Dementia is a pressing societal health problem, one complicated by the sheer number of underlying conditions that cause it as well as its direct impact on an already overburdened health-care system.
The University of Queensland (UQ) in Brisbane, Australia, is responding to this complex health issue with an interdisciplinary approach that studies dementia’s molecular underpinnings to develop viable treatments and better care options. Supported by the Clem Jones Centre for Ageing Dementia Research – housed within UQ’s St Lucia campus – scientists are making inroads into developing therapeutic solutions that could slow dementia’s onset among an ageing populace.
“(Australia) has an ageing population that is growing enormously,” says Professor Pankaj Sah, Director of UQ’s Queensland Brain Institute. “The average age of our population is growing, too, so we wanted to be prepared for that.”
Working on a breakthrough
According to United Kingdom-based nonprofit Alzheimer’s Disease International, about 50 million people worldwide are currently living with dementia, a condition involving the degeneration of brain cells, with common symptoms including memory loss, confusion, personality change, and an inability to complete everyday tasks.
In Australia, dementia affects one in ten people aged 65 and over, and with life expectancy projected to increase in coming decades, more than one million Australians could be diagnosed with dementia by 2050 if no effective treatment is found. (In the United States, there are at least 5 million people currently facing age-related dementias.)
UQ’s Clem Jones Centre is Australia’s first dedicated dementia research hub, hosting nearly 100 scientists studying the mechanisms of neurodegenerative diseases, particularly those affecting older people. Established in 2013 to support fundamental brain research at the molecular level, the center is moving toward clinical trials that converge around new dementia treatments and preventative approaches.
A team led by Professor Jürgen Götz is developing a non-invasive ultrasound technology that could delay the progression of dementia. The technique involves temporarily opening the blood-brain barrier – a filtering mechanism that lines blood vessels carrying blood to the brain and spinal cord – to clear toxic protein clumps from the brain and restore memory functions. In early studies using animal models, the approach successfully reversed dementia symptoms, leading to a small safety trial involving human subjects slated for late 2019.
Subsequent trials aim to establish ultrasound as a workable treatment for Alzheimer’s disease, which accounts for 60 to 80 percent of dementia cases, as reported by the Australian Alzheimer’s Association. In December 2018, the Australian government provided the center with $10 million in research funding to support both the center and the development of an early version of an ultrasound device, a much-needed cash infusion to support an innovation that may one day see widespread use.
“When it’s functional, a more advanced version of the device will be used in rural areas as well as cities,” says Sah. “Our vision is for this to be fully portable.”
While ultrasound is unlikely to prevent the formation of toxic protein clumps, by clearing them, ultrasound may significantly delay the onset of the disease. Considering most dementia patients begin losing core mental functions in their 70s and 80s, an onset delay of even five to ten years could result in an entire lifetime free of the condition, Sah says.
“Even if we won’t cure anyone with severe dementia, this technology is very promising and exciting,” he says. “The biggest benefit is that people won’t be going down the dementia track.”
Fostering an interdisciplinary research approach
As many dementias are progressive – meaning symptoms start out slowly and gradually worsen – early diagnosis is key in giving patients the maximum benefit from available treatments, notes Sah. Along with its ultrasound study, The University of Queensland is determining how exercise helps maintain mental performance in elderly people, with a special focus on the amount, intensity and type of workout that may decrease the risk of cognitive decline.
A person who gets dementia is not mentally the same person, and the impact on family is just enormous.
The university is also investigating the link between sleep apnea and dementia, and engaging general practitioners in fostering healthier lifestyles among their patients. Physical inactivity, obesity, poor diet, tobacco use, diabetes, and hypertension are tabbed by the World Health Organization as dementia risk factors, a list that also comprises depression, social isolation, and low educational attainment.
An interdisciplinary research approach is critical for a condition with no cure or rock-solid diagnostic test, says Sah. Doctors diagnose dementia based on medical history, lab tests, and the characteristic changes in day-to-day function associated with various types of dementia. After Alzheimer’s, vascular dementia – which occurs following strokes – is the second most common dementia type. However, reversible conditions such as vitamin deficiencies and thyroid problems may also cause symptoms.
Although it’s largely unknown why dementia touches certain people, the human and financial costs are abundantly clear. Globally, dementia is believed to have cost approximately $818 billion in medical and social care in 2015, according to WHO statistics. That figure does not take into account the overwhelming mental toll that dementia inflicts on the families of those affected.
“For a start, dementia can last a long time, and can require 24-hour care,” Sah says. “There are not many diseases where people need that type of care. These are patients who don’t know their families anymore, and their social interactions are completely changed. A person who gets dementia is not mentally the same person, and the impact on family is just enormous.”
The University of Queensland’s collaborative research approach has enabled significant discoveries in tackling dementia, and uncovering the underlying pathways of how dementia develops in the brain. Definitive answers are hard to come by, but curtailing the condition in Australia alone would save the country’s health-care system upwards of $80 billion. Sah imagines the human and capital benefits his team’s research may bring to population-dense nations such as China or India in the future. But for now, the institute director is proud to be making strides at a best-in-class research institution.
“Just our ultrasound technique alone is blue-sky research, and something granting bodies don’t normally fund,” says Sah. “But this university had the foresight to put money up for it. We are excited about the possible breakthroughs that this funding will help us deliver, which in future will ultimately lead to better outcomes for people living with dementia.”
