Alzheimer's in the press by hedongchenchen


									Alzheimer’s in the news
fear and fascination

A Behind the Headlines special report

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
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	
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

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	
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	
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		
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	
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	
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
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		
                                                                               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	
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	

  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

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