Dementia News Summary of 2020
COVID-19 overshadowed much of the news around dementia related discoveries and advances in 2020. However, some important research and development did occur including important advancements in the early detection, control, and even in the treatment of dementia. Below is a brief summary of the pages (and pages and pages) of dementia news for 2020.
Research News
Medications
Aducanumab
While there are no medications to prevent or cure dementia yet, several new drugs are showing some promise results, including one called Aducanumab. It is now under FDA review (after some initial doubt re: its efficacy). The makers of Aducanumab provided additional evidence in 2020 that the drug can delay the onset of dementia by reducing aggregated amyloid beta – a protein that normally plays an essential role in memory loss later in life.
If approved, Aducanumab will be the first therapy shown to slow dementia-related cognitive decline. Besides ongoing doubts about its efficacy, the therapy is also very pricey (about $50,000 per year per patient, not including imaging and other medical costs to monitor its effects) and its impact to Medicare funding.
Early detection initiatives
The PET scan is the gold-standard for detecting tau tangles, which are a pre-symptomatic predictor for dementia and Alzheimer’s disease. The tau proteins – are typically found in brain cells– is associated with multiple brain diseases.
Researchers are developing faster, less expensive, and more widely-available alternative methods to detecting tau using blood or cerebrospinal fluid sampling and analysis. The newer methods can result in earlier disease detection which is important for patient care and treatment decision.
Via blood and plasma-based biomarkers
Several new blood-based biomarkers are in various stages of testing. These blood-based biomarkers are more accurate than previous technologies for early detection in people at risk of dementia, who might then be enrolled in trials aimed at preventing or delaying its onset.
Via Cerebrospinal Fluid
Researchers at the Washington University School of Medicine detected and accurately measured the amount of a specific tau (MTBR tau) in cerebrospinal fluid samples. They used special chemicals to purify the specific tau out of a solution, then identified and measured the specific types of tau in each sample using mass spectrometry.
They measured samples from 100 70-somethings (30 with no cognitive impairment or signs of Alzheimer’s; 58 with amyloid plaques but no or only mild or moderate cognitive symptoms, and 12 with cognitive impairment not caused by dementia.) The researchers found a clear correlation between the amount of MTBR tau 243 present in the samples and the test subjects with Alzheimer’s. They also observed that the MTBR tau 243 levels increased relative to the severity of cognitive impairment and dementia in each subject.
To check the accuracy of their results, the researchers compared the amount of tau visible in PET brain scans of 35 people — 20 with Alzheimer’s and 15 without — with levels of MTBR tau 243 in the cerebrospinal fluid. MTBR tau 243 levels were highly correlated with the amount of tau identified in the brain scan, suggesting that their technique accurately measured how much tau — and therefore damage — had accumulated in the brain.
Lifestyle Interventions
Three new lifestyle interventions were identified by The Lancet Commission on Dementia prevention, intervention, and care 2020. The commission added excessive alcohol consumption, social isolation, and depression to its list of “modifiable risk factors” that if modified could reduce the number of cases of dementia by 40% worldwide.
The original list from a 2017 commission included nine risk factors:
- Less education
- Hypertension
- Hearing impairment
- Smoking
- Obesity
- Depression
- Physical inactivity
- Diabetes
- Low social contact
The new commission added three factors in its July 2020 report:
- Excessive alcohol consumption
- Traumatic brain injury
- Air pollution
Dietary Interventions
Some dietary supplements appear to make a difference in preventing dementia-related brain atrophy – Research on pre-dementia (“prodromal”) patients who consumed a special multi-nutrient “LipiDiDiet” supplement in a three-year-long study showed significant improvements in cognition and mental function and a slowing of brain atrophy when compared to a control group. The LipiDiDiet supplement used in the study and not currently available in the U.S., contains Omega 3 fatty acids, Uridine, Choline, B Vitamins, Antioxidants, and Phospholipids.
Inflammation and Junk Proteins
One widely-reported 2020 study looked at inflammation and the buildup of junk proteins in the brain. Researchers at the University of Cambridge studied brain scans from 31 donated brains and found a direct relationship between the amount of inflammation and junk proteins. Researchers theorize that a type of vicious cycle may occur in dementia patients between cell damage (indicated by the presence of junk proteins in the study), which then causes inflammation in the brain, which causes additional cell damage, which causes more inflammation, etc.
Enzymatic Interaction Causes “Abnormal Chemical Events” leading to Synapse Loss
Scripps research scientists uncovered an entirely new series of biochemical events that apparently occur only in nerve cells of patients affected by Alzheimer’s. They found that small clumps of beta amyloid protein trigger excessive neuron activity and inflammation, leading to the destructive series of reactions.
Scientists observed that excess nitrogen and oxygen atoms joined together, then transferred to a protein building block called cysteine. From there, abnormal protein reactions disrupted cell mitochondria and blocked power needed for cellular biochemical reactions, resulting in synapse loss.
When researchers prevented these reactions in animal brains, the synapses were protected.
Hope for More Dementia Related Developments in 2021
Of all the developments in dementia research in 2020, the one with possibly the greatest potential is the drug mentioned above – aducanumab. The medication is considered to be “major progress,” and the FDA is expected to announce by March 2021 whether or not it will approve the medication. If it passes, the next step will be to develop a pricing strategy to make the meds more readily available to a great population.
Sources
References
Junk proteins – The relationship between inflammation and all forms of dementia: https://www.upi.com/Health_News/2020/03/18/Brain-inflammation-linked-to-several-types-of-dementia/8511584539279/
LipiDiDiet
- https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.12172
- Report on the results of a three year study of the Lipidiet and its effect on brain atrophy and cognition: Hilkka Soininen et al, first published 13 September 2020, https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.12172
- The dietary supplement used in the study is not currently available in the U.S. The manufacturer’s website. https://www.nutricia.com/specialize/alzheimers.html. Note that it’s possible to create a set of similar dietary supplements: https://www.researchgate.net/figure/Nutritional-composition-of-Fortasyn-Connect_tbl1_245820372
Other Lifestyle Changes: https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(20)30453-1/fulltext
Dementia Biomarkers
In Blood and Blood Plasma
https://source.wustl.edu/2020/07/alzheimers-protein-in-blood-indicates-early-brain-changes/
In Cerebrospinal Fluids
https://www.sciencedaily.com/releases/2020/12/201207091304.htm
Articles reviewed
https://www.sciencedaily.com/news/mind_brain/dementia/#page=7
https://alz-journals.onlinelibrary.wiley.com/doi/full/10.1002/alz.12068
https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext
http://blog.aginglifecare.org/blog/the-latest-discoveries-in-alzheimers-and-dementia-research/
https://www.alzheimers.org.uk/blog/three-new-developments-dementia-treatment-research-happened-2020
https://www.sciencedaily.com/releases/2020/03/200316204635.htm
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