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Understanding the mechanism of the disease is also changing, as early diagnosis can be more valuable. Dementia has a very long preclinical phase — 20 years, in some cases — and scans and blood tests can detect subtle changes, but symptoms have not yet appeared.
In this window, two proteins begin to appear in the brains of patients with dementia: tau and amyloid. Researchers have been fighting for years to figure out exactly what their role is, but now some believe they have the answer. In patients with dementia and Alzheimer’s, amyloid creates intricate and plaque in the spaces between brain cells. The theory that is, when it rises to a certain level, it triggers the tau protein — usually part of the scaffolding of neurons — to go from being normal to toxic. This is what causes most of the symptoms, which is the ability of cells to kill and send out clear signals to neurons.
June 2021, The FDA granted expedited approval with indiranumab, the first new drug for Alzheimer’s disease in 18 years. It is designed to adhere to amyloid molecules and facilitate the immune system. But it is a controversial approach, as in the past drug treatments aimed at clearing amyloid have not made much difference.
In emerging dementia theory, however, the timing of intervention can be very important. With better early detection, medications like adducumumab could be given when they still have time to change. “If you get rid of amyloid very early on, maybe that’s when the real benefit happens,” Koychev says. Before the amyloid could be cleared from the brain into a toxic tau, perhaps the worst effects could be delayed or completely avoided.
Easy-to-use digital tests could be combined with brain scans and blood tests to help researchers build a map of how amyloid and tau proteins relate to cognitive impairment, and whether cleaning them makes a difference. Rather than an overview of all of them, Koychev proposes to target the most at-risk groups with regular assessments.
He noted, however, that there is still a great deal of disagreement in the area, and there are serious doubts Whether the new anti-Alzheimer’s medicine will work as expected. But the research has been revived after what Habibi calls a “long period of drought,” in terms of investment and interest from pharmaceutical companies that have been left behind by cancer. Dening believes it happens as a result of a combination of factors: the stigma of the disease, the advanced age of people who are accustomed to it, and a “well, that’s what happens when you get older” to a fatalistic attitude.
Eventually things are changing as a large and wealthy demographic cohort moves into the age range that is most at risk. Tests like the ICA are aimed at them, but Koychev hopes they will “also democratize access to brain health.”
Because they are digital and semi-supervised, they can be carried anywhere you can carry an iPad. This means that they can reach out to people who have been left out of their regular studies of the situation, who are often made up of groups of volunteers who do not accurately reflect the underlying population. They can also be taken more often to build an image of an individual’s cognitive performance over time – Connectivity has a separate iPhone app called OptiMind, designed to do this for home testing.
We still lack good treatments for dementia and Alzheimer’s disease, but the ability to detect them earlier can change our attitude toward them, which in turn can improve our understanding and spark investment in the solutions we need. “Brain health will become something that people control and care about, just like you care about your physical health,” Koychev says.
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