After decades of painstaking research, scientists backed by billions of pounds are now, undoubtedly, one step closer to thwarting Alzheimer’s.
Although a cure has so far eluded pharmaceutical firms, game-changing drugs that stop the memory-robbing disease in its tracks have emerged.
Yet one problem remains: diagnosing Alzheimer’s is incredibly tricky.
Currently, patients must undergo a swathe of tests, including scans and a lumbar puncture, with some facing waits of up to four years for their diagnosis. Others die before being told they have the condition.
That’s why top neurologists are so excited by the latest medical breakthrough — a simple blood test that can seemingly spot signs of Alzheimer’s in the brain up to 15 years before symptoms strike.
What’s more, while blood samples in that study were pored over in labs, researchers hope to turn the test into a finger prick — binning the years-long agonising waits that some patients are forced to endure.
The NHS will launch a series of pilots from January in what charities say will be a major milestone in tackling the disease. Pictured: Graphic showing how Alzheimer’s blood tests could work
Trials are ongoing into remternetug, also made by Eli Lilly. Full results won’t be ready until 2025, however. But early data suggests remternetug — given through an injection, not IV drip — is set to outperform donanemab. Some 75 per cent of patients on remternetug for six months saw amyloid plaques cleared from their brains, Eli Lilly announced at a medical conference in Sweden in March
Charities are hopeful the test could be rolled out in the NHS within the next three years.
It could see patients access vital treatments much faster, including drugs that ease confusion and forgetfulness and ones that tackle the root cause of the condition.
The breakthrough discovery also paves the way for a screening programme, mirroring ones for breast cancer and cholesterol.
For example, all over-fifties could be routinely tested for Alzheimer’s every few years, suggested Professor David Curtis, an honorary professor at the UCL Genetics Institute.
‘The combination of a simple screening test with an effective treatment for Alzheimer’s would have a dramatic impact for individuals and for society,’ he said.
Yet, despite being obviously good news, that concept has attracted criticism.
Professor Rob Howard, an expert in old age psychiatry at UCL, told MailOnline that there are dangers around people thinking there is a blood test for Alzheimer’s (the most common form of dementia), as many who have the hallmarks of the condition won’t develop symptoms.
Therefore, rolling out the test en masse would cause unnecessary worry and anxiety among those who will never suffer from memory or thinking problems.
Additionally, high cholesterol can be treated through lifestyle changes and medication, which reduces the risk of heart attacks and strokes, Professor Howard noted.
But there is no treatment for those who have a build-up of tau in their brains without dementia symptoms, he said.
Professor Howard said the test is ‘great and really important’ for dementia patients, as it can speed up their diagnosis, identify what type of dementia is behind their symptoms and see painful lumbar punctures effectively scrapped in dementia care.
‘But the test should not be used to try and find new cases of dementia,’ he added.
Dementia was first described by a German doctor, Alois Alzheimer, in 1906.
He reported the case of a patient who suffered profound memory loss and unfounded suspicions about her family.
After her death, an autopsy revealed that parts of her brain had shrunk and there were abnormal clumps in and around her nerve cells.
One of his colleagues later named the condition after him.
But it wasn’t until the 80s that researchers labelled the clumps Dr Alzheimer identified as amyloid and tau.
If these proteins build up in the brain, they can form plaques and tangles that make it hard for the organ to work properly.
This process is now widely understood to be a key cause of Alzheimer’s disease.
Eventually, the brain struggles to cope with this damage and dementia symptoms — such as memory, thinking and reasoning problems — develop and worsen over time as nerve cells across the brain become damaged and die.
The 90s saw the first Alzheimer’s medicines approved.
Standard treatment for the condition has remained largely the same since then, with acetylcholinesterase (AChE) inhibitors used to help the nerve cells in the brain communicate with each other.
Meanwhile, memantine works by blocking the effects of glutamate — a chemical that damaged nerve cells make, which can further impact the brain.
While these drugs can help manage symptoms, Britain has not had a new Alzheimer’s drug approved in 20 years.
But a new class of medicines has raised the hopes of that the UK will approve next treatments as early as this year.
While existing drugs only treat the symptoms of Alzheimer’s, immunotherapies work by clearing amyloid from the brain and slow down the progression of the illness.
However, despite hundreds being in the pipeline, the development of these drugs has so far proved difficult.
Hopes were raised by aducanumab, made by US-based Biogen and Japan-based Eisai, which became the first new Alzheimer’s treatment in 20 years when it was approved by the US Food and Drug Administration in June 2021.
However, the EU medicines watchdog then rejected it, concluding that it was not effective at treating Alzheimer’s and could cause potentially dangerous swelling and bleeding in the brain.
But hopes remain that three others could work.
The number of people living with dementia in the UK was estimated to be close to one million in 2021 (944,000). By 2050 this figure is expected to rise to 1.6 million
But they can also be a sign of dementia — the memory-robbing condition plaguing nearly 1million Brits and 7million Americans
Changes in humour and swearing more are all signs of Alzheimer’s and frontotemporal dementia (FTD) a type of dementia that causes problems with behaviour and language. According to experts bad parking, and dressing scruffy are also signs of the memory-robbing disease. Graphic shows: Six signs of Alzheimer’s disease
Lecanemab, which destroys amyloid as it begins to form fibres, is expected to be the first of its kind to be approved in the UK later this year.
Clinical trial results showed that the treatment, given once a fortnight, slowed cognitive decline by 27 per cent over 18 months.
Donanemab, made by Eli Lilly, is another drug being tested for Alzheimer’s. Like lecanemab, it targets amyloid. However, it binds to the protein at a later point, when fibres have already clumped together to become a larger plaque in the brain.
Results from trials suggest that it delayed the progression of Alzheimer’s by 36 per cent over an 18-month trial.
Charities hailed the two drugs as potentially the ‘beginning of the end for Alzheimer’s disease’.
The UK’s medicines watchdog is expected to issue a ruling on lecanemab this year, while a decision on donanemab isn’t expected until 2025 at the earliest.
Remternetug, also made by Eli Lilly, targets the same type of amyloid as donanemab but it is hoped it will be more effective. Unlike lecanemab and donanemab, which are given through drips, it is administered as an injection.
Early data shows that three-quarters of recipient had amyloid cleared from their brains after six months of treatment.
However, a major stumbling block for these treatments is that studies so far have shown that they work best the earlier they are given to Alzheimer’s patients.
But a formal Alzheimer’s diagnosis — a crucial step before being eligible for treatment — can take years.
And around four in 10 over-65s with dementia have not been diagnosed, according to Alzheimer’s Research UK.
While some are told that they have the condition in just a few weeks, others face waits of up to four years for a formal diagnosis.
In part, this is down to there not being a single test for dementia. Sufferers have to complete mental ability tests and undergo expensive brain scans and lumbar punctures — which collects fluid from the spine — before being diagnosed.
Medics are therefore pinning their hopes on new tests that can diagnose the memory-robbing condition much faster, effectively streamlining the steps to treatment.
The NHS this month launched pilots in a bid to identify the best contender.
A range of tests for Alzheimer’s are currently in the research stages. Pharmaceutical giants Roche and Eli Lilly have joined forces to develop a blood test, while some are already being used in private clinics in Hong Kong and the US.
However, UK charities say more work is needed to ensure tests are measuring the right combination of biomarkers.
From 1906 when clinical psychiatrist Alois Alzheimer first reported a ‘severe disease of the cerebral cortex’ to uncovering the mechanics of the disease in the 1980s-90s to the recent ‘breakthrough’ drug lecanemab, scientists have spent over a century trying to grapple with the brutal disease that robs people of their cognition and independence
Around 75 per cent of people have the e2 or e3 of the APO gene, while 20 per cent have one copy of APOE4 – the dementia gene. Between 3 and 5 per cent of people have two copies. The e4 variant is linked to an increased risk of developing Alzheimer’s, whereas e3 appears to have no effect and e2 may even offer protection against the disorder. People born with one copy of the e4 variety suffer a doubled risk of developing Alzheimer’s between the ages of 65 and 80. Those with two copies have a 10 to 15-fold increased risk of developing the disease after the age of 65, scientists estimate
Eventually, it is hoped they could be used as part of a national screening programme to detect dementia early, like mammograms for breast cancer, once proven treatments are available.
In the major step forward yesterday, researchers in Sweden revealed they had identified a blood test that can spot a specific type of tau up to 15 years before dementia symptoms develop.
They found the test, which is expected to cost £150 and made by US firm ALZPath, was as accurate as the current gold standard lumbar puncture for diagnosing Alzheimer’s.
It checks for levels of p-tau217 — a protein that slowly accumulates in the brain and is thought to drive Alzheimer’s. These proteins start to build up on the brain 10 to 15 years before symptoms start showing.
The findings, published in the journal Jama Neurology, show that the approach was 97 per cent accurate.
This makes the test as effective at spotting Alzheimer’s as the current gold-standard tests and scans.
Dr Susan Kohlhaas, executive director of research and partnerships at Alzheimer’s Research UK, said the findings are ‘really encouraging’.
She told BBC Radio 4’s Today programme that the next step is checking that the results still stand when used in clinics among people with memory problems.
The test would then need to be approved by the Medicines and Healthcare products Regulatory Agency and recommended by the National Institute for Health and Care Excellence before the test could be rolled out on the NHS.
As a result, Dr Kohlhaas said it will likely be three to five years before the test is available to patients.
She said: ‘It’s probably on the closer end of five years.
‘What’s really important is that this is really urgent to sort. We can see the time where treatments are just coming round the corner that, for the first time slow progression of diseases like Alzheimer’s.
‘If people can’t get a diagnosis, they won’t have access to those treatments.’
Dr Kohlhaas added: ‘Eventually it would be great to be able to screen people and make sure that they have access to treatments as quickly as possible.’
