Pharmaceutical Market Europe • June 2024 • 38
DEMENTIA
Dementia – risk factors, research and treatment
There are over ten million new cases of dementia each year worldwide, which translates into one new case every 3.2 seconds
Dementia is a debilitating disease that affects millions of people worldwide, according to the World Health Organization. It is a progressive condition that leads to memory loss, cognitive decline and behavioural changes.
There are currently no known cures for the disease, but research is ongoing to find new treatments and ways to prevent or delay its onset. The US Food and Drug Administration (FDA) has approved antibody-based treatments like Lecanemab, which are given intravenously every two weeks and modestly slow cognitive and functional decline in people with early-stage Alzheimer’s disease. They work by clearing amyloid plaques, which have been shown to cause nerve damage and thereby slow down disease progression. Lecanemab is most effective if given in early dementia, but costs $26,500 a year and is associated with amyloid-related imaging abnormalities (ARIA) with edema (ARIA-E) or hemorrhage (ARIA-H) in the brain, which can lead to death.
Minimising risk factors for dementia
There is currently no cure for dementia, but there are ways to reduce the development and progression of dementia by reducing the risk factors associated with the disease. Modifiable risk factors include obesity, diabetes, hypertension, cardiovascular disease and social isolation. These risk factors can be addressed through regular exercise, a balanced diet, avoiding smoking and reducing alcohol consumption.
Maintaining a healthy weight through regular exercise and a balanced diet can reduce the risk of developing type 2 diabetes, which in turn lowers the risk of dementia. Furthermore, recent studies with the GLP-1 receptor agonists that reduce weight, hyperglycaemia, blood pressure and lipids have shown that they can reduce the development of dementia. A recent large study of over 100,000 healthcare workers showed that those who reported eating more than 7 grams of olive oil a day, compared to those who consumed no olive oil, were 50% less likely to die from dementia. Staying socially engaged and maintaining strong social connections can also have a protective effect against dementia.
Having an education reduces the risk of developing dementia and indeed if you have not been to secondary school, your risk of dementia is two- to three-fold higher. How can you counter this if you are 50 years old? Using your brain by learning a new language, doing crosswords and activities that make you work your brain can help reduce your risk of dementia.
Ongoing research on dementia detection and treatment
There is still a long way to go in the fight against dementia, but progress is being made. One of the fundamental problems is early detection and getting new drug therapies approved. To date, we do not have a readily available test that identifies early dementia. Indeed, even in high-income countries only 20-50% of dementia cases are diagnosed in primary care and in a study from India, 90% remained undiagnosed. This is where groundbreaking research in Qatar in people with dementia and mild cognitive impairment has shown that a special instrument called a corneal confocal microscope can be used to rapidly scan the nerves in the front of the eye (cornea) and identify nerve degeneration earlier than changes in brain volume assessed using an MRI. Furthermore, the extent of corneal nerve damage was related to cognitive impairment and reduced activities of daily living. These eye scans also identified greater corneal nerve damage in people with mild cognitive impairment who developed dementia. This world-leading research has the potential to change the way we diagnose early dementia through a simple eye scan. It could also change the way we do drug trials for new dementia therapies by identifying people with mild cognitive impairment who are most likely to develop dementia and identify nerve regeneration in response to disease-modifying therapies. This would enable quicker assessment of the effectiveness of new drug therapies that prevent the development of dementia.
Dementia is a complex disease that affects over 55 million people worldwide. With the tremendous successes in treating infection and cardiovascular disease, many more people are now living longer. Given that dementia mainly affects those over the age of 65, there are over ten million new cases of dementia each year worldwide, which translates into one new case every 3.2 seconds. While new treatments have been approved to slow down dementia progression, there is no known cure. Thus, identifying early cognitive dysfunction and neurodegeneration with improved management of modifiable risk factors, engagement in cognitive activities and maintaining social interactions is key to minimising the risk of dementia.
Rayaz Malik is a Professor of Medicine at Weill Cornell Medicine-Qatar (part of Qatar Foundation)
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