Will more cash for research help lead to a cure for dementia?

With the coalition government committed to boosting dementia research funding, Vern Pitt looks at where increased resources could make a difference

Dementia costs the UK economy five times as much a year as ­cancer but government and charities spend 12 times as much on cancer as dementia research, the Alzheimer Research Trust’s Dementia 2010 report found this year.

Now the coalition government has pledged to prioritise the funding of dementia research to help close the gap.

Currently, all bids for funding to the Department of Health Policy Research Programme or the National Institute for Health Research, through which government money is routed, compete against each other. Bids for dementia research have for some time been low in number and quality.

Last year, the Labour government held a summit on dementia research to identify areas for improvement and increase the number and quality of bids.

It then proposed to issue a “themed call for research”, in effect ring-fencing funding for dementia research for the best bids. Whether the coalition will follow this track is uncertain and, whatever the rules, competition for finite resources will remain tight.

The causes of dementia

In the past two years the number of genes that have been connected to a risk of developing Alzheimer’s disease has risen from one to seven.

Julie Williams, professor of neuropsychological genetics at Cardiff University, says the new genes have led researchers to identify the way the body processes cholesterol as a key factor in the development of Alzheimer’s. Cholesterol is good for the health of nerve cells. That finding allows for further, more targeted research into what happens in the brain and how to fix it.

Williams says developing treatments may take 10 to 15 years but investment is needed now to start on that path. Some international studies are under way to identify more genes, and could yield results within a year.

She says about £3m is needed to look at the less common forms of the disease by sequencing the genes of a large number of sufferers. Although tens of millions of pounds will be needed to understand what those genes do, the pay-off could be huge. “Within 15 years the next generation can be taking therapies to reduce the risk of dementia,” says Williams.

The signs

There are no scientific tests for dementia presently used in clinical practice. This makes diagnosis, monitoring the disease’s progress and making treatment effective more difficult and less exact.

Simon Lovestone, director of the Biomedical Research Centre for Mental Health, a partnership between South London and Maudsley NHS Foundation Trust and King’s College London, is seeking biological markers to test the progress of the disease.

“Clinical trials is where biomarkers will find their earliest utility,” says Lovestone. Improving the accuracy of measuring the effectiveness of a drug could reduce the number of volunteers and time needed to carry out a clinical trial, reducing today’s £17m-£35m bill for most trials by up to 90%. Because nine in 10 trials fail, it could also free resources to test more drugs.

Molecular brain imaging can help test for the disease and MRI and spinal fluid scans are not far away from approval, he says. Blood or gene tests, which are cheaper and safer than brain scans and spinal taps, are also in the early stages of development.

“In 10 years we may have established biomarkers for dementia but how fast we get to that point is simply a question of funding,” Lovestone says.

Therapies

Investment has been poor in therapeutic research for dementia because of a lack of public funding, says Esme Moniz-Cook, professor of clinical psychology and ageing at the University of Hull.

Moniz-Cook has spent years focusing on developing talking therapies to delay the worst effects of dementia. She says more investment is needed in developing support immediately after diagnosis so that people can manage the condition themselves.

“Mind over matter is the big project. We’ve had that in cancer but not in dementia,” says Moniz-Cook. She adds that visualisations and positive thinking can remove stress and have an effect on the immune system. This increases quality of life and improve the effectiveness of clinical treatments.

However, studies over five years will tell us more about their effectiveness and allow researchers to hone practice which can then be spread throughout health and social care.

Though the costs of this research run into millions, Moniz-Cook says it is justified. “If you can delay people entering care homes you can save huge costs. Cognitive stimulation therapy, for instance, has produced better results on quality of life and cost than some dementia drugs.”

The mechanics of the disease

Only in the past two to three years have large-scale studies to investigate how genetic variations lead to dementia been possible. “However, we know nothing about how changing a gene leads to greater susceptibility to dementia,” says Richard Wade-Martins, head of the Molecular Neurodegeneration and Gene Therapy Research Group at Oxford University.

He does know, however, that the way dementia patients’ bodies produce a protein called tau is different from how it is produced in those without the condition, but the effect of this variation on nerve cell function is unclear.

The best way to find out is to create nerve cell cultures in a laboratory using skin cells from live dementia patients and compare them with those of healthy patients. “This field didn’t exist until 2007,” says Wade-Martins. “It has revolutionised the way we study diseases.”

“The best hope for treatment is neuroprotection. You work out why the cells are dying and then you find drugs that will stop them dying,” he adds.

But it’s expensive. Wade-Martins estimates an average-sized study over five years costs about £5m. Yet dementia develops slowly so studies need to run over 10 and 15 years. However, Wade-Martins says investment of this level can significantly reduce the number of cases of dementia and ease pressure on health and social care services, reducing long-term costs.

Research infrastructure

Dr Craig Ritchey, research and development director at West London Mental Health Trust, who has been conducting drug ­trials for the past 15 years, points to a ­common problem. “If you want to use 1,000 people in a drug trial you have to go to 20 countries, with 10 centres in each country, to get five people in each centre. That ­creates a lot of noise in the system,” he says. Language ­barriers, differing health systems and distance make it complicated and costly.

But the UK, with its single health service, high number of dementia patients and a good record of dementia research, is uniquely placed to remedy this. Ritchey says the UK could be an attractive testing ground for drug trials, while boosting the economy and helping patients, all for minimal government investment.

Ritchey admits research infrastructure might not be eligible for the same funding as individual research projects now but implores politicians to change this.

His team is already piloting a web-based database of dementia patients who are willing to be involved in trials. He sees no reason this couldn’t be expanded at a small cost. “Where it needs investment is with NHS staff time to approach patients and input data,” he says, before adding: “I see this as a win, win, win situation.”

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Published in the 1 July 2010 edition of Community Care under the heading When will dementia be cured?