Dementia: A Very Short Introduction by Kathleen Taylor

Author:Kathleen Taylor
Language: eng
Format: epub
ISBN: 9780192559807
Publisher: OUP Oxford
Published: 2020-07-22T23:00:00+00:00

The story so far

Research into dementia in the modern era has been dominated by the amyloid cascade hypothesis. However, while that hypothesis has produced tens of thousands of scientific papers, its clinical outcomes have, to put it mildly, been disappointing. Some commentators criticize this decades-long effort as a huge waste of money and time. Yet to do that is to fail to realize just how complicated a problem researchers face. There are some brain diseases which may be traced to a single defective gene, for which a quick fix will someday be available. With recent advances in genetics, that day could come sooner than we think. But most of the disorders which affect our brains are more like death by a thousand cuts than by a single bullet. If neurodegeneration were simple, it would have been cured by now.

This complexity has left room for other ways of thinking about dementia to develop alongside the biomedical approach: alternatives such as person-centred care and the disability/human rights movement that prioritize the individual rather than the illness. It has also forced scientists to discover a good deal more about human brains, in sickness and in health, than the pioneers who began the field could have imagined would be necessary. In doing so they have learned about much more than Alzheimer’s, frontotemporal dementia, DLB, or vascular dementia. We all age, and our brain function changes as we do so, whether or not that change slips into cognitive decline. Understanding how brains age, and which factors make that ageing more or less successful, has implications for every human being. Accepting that many factors contribute to dementia—natural effects of ageing, genetic vulnerabilities, other diseases, traumatic life events—additionally reminds us that this is an illness whose presentation, at least in its earlier stages, is likely to vary considerably, both from day to day and between people. Every brain, life history, and person is unique.

Considering other contributing factors than amyloid also opens up the possibility of new treatments. Looking at inflammation, for example, may allow a formidable array of existing drugs to be re-applied, at much less cost than developing new ones from scratch. Among the candidates are some with promising, if preliminary, signs of clinical benefit.

Treatments, however, are a last resort, especially for illnesses which may smoulder in brain tissue for decades before becoming apparent. And treatments are costly. Alongside clinical research, therefore, many scientists, health economists, and governments favour trying to prevent, or delay, the onset of dementia. Pushing back the start of cognitive decline by even a year would mean fewer people needing expensive drugs, or care, for less time. Ideally, the kind of behaviours which help to prevent dementia would be taught in schools and encouraged in adulthood, making brain health as much of a lifelong habit as maintaining a healthy body weight.

To achieve this, we need to know which behaviours are good, and which bad, for brain health. That brings us to the science of risk factors, our next topic.

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