Here's Why.
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| Mechanisms of action by which addressing each risk factor can potentially reduce dementia risk. (WHO) |
Dementia research has reached a profound turning point.
Alzheimer's
disease was once considered 'untreatable', but that is not the universal rule
any longer, according to this year's World Alzheimer Report.
In the past five years alone, novel drugs have been shown to
modestly slow decline in early Alzheimer's, while growing evidence suggests
some dementia cases could potentially be delayed or prevented through risk
reduction.
Today, hundreds of clinical
trials worldwide are now investigating possible medicines, new diagnostic
options, and lifestyle interventions to identify, treat, or delay cognitive
decline.
The possibility of a cure is still far away, but it
"feels like a more palpable prospect than ever before," according to
the 2026 World Alzheimer Report, coauthored by Alzheimer's Disease
International (ADI) and leading health journalist Paul Gallagher.
"After decades during which dementia was widely
regarded as an inevitable consequence of old age and neurodegeneration with few
therapeutic options beyond symptom management, research has entered an era of
unprecedented activity," reads
the report.
"Alzheimer's disease is no longer universally described
as untreatable; instead, it is increasingly viewed as a condition for which
earlier diagnosis, better understanding of disease biology, and a wider range
of interventions may collectively improve outcomes."
ADI
calls itself the 'global voice of dementia'.
It is a worldwide federation of dementia associations in official relations
with the World Health Organization (WHO).
Every year since 2009, the ADI has published a report on dementia research, and each year, it covers a different topic.
This year's report is titled 'A New Era in Dementia Clinical
Trials', and it argues that dementia research has now entered a period of
remarkable scientific momentum.
This moment is akin to oncology in the 1990s, argue the
authors, when the first generation of cancer therapies,
while imperfect, opened the door to effective drug combos, precision medicine,
and earlier intervention.
"For now, there is no single breakthrough to rival the
discovery of penicillin or the advent of statins," argues
the report.
"Instead, there is something quieter… It is a shift
from cure to prevention, from molecule to lifestyle, from inevitability to
possibility."
As populations age worldwide, some estimates predict there
will be 139 million people living with dementia by 2050.
Even modest delays in the onset of cognitive decline could
translate to millions fewer cases.
Just recently, for instance, WHO published
new guidelines on how to reduce the risk of dementia.
According to emerging research, as many as 45 percent of
dementia cases could potentially be prevented or delayed by addressing 14
modifiable risk factors across the lifespan.
These include hypertension, depression,
physical inactivity, smoking, diabetes, excessive alcohol use, and high cholesterol.
Dementia clinical trials also stand at an important moment in history, according to the report.
Between 2000 and 2020, more than 99 percent of experimental
drugs failed in clinical trials.
The recent arrival of the drugs donanemab and lecanemab was
a huge moment, argues
Cath Mummery, director of the UK's Dementia Trials Network.
These were the first fully approved drugs shown to modestly
slow the progression of early Alzheimer's disease, rather than merely treating
its symptoms.
"What you really hoped for was a bigger effect [on
patients], but it was a huge moment because it showed you could change the
course of the disease," says
Mummery in the report.
"That's the foundation. It's the first brick, and
there's an awful lot to build on."
Today, not all researchers are convinced
that donanemab and lecanemab lead to clinically meaningful benefits; for
instance, they don't seem to work the same for every
patient or in every
part of the brain.
But the approval of these two drugs represents a positive
turn of events, which has changed our expectations for what dementia research
may achieve, argues the new report.
Over the past decade, the number of candidate medicines
under investigation for dementia has increased by around 40 percent.
Currently, researchers are evaluating 158 potential
therapies across 192 clinical trials worldwide.
This year alone, we should get results from eight Phase III
trials – which rigorously test treatments on a large number of people in
comparison to standard care.
A lot of these drugs are already approved for use in humans.
In fact, more than a third of dementia drugs currently in the pipeline were
originally developed for other conditions.
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| Explanation for phase III clinical trials. (ADI 2026 World Alzheimer Report) |
Unfortunately, however, many patients in the early stages of cognitive decline do not know these possibilities exist.
Neuroradiologist Emer MacSweeney told ADI:
"The biggest mistake that's happening at the minute is people who are
clearly, obviously, most likely in the early stages of Alzheimer's, being
ignored and completely missed… because that window of opportunity is really
small for treatment."
MacSweeney says patients are often uninformed about clinical
trials or how to access new medications.
"This is a pandemic,"
MacSweeney emphasizes.
"We need a change in mindset in the medical profession to ensure more
people are told about clinical trials and supported to join them. We need
action, not rhetoric."
One of the biggest potholes in the road is diagnosis.
A new generation of treatments that can potentially slow the
decline of memory and thinking is all well and good, but these medicines are
only useful if they actually get to patients.
In the United Kingdom, for instance, only about 2 percent of
people diagnosed with Alzheimer's have access to a gold-standard diagnostic
test, according to a study co-led by Jonathan Schott, Chief Medical Officer at
Alzheimer's Research UK.
Blood
tests that look for biomarkers of dementia could be a solution.
While these new tools look promising in initial studies,
they still need to be tested at a population level to see if they can
accurately identify those individuals with early signs of cognitive decline.
"A breakthrough drug means little if the majority of
people living with dementia are never identified in the first place," argues
the ADI report.
"In that sense, the future of dementia care may depend
as much on family doctors in Havana, Lima, or Bangalore as on billion-dollar
laboratories in California."
According to the report, there is genuine cause for
optimism. Now we just need to make sure that scientific progress is matched by
clinical progress.
"The challenge for the next decade is to ensure that
taking part in dementia research no longer depends on persistence or good
fortune," concludes
the report, "but becomes a realistic opportunity for everyone who wishes
to consider it."
The report is published on the ADI website.
This article was fact-checked by Peter Dockrill and edited by Peter Dockrill.
