Dementia

Baroness Greenfield Excerpts

Thursday 18th January 2024 Grand Committee

[Baroness Greenfield (CB)]

I thank the noble Baroness, Lady Browning, for drawing attention to this timely and important issue. I am a neuroscientist working on brain mechanisms that underlie dementia and, accordingly, I declare an interest as the founder and CEO of a biotech company, Neuro-Bio Ltd, which is developing a novel approach to the diagnosis and treatment of Alzheimer’s disease. From first-hand experience, I can speak to the importance of strengthening the dementia research landscape. It is only by increasing resources for research that we will ever be able to realise if not a cure then, very plausibly and at last, a truly effective treatment. I thank the Alzheimer’s Society for its assistance in preparing these remarks on the situation in the UK, where, as we heard from the noble Baroness, Lady Browning, some 900,000 people are already living with dementia, a figure expected to rise to 1.6 million by 2040. As we also heard, one in three of those born today will develop the condition in their lifetime.

Yet combating this devastating disease is still not seen as the political priority it needs to be, and it has been historically underfunded. For example, just 31p is spent on dementia research for every pound invested in cancer research. That said, we should welcome the launch last year of the Government’s £95 million commitment to the Dame Barbara Windsor dementia mission, but we now need to see a delivery timeline for this funding, and we urgently request further detail about how the Government plan to invest the money.

But it is not just about the money. The APPG on Dementia, of which I am a proud member, released in 2021 a report entitled Fuelling the Moonshot, which found that people affected by dementia feel a sense of empowerment from being involved in research, but also that patients are often unaware of the opportunities to take part. This has to change—action must be taken to improve participation in, and access to, clinical trials. Recent investment in research is welcome, but it will be wasted without increased participation in these studies.

Moreover, any consideration of those living with dementia also needs to include the carers. This is where social issues should be given equal attention. In 2011, I gave a lecture tour on behalf of Alzheimer’s Australia, and I still vividly recall a conversation with a husband who had been caring for his wife, to whom he had been married for many decades. In the early hours of one morning, when he was changing her incontinence pads during a bout of diarrhoea, she, the love of his life, just stared at him, questioning who he was. It was then, he said, that he snapped. This gentleman described his situation as a “living death”, which is a phrase that I have heard repeated by other carers of those with dementia. Often, those closest undergo all the experiences of bereavement, no longer able to share memories with a very special individual who none the less is still breathing. The big difference is that society does not accord them the time and support it would to those grieving an actual death.

We need more resources for research, action on optimising clinical trials and wraparound support for the carers. Indeed, as highlighted in this debate, we need parity in health and social care. Dementia presents the biggest unmet clinical need of our time. Let us work towards a future where we are no longer haunted by the spectre that perhaps, one day, we will ask our spouse who they are, or that they in turn will describe their life with us as a living death.

Ageing: Science, Technology and Healthy Living (Science and Technology Committee Report)

Baroness Greenfield Excerpts

Wednesday 20th October 2021 Grand Committee

[Baroness Greenfield (CB)]

I thank the noble Lord, Lord Patel, for the opportunity to consider how we might enhance the prospect of a long and healthy life. Accordingly, I declare an interest as founder and CEO of Neuro-Bio Ltd, a biotech company developing an innovative treatment for dementia, specifically Alzheimer’s disease. As the noble Lord correctly predicted, I will focus most of my comments on that subject.

Alzheimer’s is a neurological condition characterised by memory loss, disorientation and general cognitive impairment. It is a disease typically, though not exclusively, of older people. One in six over the age of 80 have dementia, a condition that affects as many as 70% of residents in care homes. The spectre of Alzheimer’s is one of the cruellest potential scenarios awaiting us in later life. While heart disease and cancer are serious, often disabling and sometimes terminal, you can still reminisce over old photographs and spend meaningful and precious time with your grandchildren. These life-enhancing moments are gradually closed off to an individual with dementia.

Despite hearing from witnesses from both Alzheimer’s Research UK and the Alzheimer’s Society, there seems to be no substantive discussion in the report of the very real threats that Alzheimer’s currently poses to enjoying a healthy older age. It is cited as the most common cause of death for women, then flagged in relation to air pollution and reported as mitigated by cognitive reserve. That is three mentions of one of the most important issues related to ageing and its potential alleviation by science.

The Alzheimer’s Society’s website reports facts and figures that are truly concerning. First, there is the societal impact of dementia as one of the main causes of disability later in life. There are currently around 850,000 sufferers in the UK; this figure is projected to rise to 1.6 million by 2040. This year, 209,600 people are expected to be diagnosed with dementia; that is one person every three minutes.

Secondly, there is the economic factor. The total cost of care for people with dementia in the UK is £34.7 billion. This is set to rise sharply over the next two decades to £94.1 billion by 2040.

Thirdly, there is the impact on carers, in addition to the financial and mental health repercussions of perhaps giving up a job to care for a loved one. On more than one occasion, I have heard this daily existence described as a living death.

Since these problems are not raised in the report, it is unsurprising that there are no recommendations specifically to resolve them. I want to make a few suggestions for brief consideration here. The only successful way to combat Alzheimer’s disease will be to devise an effective treatment. In turn, this is dependent on gaining insight into the underlying brain processes. Further research, both basic and translational, is thus essential.

However, dementia research is desperately underfunded. For every individual living with the condition, the annual cost to the UK economy is more than £30,000, yet only £90 per patient is spent on research. Five times fewer researchers choose to work on dementia than on cancer. Yet if we could come up with a means of delaying the onset by five years, the number of deaths from the condition would be halved, saving 30,000 lives a year.

Admittedly, various recommendations in the report are concerned with drug development in a more general sense in relation to older people. However, sadly and strangely, no specific issue is raised in relation to improved therapies for Alzheimer’s disease. An obvious and predictable recommendation would be to make more funds available for research, be they from public, private or philanthropic sectors.

Just as important, but much less obvious, is the question of how such resources should then be deployed. Currently, the majority of funding is directed at just one strategy to combat the histological marker in the brain—amyloid—as it is a frequent feature of Alzheimer brains. However, drugs designed to antagonise amyloid at best only slow down the progression of the disease. There is increasing doubt that it is the primary cause of the neurodegenerative process. The report could have highlighted the lack of success of current treatments and thus argued the case for promoting initiatives pursuing innovative lines of inquiry. In this way, we could truly understand the degenerative mechanism in order to intervene with a successful pharmaceutical strategy.

The hunt for an anti-Alzheimer’s drug that actually works is far from straightforward. As yet, there is a no accepted narrative for how and why neuronal loss starts, nor for—of equal importance—how it is perpetuated for decades before the classic profile of cognitive impairment presents. Unless and until we understand what is happening in the brain for this period, we will only ever be able to deal with downstream symptoms, such as amyloid accumulation, rather than halting cell loss by intercepting the driver of the disease.

The second reason for failure to date is the lengthy time window of 10 to 20 years between the onset of cell loss and the eventual presentation of cognitive impairment. Any treatment initiated at this late stage is comparable to closing the stable door after the horse has bolted, as the pernicious cycle of cell loss would have been under way for decades. Analogous to the measurement of cholesterol for detecting cardiovascular problems, we need a routine blood test, say, that would enable easy screening to determine whether the degenerative process was already in train, even though the person may feel perfectly fine at the moment. Imagine if we had a blood biomarker indicating early on that degeneration had already started, well before the behavioural symptoms of Alzheimer’s were apparent. Imagine if we had a drug that stabilised cell loss and halted neurodegeneration. If such a drug were taken before the symptoms became apparent, those symptoms may never arise—not a cure in the literal sense, but effectively just that.

What is stopping us developing such a biomarker and such a drug? We need to facilitate more innovative lines of research and challenge existing dogma. Admittedly, there will be false dawns and blind alleys. There will be risks to take and cynicism to overcome, but that is the only way we will ever develop an effective treatment for Alzheimer’s disease. The American physicist and philosopher Thomas Kuhn famously argued that science does not evolve gradually towards truth but has a paradigm; that is, it has an accepted approach that remains constant until anomalies start to accumulate, and accumulate to such an extent that it is finally accepted that established thinking cannot explain the phenomenon in question. A completely new theory must then be conceived—a paradigm shift. If we are to understand and tackle this devastating condition successfully, we are long overdue for such a shift in our thinking.

Alzheimer’s disease is not an inevitable consequence of ageing, but it is a disease of old age. In my view, the report has missed a golden opportunity to draw attention to its current impact and future threat. Most importantly, it has missed the opportunity to promote new strategies to consign dementia to being a disease of the past. Only when this happens will we be able to have justified confidence in an old age that is not only able-bodied but clear-minded.