Our understanding of the disease process is changing, in a way that can make early diagnosis more valuable. Dementia has a very long preclinical stage – as long as 20 years, in some cases – during which scans and blood tests can detect subtle changes but the symptoms have not yet been seen.
In this window dementia patients begin to show two proteins in the brain: tau and amyloid. Researchers have struggled for years to find out exactly what role they play, but now some people think they have an answer. In patients with dementia and Alzheimer’s, amyloid forms tangles and plaques in the gaps between brain cells. The Theory Once it is made up to a certain level, it triggers the Tau protein – which is usually part of the weight of the neuron – to convert from normal to a toxic state. It kills cells and interferes with the ability of neurons to send clear signals, causing most symptoms.
In June 2021, The FDA has given quick approval aducanumab, the first new drug for Alzheimer’s disease in 18 years. It is designed to stick to amyloid molecules and makes them easier for the immune system to clean. This is a controversial method, however, because drug treatments aimed at clearing amyloid have failed to make much difference in the past.
In the emerging theory of dementia, however, the timing of the intervention may be critically important. With better early detection, drugs like aducanumab can be given when they still have time to differentiate. “If you remove amyloid at a very early stage, that’s probably when the real benefits come,” Koyechev said. If the amyloid could be cleared from the brain before triggering the toxin to be toxic, perhaps the worst effects could be delayed or avoided altogether.
Easy-to-use digital tests can be combined with brain scans and blood tests to help researchers map out exactly how amyloid and tau proteins are related to cognitive impairment – and whether clearing them makes a difference. Instead of a blanket method of screening everyone, Koyechev recommends targeting people in the most at-risk groups through regular assessments.
He mentions, however, that there are and still are many disagreements in the case Serious suspicion Whether the new drug will work as expected for Alzheimer’s. But it has revived research that Habibie calls a “long-term drought” that lags behind cancer in terms of investment and interest from pharmaceutical companies. Denning thinks it’s due to a combination of different factors – the stigma of the disease, usually the advanced age of those who drink it and a fatalistic “okay, when you get old” attitude.
As a large and prosperous demographic group moves into the age bracket, the situation is changing where the risk is highest. Experiments like the ICA have targeted them, but Koyechev hopes they will “democratize access to brain health.”
Since they’re digital and only semi-supervised, they can be taken anywhere you pick up an iPad. This means that they can reach people who are excluded from traditional studies, often overcrowded by volunteer groups that do not accurately reflect the underlying population. These can be taken more often to create a picture of a person’s cognitive performance over time.
We may still lack good treatment for dementia and Alzheimer’s disease, but the ability to identify them early can change our attitude towards them, which in itself can improve our understanding and invest in the solutions we need. “Brain health will become something that people monitor and care for, just as you take care of your physical health,” Koyechev said.
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