Treating Dementia: Challenges and Innovations

What causes dementia? And how do we diagnose and treat it? Is there anything we can do to stop ourselves from developing dementia? These are the crucial questions we’ll be exploring with clinical neuropsychologist Barbara Sahakian, sociologist Richard Milne, and neurologist James Rowe. In this episode, we’ll find out more about what dementia actually is, some surprising factors that increase a person’s risk of developing dementia, and computer games that can actually help detect and diagnose dementia.

This episode was produced by Nick Saffell, James Dolan, Naomi Clements-Brod and Annie Thwaite. 

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Timestamps: 

[00:00] - Introductions

[01:10] - A bit about the guests’ research

[02:20] - Defining dementia and what causes it

[03:10] - Dementia and Alzehiemers 

[03:10] - What we mean by the term neurodegenerative and tau proteins  

[04:15] - How Dementia is different from normal aging  

[05:15] - Who does dementia impact and the number of people in the UK who have dementia

[05:45] - One in three will get dementia. One in six over the age of 80 have dementia in the UK. WHO estimates 55 million people worldwide and this figure is set to rise to 78 million by 2030.  

[07:10] -The impact on families and carers. What is the cost to the economy? Trillions globally. 

[08:45] - The lifespan of dementia. How the combination of our genes puts us at a higher or lower risk of dementia. How this proceeds through adult life.  

[10:20] - Normal ageing vs dementia 

[12:35] - Time for a recap! 

[16:40] - How do we detect dementia? Declines in cognition and the importance of episodic memory.   

[18:35] - CANTAB: a tool to detect early Alzheimer’s disease

[20:05] - Establishing the value of early detection and early diagnosis.  

[21:10] - APOE tests and the debate around if early diagnosis is useable information. Does it cause more worry and anxiety? What can be people do with the information? 

[23:00] - Does this argument focus too much on the stigma associated with dementia. We should all want to know as we can do something around our own personal risk. 

[24:40] - Should these risk factors simply be explained as steps that we should do anyway. Do we have to be given information about risk?

[25:15] - How can we reduce our risk of dementia? Early detection also allows people more time to get some treatments and their finances together. 

[27:10] - Is there a way to look for the clumps of proteins in your brain? Physical test options. 

[27:40] - it is less about technology. The bigger question is about how we use the information to reduce personal risk. Diagnosis, screening and preventative interventions. 

[29:30] - The possibility for behaviour change? How do we put in place systems that change behaviour. Policy and health system change. 

[31:00] - The risk factors - depression, social isolation, hearing loss, cognitive inactivity, air pollution. 

[31:30] - Time for another recap! 

[36:40] - Dementia isn’t just a problem for people over the age of 65. 42,000 people under the age of 65 in the UK have dementia

[37:25] - Hearing loss as a modifiable risk factor of dementia. Hearing loss is the biggest single factor as a contributor of dementia 

[38:45] - What can we do to slow down or prevent dementia? 

[39:20] - Good brain health and evidence-based brain training. Brain Training “Game Show” App Improves Memory in People with Early Dementia

[40:20] - What you might do depends on your stage of life. Moderating alcohol. Concussion risks in sport at a young age. 

[41:45] - We should focus more on good brain health at an early age and particularly in schools. 

[43:45] - Are we at a tipping point for rare diseases like Huntington’s disease. 

[45:15] - The importance of funding and the role of the public 

[46:45] - Potential for treatments - Modafinil and cognition. Research into cognitive enhancing.  

[49:20] - Distinctive proteins and dementia. Symptomatic or disease-modifying. Dopamine and Parkinson’s disease.   

[51:05] - Societal impact of new therapies. 

[51:40] - If you’re worried about your memory, get yourself assessed. 

[52:10] - Let's break this episode down and close this thing out

Guests

Dr Richard Milne 

Richard is a social scientist whose work addresses social and ethical challenges associated with new medical technologies, primarily in the domains of genomics and dementia, and the development of data-driven medicine. He is based in the Institute of Public Health and at the Society and Ethics Research Group at the Wellcome Genome Campus. He currently holds a Wellcome Trust Seed Award in Society and Ethics to study the development of digital tools for detection and diagnosis of cognitive decline, and co-leads ethics workpackages within the Innovative Medicines Initiative EPAD and AMYPAD projects, and research on participant experience within the MRC Deep and Frequent Phenotyping Study.

Professor James Rowe @CambridgeFTD 

Professor James B. Rowe is Director of Cambridge Centre for Frontotemporal Dementia and Related Disorders. Dementia and Neurodegeneration have devastating consequences. My work aims to protect brain function in those at risk of dementia, and restore brain function in those with symptoms. He is an active consultant neurologist, leading regional specialist clinics for patients with early dementia, frontotemporal dementia, Progressive Supranuclear Palsy, and other ‘tauopathies’, and he is a consultant in the Cambridge Memory Clinic.

Professor Barbara Sahakian @BJSahakian

Barbara J Sahakian is Professor of Clinical Neuropsychology at the University of Cambridge Department of Psychiatry and Behavioural and Clinical Neuroscience Institute. Professor Sahakian’s laboratory also focuses on improving cognition, motivation and wellbeing in people with neurodegenerative conditions and psychiatric disorders. Professor Sahakian has developed novel methods for delivering cognitive training by using app games on iPads and iPhones. In her studies with people with schizophrenia or amnestic mild cognitive impairment (aMCI), she has found that memory, global functioning and motivation improve after training with ‘Wizard’ or ‘Game Show’.

Extra Notes: 

More about CANTAB: a tool to detect early Alzheimer’s disease

Dementia and neurodegenerative disorders | Cambridge Biomedical Research Centre

As the population ages, we are likely to see more and more patients developing chronic (long-lasting) degenerative brain diseases that lead to dementia and major physical disability.

• Vascular Dementia
• Parkinson’s Disease
• Huntington’s Disease
• FrontoTemporal Dementia
• Other rarer disorders

These conditions share one thing in common – they all have a slow loss of nerve cells (neurons) in the brain. We want to find out why this is happening and which brain cells are involved.