Asking experts about dementia research through the decades

Professor Nick Fox was awarded one of our first research fellowships in 1993. Since then, he has become a professor of clinical neurology, Consultant Neurologist at the National Hospital for Neurology and Neurosurgery and Director of the Dementia Research Centre at UCL in London.

A leading light in dementia research, Nick’s work into brain imaging has had a global impact. He has received prestigious awards in recognition of his research into early detection, diagnosis and progression of the diseases that cause dementia.

Dr Carole Sudre was awarded a junior fellowship by Alzheimer’s Society in 2017.

Her research focuses on the relationship between damage to the brain’s blood vessels and thinking and memory skills.

She is using specially designed artificial intelligence software to predict how blood vessel damage is likely to progress – vital information for a neurologist.

Looking back

A fellowship is a researcher’s first major step in becoming the leader of their own research group. Nick, can you tell us how significant receiving fellowship funding from the Society was to your career and research?

Nick: The fellowship completely set the course of the rest of my life. The Alzheimer’s Society fellowship put me onto familial Alzheimer’s disease, and that has been my passion ever since. I honestly wasn’t sure about what I was going to do, and the fellowship totally captured me for dementia research.

Have you noticed a shift in public attitudes or understanding of dementia while you have been associated with the Society?

Nick: Dementia is now part of our common experience in a way that it never was before. It’s in books, films and sitcoms, and sadly affects many families. I think there are very few things that truly change the fabric of society. Yet we have seen a notable shift in attitudes to dementia, from people’s conversations to our literature and culture.

Both of you specialise in brain imaging – how far have brain scans come, in particular MRI?

Nick: MRI (magnetic resonance imaging) has come a very long way in the last few years. We can use MRI to see structural change and now also changes in inflammation. Thanks to advances in molecular techniques, such as analysis of cerebrospinal fluid and blood, we also get a far richer understanding of disease.

Looking to the future

Carole, your research is an excellent example of advances in brain imaging. Could you describe it?

Carole: We know that even the tiniest dysfunction of blood vessels in the white matter of the brain can lead to major damage and have a massive impact on cognition – thinking and memory skills. I am using artificial intelligence, specifically deep learning, to detect these areas of damage and to link their location with the cognitive impact.

How has our understanding of the significance of small blood vessel damage improved?

Carole: This has really changed in the last few years. Slowly, people have realised that you have a link between damage due to small blood vessels malfunctioning in the brain and the acceleration of cognitive decline and onset of dementia. We now know that the variety of symptoms is related to the location of the damage to blood vessels, though there is still a lot of research to do.

Better diagnosis

Why is early and accurate diagnosis important?

Nick: I believe that improving early diagnosis and giving greater precision is truly important. As it has been described to me, there’s a ‘great agony’ of not knowing. Without accurate diagnosis, people may feel like it’s themselves to blame or another condition, and they might seek inappropriate and ineffective treatment. All the time that they’re being denied access to accurate diagnosis, they’re being denied access to support and to appropriate treatments. Giving them an accurate diagnosis is a basic right – why should we not give them that?

Carole: I completely agree. It is important to make sure that people are taken care of as early as possible. It is at this point that future treatments are also likely to be most effective, before symptoms have progressed.

What potential do blood tests hold?

Nick: I think these are real advances. I was sceptical when these blood tests focused on testing thirty different things at once. Instead, the tests have now been improved to detect single ‘markers’. These can help to tell you about what is happening in the brain. This matches what we have already learned from spinal fluid and complements what brain imaging is showing us.

Carole: I think that taking these blood test measures together with spinal fluid and brain scans will help us to understand the early stages of dementia. A blood or spinal fluid test without imaging isn’t enough to give us the full picture.

Working with Alzheimer's Society

What’s it like being funded by us?

Carole: What I find unique about Alzheimer’s Society is that, every six months, I meet with my monitors from the Research Network. This is an extremely good experience, because each time I meet them I am with people who are very interested in what I am doing and want to know more. I always come out of this extremely energised and motivated.

I feel like you are not just funded by the Society, when you interact with the staff and the Research Network. You become more personally attached to and involved in your own project and in your relationship with the Society.

Nick: Alzheimer’s Society is made up of really committed staff and volunteers, including on the Research Network.

People working for the Society want to make a difference, it’s more than simply a job.

This makes one feel more of a wish to be part of the Society in a wider sense than just as ‘somebody who is funded’.

When I first joined the Society, I was explicitly told that I was to be an ambassador for them, so I went out and spoke at lots of local offices. I’ve had some really thought-provoking questions and great insights from meeting those people.

I recall a volunteer who collected me from the station in Sheffield when I was just starting out. He told me how important he felt it was to improve diagnosis. He said, ‘Let me tell you about the agony of not knowing,’ and that has stuck with me.