Asking experts about dementia research through the decades

As we celebrate the 40th anniversary of Alzheimer's Society, we asked Professor Nick Fox and Dr Carole Sudre to share their insights on the progress of dementia research and future breakthroughs.

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.

Nick and Carole interview

Carole and Nick chatting via video link

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.

Care and cure magazine: Autumn 19

Care and cure is the research magazine of Alzheimer's Society is for anyone interested in dementia research.
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Care and cure is the research magazine of Alzheimer's Society is for anyone interested in dementia research.
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11 comments

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Good day. Last Friday the telegraph printed a small article on the use of high-pressure oxygen (in a hyperbaric chamber) as a potentially successful method of slowing (and even, possibly, reversing) the progress of dementia in a trial group of patients. While such high-pressure treatment wouldn't be possible at home, could you please tell me whether regular periods of inhaling oxygen at ambient pressure ( via a cylinder or oxygen concentrator) are likely to have any beneficial effect? The financial outlay for the equipment necessary would be significant for me, so I would value an expert opinion on whether it would be worth it and, if so, how frequent and how long the sessions should be. Many thanks.

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Hi Norman,

Thanks for your comment.

The research on high-pressure oxygen that the Telegraph covered was mostly done on mice. The mice had copies of 5 different genetic errors that can cause a form of Alzheimer’s disease that can be passed down from generation to generation. When they had high-pressure oxygen therapy, the researchers that they performed better on memory tests compared to mice that hadn’t had this treatment.

There were also 6 people who took part in this study. For them, the researchers measured blood flow and memory, and thinking skills before and after high-pressure oxygen therapy. However, these weren’t people living with dementia, and we don’t know if they went on to develop dementia after the study. For this reason, it’s too early to say whether high-pressure oxygen could be helpful for people who are at risk of dementia or who have dementia.

Hope this helps.

Alzheimer's Society research team

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I am 77 years old, my mother in law said she was 'losing her memory" and she often got lost close to her home when she was driving her car... she blamed Alzhiemer's and we thought the same. A few months ago I lost some valuables when I 'forgot' to take my bag in from playing sport... I then 'forgot' about the loss as I had been feeling confused, woozy and out of balance for some time. People noticed my odd ness and, as I was later told, they asked "What's he on?" /"Why's he walking so slowly?" etc. I felt 'drunk' most of the time, gave up driving and blamed the alcohol in the hand sanitisers [that we all used to avoid covid-19]. I thought I may have absorbed alcohol via my skin. My Dr. did not agree -possibly he too thought I might have Alzheimer's-but I did more research and learnt that I could have been affected by the alcohol breathed in as a vapour... That better fits what I 'd done as, when I gave up using sanitisers, I began to feel better. I post this as a caution to anyone else who may use (high alcohol content ) sanitiser in these Covid times.

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Hi Nicholas,

Thanks for your comment. We're sorry to hear about your mother-in-law.

There is no evidence that thinking or memory is affected by using alcohol-based sanitizers on the skin. A very small amount of alcohol can enter the bloodstream from using sanitizers. However, even if you applied hand sanitizer 20 times in 30 minutes, your blood alcohol content would only increase to 20 milligrams per litre – that’s 40 times lower than the legal limit for driving in England, Wales and Northern Ireland – and it would only remain at this level for a short while.

We encourage everyone to keep regularly washing their hands or sanitizing with alcohol-based rubs to limit the spread of Covid.

However, Nicholas, please know that you can always call our Dementia Connect support line on 0333 150 3456 for more information, advice and support. More details about the support line (including opening hours) are available here: https://www.alzheimers.org.uk/dementia-connect-support-line.

We hope this helps.

Alzheimer's Society research team

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My father also has been diagnosed with dementia disease . And He is just 50 years old ,this disease is ongoing since 3 years. I am from India 🇮🇳. And I want to know about the reaserch on dementia disease and how the progress of treatment of DEMENTIA.

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Hi Nitin,

Sorry to hear about your father's diagnosis. Please do call our Dementia Connect support line on 0333 150 3456 if you need any support.

For all the latest news about dementia research, we have a free monthly research magazine and newsletter. You can sign up to receive those here:
https://www.alzheimers.org.uk/form/care-and-cure-magazine

You can also find out more about our research and the projects we're currently funding here: https://www.alzheimers.org.uk/research/our-research

Hope this helps, Nitin - let us know if we can help with anything else.

Take care,

Alzheimer's Society blog team

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Well i would like to have read more on what there is that my Husband could take to help him in getting somewhat better He is in a nursing home he can no longer read or write. he hates where he is he is sad and down. Last week another patient dragged his fingernails taking the skin off my husbands hands, this makes him rather nervous and that night he used his mobile at 1.15am early hour in the morning to call just begging me to go and get him it was a jumbled talk i thought he was dreaming. i just said said you go to sleep. when i went in the morning i saw his hands bandaged the manager was to see him that morning but never turned up. my daughter said forget it as these things happen. i am in a stressful state at times.

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Please could you tell me if you use human embryos in any areas of your research. Thank you.

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Hi Stella, thanks for your comment.
At the moment we aren’t supporting any research project using embryonic stems cells. You can read our full policy on this subject here: https://www.alzheimers.org.uk/about-us/policy-and-influencing/what-we-t…
Thanks,
--
Alzheimer's Society blog team

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I have heard a lot about the Information series online called " Awakening from Alzheimer's"- Regain your Brain" 10 episodes. We are watching these and wonder if this is a legitimate series that is supported by the American Medical Society. There are many doctors on this series that are very informative and seem to have much of the latest research into Alzheimer's. Have you heard about this series ?

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Hello Jan, thank you for getting in touch.
We think the series you are referring to focuses on a type of alternative therapy known as the Bredesen Protocol. This intensively uses diet, physical activity, nutritional supplements and herbal medicine to 'reverse' dementia. It is mostly sold through the services of alternative health practitioners, particularly naturopaths and nutritional therapists.
Given what we already know about risk factors for dementia, it makes sense that managing health issues (such as vitamin deficiencies, type 2 diabetes and high blood pressure) would have a positive effect on someone’s memory and thinking abilities. Despite some claims, there is no firm evidence that this type of intensive lifestyle regime can ‘reverse’ Alzheimer’s disease, so the way this approach is being marketed is concerning.
A holistic and person-centred approach to treating dementia is welcome, but Professor Bredesen’s intervention would need to be properly tested in clinical trials so that people can make informed decisions about its benefits.
We hope this helps to answer your question.
-
Alzheimer’s Society research team

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