established link developed dementia in sample of studies, and most of
between depression and the study was low (268 women the evidence it presented was
dementia, but the relationship out of 3,000). based on studies in animals and
is complex. Depression may be a cells. None of the studies directly
risk factor for dementia. However, Environmental factors assessed whether water from
not only do the symptoms of copper pipes contributes to
It has been suggested that
depression resemble those of Alzheimer’s disease.
several environmental factors
dementia, but the two conditions
may contribute to the risk of
can also occur at the same
Alzheimer’s. However, none
time. While depression could
of these has been conclusively
be an early sign of the brain
proven to have an effect. For
changes that eventually lead to
example, in the past, scientists
Alzheimer’s, some studies, such as
noticed that some people
the one described above, suggest The review we covered mainly presented
with Alzheimer’s disease had studies on copper in animals
that this may not be the case.
aluminium in the clumps of
In its guideline on dementia, NICE proteins – called plaques and Pesticides
notes that no prospective studies tangles – in their brains when
Meanwhile, a study in December
have examined whether reducing they died. However, it’s not
Alzheimer’s in the news
2010, which was reported in The
depression subsequently reduces possible to say that the aluminium
Independent, appeared
dementia risk. caused Alzheimer’s as the
to show an association between
accumulation of aluminium
long-term exposure to pesticides
may have occurred as a result
and a slightly greater risk of
of the disease. The current
decline in mental ability in 1,000 7
medical and scientific consensus
French vineyard workers. Behind
is that there is no convincing
the Headlines concluded that
evidence that aluminium causes
while the increased exposure of
Alzheimer’s disease.
farm workers to pesticides
NICE says that while it is clear that is an important issue, the study
consuming aluminium can have did not show that pesticides
a toxic effect on nerve cells, it is cause Alzheimer’s.
unclear whether it is responsible
There is no convincing evidence that for the deterioration of brain cells
aluminium raises risk
in Alzheimer’s disease.
Other factors Several studies on possible
environmental risk factors have
Other studies have looked at
made the news in recent years.
other diseases or conditions that
However, none of the ones we
may increase Alzheimer’s risk.
analysed provided clear evidence
For instance, The Guardian
that these factors have a role in
covered a study in August 2007 The study we covered did not assess the
causing Alzheimer’s. effect of pesticides on risk of dementia
that looked at whether a woman
having her ovaries removed
Copper pipes
increased her risk of dementia
in old age. We found that, In January 2010, the Telegraph
Prevention
although the risk of dementia reported that a review of research Another favourite media topic
was almost 50% higher in women on copper pipes found that they is how to reduce the chances
who had their ovaries removed could cause heart disease and of getting Alzheimer’s and
at a relatively young age, the Alzheimer’s. We found that this dementia. It’s an important
total number of women who review only looked at a small issue, but study findings are
often wildly overstated by the
newspapers. The problem is that What are the known risks be offered is based on what
many news stories on how to for dementia and we know about the possible
prevent Alzheimer’s are based
Alzheimer’s? modifiable risk factors for
Alzheimer’s. That largely means
on observational studies, which In their 2007 guideline on
following a healthy lifestyle,
have identified an association dementia, the National
ideally not just in old age.
between a particular factor and Institute for Health and Clinical
a reduced risk of Alzheimer’s. Excellence (NICE) and Social
Other news stories are based on Care Institute for Excellence
animal or laboratory studies, or (SCIE) mention the following
on short-term studies that look at risk factors for dementia
substitute measures, such as poor and Alzheimer’s.
performance on memory tests or Staying active is important
brain shrinkage, neither of which They say that established
non-modifiable risk factors According to the National
is the same as having Alzheimer’s.
for dementia in general and Institute for Health and Clinical
A randomised controlled trial Alzheimer’s disease in particular Excellence (NICE), factors that
(RCT) would be necessary to include being older, your may help protect against
show whether an intervention dementia include long-term
Alzheimer’s in the news
genetic make-up, being female
can truly prevent Alzheimer’s. and having a learning disability. use of non-steroidal anti-
Studies of this type randomly inflammatory drugs (NSAIDs),
split participants into two groups Established risk factors that control of vascular risk factors,
– a group that receives a drug may be modifiable include regular exercise, and doing
or intervention, and a ‘control’ high blood pressure, excessive activities that stimulate
8
group that receives an existing alcohol consumption, diabetes, the brain.
preventative measure, an inactive depression and head injury.
placebo or no intervention at all. However, so far, studies have
Other potentially modifiable not clearly shown that adopting
Randomly allocating people into risk factors may include obesity, any of these changes leads to a
groups in an RCT means that the raised levels of an amino acid reduction in dementia rates. For
groups should be very similar to called homocysteine example, four trials of therapy
each other. This means that any in the blood and raised to treat high blood pressure
differences in outcome are cholesterol levels. showed a non-significant trend
likely to be directly due to towards reduced dementia
Risk factors for vascular
differences in the interventions rates in people who received
dementia overlap with
the participants receive. the treatment, two trials of
Alzheimer’s disease and include
However, because Alzheimer’s age, vascular risk factors (stroke, statins (cholesterol-lowering
usually develops late in life, and high blood pressure, diabetes drugs) found no effect, and one
the disease process is believed and smoking) and carrying the study of hormone replacement
to start 10 to 20 years before E4 form of the ApoE gene. therapy unexpectedly found
symptoms arise, such a trial might increased dementia rates in
need to be decades long to show Is there anything I can people who received treatment.
an effect. Therefore, trials often do to reduce my risk of
Due to the lack of convincing
use intermediate measures, such Alzheimer’s?
evidence that specific drugs can
as brain shrinkage or mental
Studies have not yet conclusively reduce the risk of developing
ability, rather than looking
identified any interventions dementia, NICE recommends
at Alzheimer’s itself.
that can reduce our risk of that the following should not
Several interventions have been Alzheimer’s. In the absence be used to reduce dementia risk:
studied or suggested as possible of this type of evidence, the statins, hormone replacement
ways of reducing the risk of best advice that can currently therapy, vitamin E or NSAIDs.
dementia, based on what is However, brain shrinkage does
known about the disease and not guarantee that a person
possible modifiable risk factors. will develop Alzheimer’s, and
In their guidelines from 2007, some brain shrinkage is a normal
NICE noted that the evidence for part of ageing in people who
preventing dementia was largely do not develop the disease.
restricted to types of study (called Therefore, it is not possible to say
The leaf of the ginkgo biloba tree
observational studies) that offer conclusively whether the people
much less robust evidence than The other RCTs into preventing who took vitamin B were less
RCTs. The available RCT evidence dementia that we covered either likely to develop Alzheimer’s.
on prevention at that time had looked at substitute outcomes More information on the study
either found no significant effect (rather than dementia itself), of vitamin B and treatment of
(as was the case with statins and or had other limitations which dementia can be found later
high blood pressure drugs), or an meant we could not draw firm in this report.
increased risk of dementia with conclusions about the effects of
Exercise
treatment (for example, with their interventions on
hormone replacement therapy). Alzheimer’s disease. A study in February 2011 was
picked up by the Express.
Based on this, NICE recommended Vitamin B
Alzheimer’s in the news
This research found that the
against the use of statins,
Vitamin B is a recurring focus of volume of a part of the brain
hormone replacement therapy,
Alzheimer’s research and has been called the hippocampus increased
vitamin E or non-steroidal anti-
studied in both the prevention by 2% in older adults who did
inflammatory drugs specifically for
and treatment of the disease. This aerobic walking, while the same
the prevention of dementia.
may be partly because vitamin B area decreased in volume by 1.4% 9
Keeping your brain active has deficiency can cause symptoms in a control group who did
also been suggested as a way similar to those of dementia. mild stretching exercises.
to prevent Alzheimer’s. NICE In September 2010, the Telegraph Despite the Express’ headline,
guidelines say that further studies reported that participants in this study alone could not tell us
are needed to assess whether an RCT, who had mild mental that aerobic walking can “help
keeping the brain active can impairment, were given either beat dementia”.
protect against Alzheimer’s. vitamin B supplements (containing
folic acid and vitamins B12 and Blood pressure drugs
RCTs of dementia B6) or a placebo for two years. An RCT reported in the Mail
prevention People with mild cognitive in February 2009 tested a new
impairment who took vitamin B blood pressure medication (called
Behind the Headlines has covered
showed less brain shrinkage than indapine) against a placebo.
several RCTs that looked at
people who took the placebo. After they assessed the effect of
the prevention of dementia
the drug on blood pressure, the
(though not necessarily
researchers looked at whether
Alzheimer’s specifically).
the drug would cut the risk of
Ginkgo biloba dementia in very elderly people.
The trial found no difference in
The most relevant RCT on the
the risk of dementia between the
prevention of dementia that we
drug and the placebo. However,
covered assessed use of the herbal
when the researchers pooled their
supplement ginkgo biloba in
results with those of other similar
3,000 elderly people over six years.
studies of high blood pressure
This well-conducted study found
treatments, they found that these
that ginkgo biloba had no effect
drugs offered a modest reduction
on the risk of dementia. It is important to get aerobic exercise but
whether it helps dementia is unproven in the risk of dementia.
As this study did not specifically is likely to be quite advanced and medical bodies around the world.
look at Alzheimer’s, we cannot be their brain will have already been Research into honing existing tests
sure what the effect on this type subject to significant changes. as well as developing new ones
of dementia would be. Also, the is ongoing.
Developing new diagnostic
study was set up to assess blood
techniques, particularly those For example, some studies have
pressure and did not primarily
that allow earlier diagnosis, is a looked at developing tests to help
look at dementia. In addition, it is
key area of Alzheimer’s research. identify people who might need
not clear whether the researchers
Earlier diagnosis would allow further assessment to determine
identified all the relevant studies
us to use existing treatments at if they have dementia. One such
to include in their pooled analysis.
an earlier stage. However, the test is the self-administered Test
Therefore, these results should be
available treatments cannot Your Memory (TYM) method,
interpreted very cautiously.
reverse existing damage or stop which Behind the Headlines
Several non-RCT studies have also the disease from progressing looked at in June 2009. The
claimed to identify interventions altogether. The hope is that, if we Independent said that the test,
that can protect against can identify the disease earlier
Alzheimer’s. Many of these have in its development, this will
not even reached testing in help us study and develop new
humans, and are still at the stage treatments to halt the progression
Alzheimer’s in the news
of cell or animal research. These of Alzheimer’s disease before the
studies should be considered damage it causes is advanced.
as very preliminary and not as
Most diagnostic techniques
conclusive evidence that the
currently being developed
interventions have an effect. They
concentrate on three different 10
should certainly not be seen as
aspects of Alzheimer’s disease:
definitely forming the basis of a
• changes in a person’s memory
new prevention or treatment, as
and mental functioning
newspaper reports often suggest.
• physical and structural Brain scans identify changes in the brain
changes in the brain
Tests and diagnosis • changes in the chemical
Currently, there is no way to test balance in the body and blood
which featured simple tasks such
people for Alzheimer’s before the Some studies that made it as drawing the time on a clock,
symptoms appear, even though into the papers were well could detect 93% of Alzheimer’s
the processes behind the disease designed and may eventually cases. The news was based on a
start some time before these lead to improved detection of trial that compared TYM with
symptoms become apparent. This Alzheimer’s. However, sometimes the MMSE in 139 people with
means that by the time someone newspapers give too much Alzheimer’s disease or other types
is diagnosed, the disease process significance to findings from very of dementia, as well as 540 people
preliminary research. without dementia.
The trial found that the
Memory tests new assessment was more
accurate than the MMSE alone
Tests of memory and mental
for identifying people with
functioning are already used to
Alzheimer’s. However, the test
diagnose Alzheimer’s disease and
wrongly identified a relatively
dementia. For example, one of
high proportion of healthy
the most widely used tests is the
participants as having dementia.
mini-mental state exam (MMSE), a
We concluded that the test had
validated testing technique that is
Earlier diagnosis would allow care to be potential, but that it needed
given earlier recognised by NICE and numerous
to be assessed in further trials, to develop and improve, scientists small number of people. Having
for example to verify the exact are researching new ways to greater numbers of participants
score that would be considered detect the earliest brain changes generally increases the reliability
as indicating potential dementia. in Alzheimer’s disease. of studies as it reduces the
In addition, people with more chance of anomalies distorting
In April 2011, the Daily Mail
severe cognition problems might the results. However, the study’s
announced a technique that
struggle to carry out the test design – which involved testing
“could help detect changes
themselves, although this is people before they were known
leading to Alzheimer’s disease up
unlikely to be a major issue if to develop Alzheimer’s and
to a decade before the symptoms
the test was to be used as following them up over several
develop”. The study behind
a screening tool to identify years to see who developed the
this news story involved the
Alzheimer’s that has not yet been disease, using accepted criteria
development of a method based
detected, which would probably for diagnosis – is the best way to
on using MRI (magnetic resonance
be at an early stage. tell whether a new test might be
imaging) scans to examine the
a good early detection method.
Overall, if future studies are thickness of nine different brain
favourable, this test could regions, dubbed “Alzheimer’s Repeating the study in larger
potentially be used by non- signature areas” by researchers. numbers of participants should
specialist doctors as an initial The study followed 65 people give a clearer indication of
Alzheimer’s in the news
screening tool for Alzheimer’s. without Alzheimer’s disease with whether Alzheimer’s signature
As with current methods, an average age of about 70. areas can help predict who is at
suspected cases of Alzheimer’s Researchers used scans to identify risk of developing the disease
would still need to be followed the dimensions of the volunteers’ in the next decade.
up with further testing and signature brain areas and
While this research looked at the 11
assessment by specialists to make followed them for up to 11 years
risk of developing Alzheimer’s in
a firm diagnosis. to see which of them developed
elderly people, some newspaper
the disease. They found that
The Test Your Memory test is reports suggested that brain scans
55% of volunteers whose brains
available to view online can be used to predict whether
were thinner in these nine areas
(PDF 4kb). someone would get the disease
developed Alzheimer’s, compared
decades before symptoms would
to 20% of those with signature
Brain scans areas of average thickness and
typically appear. For example, in
November 2010, a story in the
Brain scans are harder to carry out none of those with the
Daily Mail announced “an instant
than memory tests, but they can thickest signature areas.
test at 40 to predict Alzheimer’s.”
help identify important changes Although these results suggest
in the structure of the brain, such The story, which said that a
a link between the thickness of
as shrinking (atrophy), as well as “30 second test” to screen for
these brain regions and later
areas with reduced functioning or Alzheimer’s could be available
risk of Alzheimer’s, this was a
unusual patterns of blood flow. in as little as two years, was
preliminary study in a relatively
Although no tests are available unfortunately overly optimistic.
to make a definite diagnosis The research looked at how
of Alzheimer’s disease in living the presence of brain lesions
patients, these scans can help was linked to a person’s current
rule out conditions such as stroke mental function. It examined 428
or tumours that produce similar healthy people in their 40s who
symptoms to Alzheimer’s. It is only did not have dementia and found
after ruling out conditions such as that changes in the extent of one
these that doctors will diagnose type of change in the white
Alzheimer’s disease. matter of the brain were linked
to poorer performances in mental
As scanning technology continues Brain scans showing white matter lesions ability tests.
However, as the study did that examined a range of proteins
not follow the people up to in the blood to see whether
see whether they developed people who develop Alzheimer’s
Alzheimer’s, we cannot be sure have different levels of these
that brain scans looking at white proteins compared to people
matter lesions can predict who without the disease. The study
develops Alzheimer’s. In fact, found that the levels of a
while the Mail suggested this protein called clusterin was
research could lead to a test in linked to mental decline, the
two years, it will probably take severity of disease in people with
several decades to tell which of Alzheimer’s and the rate at which
Can “special milkshakes” slow Alzheimer’s?
the participants, if any, develop Alzheimer’s progressed.
Alzheimer’s disease. The research
However, the researchers studies, often carried out in cells
should be seen as providing clues
were looking at proteins in an in the laboratory or in animals.
to the disease, rather than a new
experimental way and did not Any treatment for humans that
diagnosis method.
suggest that this protein may be might be developed from these
used to diagnose Alzheimer’s, at studies remains many years away.
least not yet. In fact, they said However, this doesn’t discourage
Alzheimer’s in the news
that their findings did not support headlines writers, who admittedly
using clusterin levels alone to might have trouble fitting in this
predict Alzheimer’s disease. caveat while keeping the readers’
interest. Many headlines about
these studies have exaggerated
Potential treatments 12
their significance, often referring
Unfortunately, current treatments to them as a ‘holy grail’, ‘fresh
for Alzheimer’s disease only hope’ or ‘cure’ for dementia.
It is hoped that blood tests might one day
detect early stage Alzheimer’s temporarily slow the decline of
brain function or deal with certain
Blood tests symptoms of the disease. They
cannot stop the disease from
Blood tests are not currently
progressing altogether, or reverse
used to detect Alzheimer’s,
the damage that has already been
although they may be used to
done to the brain.
help rule out other potential
causes of memory loss. Studies looking at potential
‘cures’ for Alzheimer’s – be they
Research into the possible use Results from lab studies are often just the
coffee, magnet therapy or even first step in a lengthy research process
of blood tests to help detect
an Alzheimer’s ‘milkshake’ – are
Alzheimer’s is at a very early
frequently talked up by the
stage, and there is still some way For example, in November 2010,
media. It’s often ignored that
to go before we know if such tests BBC News reported that the
while the results of some of these
could have a role in detecting diabetes drug metformin might
trials look promising, developing
Alzheimer’s. Several news stories offer “Alzheimer’s hope”.
safe and effective new drugs
have covered these early studies. This early-stage study on mouse
for any disease is a slow and
cells found that metformin
In July 2011, the Telegraph painstaking process that requires
increased the activity of an
reported that a blood test several stages of research and can
enzyme that can counteract the
may soon be able to “predict take many years.
development of tau protein
Alzheimer’s disease up to 10 years tangles, which are characteristic
A large proportion of the studies
before symptoms appear”. of the disease. As metformin is
of potential treatments reported
The report was based on a study in the papers are preliminary already used in diabetes, it
could potentially reach the In June 2008, BBC News reported
stage of human testing for that “Ginkgo ‘does not treat
Alzheimers’ disease more quickly dementia’”.
than a new drug. However, more
The RCT behind this story
laboratory and animal research
compared the effects of ginkgo
would probably be needed
biloba extract in 176 people with
before the start of testing in
mild to moderate dementia.
people with Alzheimer’s. NICE says that vitamin B supplements offer
It found that ginkgo did not no clear overall benefit in dementia
Early studies like these are improve mental performance
essential first steps in identifying compared to placebo over six the vitamin B supplement did not
drugs that could eventually be months. We concluded that the slow mental decline any more
used in treating Alzheimer’s study was well conducted and than a placebo did.
disease in humans. However, they provided good evidence that Vitamin B was back in the news
need to be seen as preliminary. ginkgo does not improve brain in September 2010, when the
Many of the drugs in these function or quality of life in
early studies do not prove to people with mild to moderate What does NICE say
be effective or safe enough for dementia. The findings of this
about vitamin B?
human testing. For those that do, study are supported by a review
Alzheimer’s in the news
it can still take many years before of the evidence, published by In its 2007 guidance on
we know if the drug works the Cochrane Collaboration the dementia, NICE concluded
and is safe. following year, which concluded that there was insufficient
that there was no convincing evidence from RCTs to
Randomised controlled evidence that ginkgo biloba is determine whether vitamin
13
trials of treatments effective for dementia and mental B12 has benefits that
impairment in general. outweighed the risk of
The best way to investigate the adverse effects in people with
effects of a treatment is with B vitamins dementia. It also concluded
a randomised controlled trial that the increased risk of
(RCT). Of the 100 or so studies on B vitamins are a recurring story in
adverse effects with folic acid
Alzheimer’s and dementia that we the treatment and prevention of
supplementation outweighed
have covered over the past four dementia. They are also a good
any potential benefits in
years, just under a third looked at example of how something can be
people with dementia.
current or potential treatments. reported to be helpful one month
Of these, only six were RCTs and useless the next. People are
that looked at the effects of clearly interested in the subject, Telegraph reported: “Vitamin
treatments for Alzheimer’s or as some of Behind the Headlines’ B tablets could slow and even
dementia in humans. most popular articles are on B halt the devastating march of
vitamins. The Times reported in Alzheimer’s disease.” The study
These RCTs looked at the use of 2008 that Alzheimer’s patients in question was a well-conducted
the herbal supplement ginkgo were “wasting their time” taking trial in 271 elderly people who did
biloba, vitamin B, a multinutrient vitamin B supplements in their not have dementia but who did
milkshake, a type of magnetic attempts to slow the progress of have mild memory problems. The
therapy and two drug treatments. the disease. study found that those who were
given vitamin B experienced brain
Ginkgo biloba The RCT behind this story looked
shrinkage (atrophy) 30% slower
at the effects of a daily high-dose
The studies that tested ginkgo than those given inactive tablets.
vitamin B supplement (containing
biloba and vitamin B in humans folic acid and vitamins B6 and Despite being promising, the
suggested that they do not help B12) over 18 months in 409 people results could not show that
people with dementia. with mild to moderate probable vitamin B can prevent dementia
Alzheimer’s disease. It found that because the study cannot tell us
whether this reduction in brain unlikely as it sounds. However, the
shrinkage would have benefits for research on which it was based
people with dementia. is still at an early stage and the
findings were exaggerated by the
Other RCTs of dementia newspaper, which said that the
treatments “once-a-day miracle drink” could
be available within two years.
The other RCTs we covered that
assessed potential Alzheimer’s The RCT compared a daily
treatments had more promising multinutrient milkshake
initial results. However, these (containing ‘phosphatide Hayfever medication
studies also had some limitations, precursors and cofactors’) with a
placebo drink in 225 people with sentence comprehension test after
such as their small size or not
mild Alzheimer’s over 12 weeks. two weeks of rTMS but not after
being fully published at the time
The milkshake was found to a sham treatment. However, this
they were reported.
improve participants’ verbal recall trial was too small and short to
more than the placebo drink, but tell us whether any important
Rember trials
did not have the same effect on long-term benefits can be
The Daily Mail reported in 2008 other mental functions. expected with this treatment.
Alzheimer’s in the news
that the findings from an early You can find out what treatments
human trial of a drug called Hayfever pill are currently available on the
methylthioninium chloride NHS for dementia in NHS Choices
(Rember) was “the biggest In 2008, The Sun reported that Health A-Z.
breakthrough against brain a hayfever pill called dimebon
disease for 100 years”. The can “combat memory loss in 14
drug reportedly targeted the patients with the brain disease” Tomorrow’s
tau protein – which forms the An RCT looked at 183 Russian headlines
characteristic tangles in brains of patients with mild to moderate
Alzheimer’s and found that Trials of treatments that make
people with Alzheimer’s disease
dimebon improved symptoms the news, such as Rember and
– and reduced mental decline by
compared to a placebo over 26 dimebon, are only one area
81% over a year in people with
weeks. Although the study was of research.
mild to moderate Alzheimer’s.
However, the findings had only small and limited to one country,
Over the past few years, scientists
been presented at a conference. it highlights that dimebon
have made some key advances,
While they may look encouraging, may have potential in treating
notably in the field of genetics, in
results presented at conferences Alzheimer’s. However, this was
progress towards earlier diagnosis
should be interpreted with early research and further studies
and in developing drugs that may
caution until they have been are required.
one day prevent Alzheimer’s from
fully published in a peer-reviewed progressing. We asked researchers
journal. Without being able
Magnet therapy
in the field what areas of
to look at the study’s methods The Independent reported in Alzheimer’s research they expect
or results in detail, it is difficult 2010 that: “Applying magnets to hit the headlines in the future.
to draw firm conclusions about to the brains of Alzheimer’s
these findings. disease sufferers helps them Gene research
understand what is said to them.”
Nine of the 10 genetic variants
The anti-Alzheimer’s This very small RCT assessed the
associated with late-onset
milkshake effects of repetitive transcranial
Alzheimer’s have been discovered
magnetic stimulation (rTMS) in 10
The story of a milkshake that in the last two years. Research
people with moderately severe
could treat Alzheimer’s, reported that uncovered the last five was
Alzheimer’s disease. Participants’
by the Daily Mail in 2010, is not as published in 2011 in the journal
performance improved in a
Nature Genetics and was covered The most recent and exciting “One of the things we know is
in Behind the Headlines. breakthrough concerns a that Alzheimer’s starts 10 to 20
process called endocytosis. This is years before clinical symptoms
Professor Julie Williams of the
basically how a brain cell appear,” he says. “So any drugs
department of psychological
brings in ‘big molecules’ from targeting the disease are unlikely
medicine and neurology at
outside and how they are to be helpful after the clinical
Cardiff University, and chair of
processed. “We now have several disease has started. I’m really
the scientific advisory board at
genes that suggest that problems interested in whether we can
Alzheimer’s Research UK, sees this
with this process are playing a potentially reverse this disease.
as an exciting breakthrough.
strong role in the development of But to be successful, even to
“The more genes we can identify Alzheimer’s disease.” set up clinical trials of new
that increase risk of the disease, treatments, we need to be able to
The findings suggest that
the more we understand what is diagnose it a lot earlier.”
scientists are beginning to piece
going wrong biologically in the
together the jigsaw of how and
brain,” says Professor Williams.
why the disease develops.
“Eventually that will lead to
new treatments.” “If we were able to develop
treatments to remove the
Alzheimer’s in the news
detrimental effects of these
gene variations, we should be
able to reduce the numbers of
people developing Alzheimer’s
disease in the long term,” says A lumbar puncture to sample spinal fluid
Professor Williams. 15
How these more recently Over the last 10 years, promising
discovered factors relate to the developments in detection include
Our genes appear to play an important plaques and tangles found in the the use of lumbar punctures to
role in development of dementia
brains of people with Alzheimer’s look for levels of certain proteins
is not yet known. However, it is in cerebrospinal fluid (which
What is very exciting, she says, possible, she says, that the plaques surrounds the brain and spinal
is that the identified genes are could be side effects of a more cord) and highly specialised scans,
clustering in patterns, which point fundamental disease process. called PET scans, to detect protein
to possible disease pathways that deposits in the brain. Both of
“I’m excited by these findings and
in future could be targeted for these are being tested in clinical
I know that eventually they will
treatment. For example, several trials on early diagnosis. However,
make a difference. We have lots
genes suggest that the immune they are expensive and require
of questions still to answer about
or inflammatory response of specialist skills to administer them.
genetics and we know they can
people who develop Alzheimer’s is Therefore, researchers are looking
result in potential therapies,” says
somehow different from normal. at the potential of two other
Professor Williams.
Other genes that have been methods for early detection of
identified are involved with how dementia, including Alzheimer’s:
we process fatty substances such
Early diagnosis and MRI scans and blood tests.
as cholesterol, which indicates detection
that this process may differ in Early detection of Alzheimer’s “So far MRI scans have only
people with Alzheimer’s. “The disease, years before symptoms been used to rule out conditions
brain makes its own cholesterol first appear, is crucial if new other than Alzheimer’s. We
and there seems to be a problem drugs are to stop the disease haven’t been able to use them
with the way people with developing, says Simon Lovestone, to diagnose the disease,” says
Alzheimer’s process this,” says professor of old age psychiatry at Professor Lovestone. “But we
Professor Williams. King’s College London. have now developed a complex
analysis of what they show, which In the future, it is hoped that
means we can use them to make blood tests may be able to
a positive diagnosis of dementia. identify protein deposits in
In fact, MRIs are now being used the brain early in the disease,
to diagnose dementia in routine some 10 to 20 years before
clinical practice. symptoms appear.
“With MRIs, digital data are “Levels of certain proteins in the
collected and turned into a photo blood may reflect the amount of
to see if there has been brain amyloid protein in the brain well
shrinkage. In our analysis, we are before clinical symptoms,” says
able to look at different volumes Professor Lovestone. “So a blood
of atrophy in different regions of test could eventually be used on
the brain and compare this to a people very early in the disease.
large database of normal MRIs. “We’ve discovered 30 proteins Scientists are studying differences in
As yet, we cannot differentiate which are at different levels in the proteins in the blood of people with
Alzheimer’s
between Alzheimer’s and other blood of people with Alzheimer’s
dementias, but we know that disease. We are now doing a New drugs
regional patterns of atrophy are Europe-wide clinical study with
Alzheimer’s in the news
Developing drugs is a lengthy
different in different disorders, so samples from control groups and
and painstaking process. From a
we hope to be able to do this in from those with Alzheimer’s, to
key discovery about the disease
future. We are also hoping to use pinpoint the differences further.
process, it can take 20 years to
this analysis early – in the pre- Within the next year, we will
develop a drug to target that
dementia phase – in people who know how the new tests we’ve
process and enter it in clinical 16
have mild cognitive impairment, developed are functioning and
trials, and another 10 years before
to predict which of them are likely after this we need to set up
the drug will be used in practice.
to go on to develop dementia.” clinical trials, to try them on large
Therefore, discoveries made about
numbers of patients.”
The second area that is interesting Alzheimer’s 20 to 30 years ago are
researchers is the development of One blood protein that has been only now coming to fruition.
a blood test to look for protein linked to the development of
“fingerprints” for Alzheimer’s. Alzheimer’s is clusterin, Thirty years ago, the beta-amyloid
Using a complex array of which intriguingly has been protein that forms plaques
technologies, researchers can found in higher levels in the in the brain was discovered.
identify individual proteins in blood as much as 10 years before Following this, 20 years ago,
blood samples and compare the the first signs of the disease two enzymes that generate the
levels in people with Alzheimer’s appear in the brain. “At the protein, called gamma-secretase
and those without the disease. same time as we discovered this, and beta-secretase (or BACE).
scientists working in genomics Scientists then set out to find
found that a gene for clusterin drugs to stop that activity. It is
is associated with Alzheimer’s – only now that these drugs, called
an amazing coincidence,” says gamma-secretase inhibitors and
Professor Lovestone. BACE inhibitors, are in clinical
trials, with results expected in
Early diagnosis is valuable to
the next year or two. If they are
patients and families because
found to be effective, they could
it enables them to plan ahead,
be ready for use soon after.
he says. “But the underlying
assumption is that one day we In the future, says Professor
will have the treatment to halt Lovestone, another enzyme,
the progression.” called GSK3, could also be a target
MRI scan of the brain for drugs. GSK3 adds phosphate
He is also trying to understand
more about the basic processes
involved in the disease to
identify possible new treatments,
in particular how the two
abnormalities characteristic of
Alzheimer’s – amyloid plaques and
tau tangles – are related.
Is an Alzheimer’s vaccine a possibility?
A vaccine against
Alzheimer’s?
that the vaccine can do this. The
Another exciting development question is whether that is of
according to Clive Ballard, benefit to patients – whether it
professor of age-related disorders will help them in daily life,” says
at the Institute of Psychiatry Professor Ballard. “Clinical trials of
in King’s College London, and the vaccine on patients with mild
director of research for the to moderate Alzheimer’s disease
Alzheimer’s Society, is a potential are now at the finishing stage. We
Alzheimer’s in the news
vaccine against Alzheimer’s, will know within two years if the
Developing drugs is a lengthy process
currently being trialled. Although vaccine works or not. It would be
to the tau protein which forms not a vaccine in the usual sense very exciting but also bring lots
the characteristic tangles seen in of the word, it is hoped that of challenges, since this approach
Alzheimer’s, and drugs to target the drug can clear amyloid depends on having infusions in
17
this enzyme are now entering plaques from the brain. “We hospital, is expensive and requires
phase 2 clinical trials, he says. have evidence from initial studies specialist skills.”
Find out more about dementia and Alzheimer’s
On NHS Choices
Worried about dementia? - learn the basics about dementia
Health A-Z: Alzheimer’s disease - a straightforward guide to the causes, symptoms and treatments
for Alzheimer’s disease
Health A-Z: Dementia – read about the different types of dementia and how they are treated
Carers Direct – advice on the practical and financial support available if you care for someone with
dementia
Official guideline on dementia treatment
NICE Guidance on Dementia – medical guidelines detailing the best practice for treating dementia
and Alzheimer’s disease
NICE: Dementia Quality Standard – a checklist explaining what high-quality dementia care should
provide to patients
National Dementia Strategy – the Department of Health’s plan for improving dementia care and
treatment across the UK
