Qatar Biomedical Research Institute QBRI

According to the World Health Organization (WHO), around 50 million people worldwide have dementia, and there are nearly 10 million new cases every year.

Dementia is a devastating disease that causes great stress for patients and their families, and there are many forms of dementia. Alzheimer's is the most common cause of dementia, which is thought to be caused by an abnormal build-up of proteins in and around brain cells. This leads to a decrease in neurotransmitters involved in sending signals between brain cells, a process that begins up to 18 years before symptoms appear. The process that destroys the brain involves two proteins, beta-amyloid and tau. Beta-amyloid clumps into plaques, which slowly build up between brain cells. Abnormal tau accumulates inside brain cells, forming tangles which lead to cognitive decline.

Dementia patients already experience memory loss and confusion, but 2020 has been even more difficult for patients, and a time of concern for their families. A regular daily routine is essential for people with dementia, but this has not been possible during 2020 due to COVID-19 restrictions and has left family members unable to visit and/or interact with them. People living with dementia also struggle to remember safeguarding procedures, such as wearing masks, which exposes them to an even higher risk of infection. 

The pandemic has led to an extremely high death rate among people with dementia globally, according to Alzheimer’s Disease International. In Canada, for example, 85% of all COVID-19 deaths are people in long-term care, while up to two thirds of all COVID-19 related deaths are people with dementia. In the UK, that figure is 26%, and in regions of Italy it is 20%.

The total number of people with dementia is projected to reach 82 million in 2030 and 152 million in 2050, which is one of the reasons why research on new strategies for earlier diagnosis is among the most active areas in the Alzheimer's research community. The disease is typically diagnosed only after symptoms appear, and when there is little that can be done.

Currently, the brain changes that occur before Alzheimer’s dementia symptoms appear can only be reliably assessed by positron-emission tomography scans, and from measuring amyloid and tau proteins in cerebral spinal fluid. These methods are expensive and invasive.

However, a very important recent finding provided excellent news. At the recent annual Alzheimer’s Association International Conference, scientists reported results of multiple studies on advances in blood tests for abnormal versions of the tau protein, which may be able to detect changes in the brain 20 years before dementia symptoms occur. 

The reports focused on a specific form of tau known as p-tau217, which appears to be the most specific to Alzheimer’s disease and is the earliest to show measurable changes.

Given that there is no cure for Alzheimer’s disease, early detection is crucial given that the WHO has warned that, if left unattended, the disorder could triple in the next 30 years.

Experts believe that biomarkers (short for biological markers) offer one of the most promising paths. Dr. Omar El-Agnaf, Executive Director of the Qatar Biomedical Research Institute (QBRI) at Hamad Bin Khalifa University, is excited by the developments.

He said: “It is a compelling development in the research of Alzheimer’s disease and can be as good as imaging, which is very expensive, takes a long time, and is not available in every hospital. To have a simple blood test that can identify those at higher risk of developing Alzheimer’s disease, and to do so up to 20 years before symptoms show, would be a huge step forward in the battle against Alzheimer’s disease.”

“I would like to see QBRI become involved in developing this blood marker in-house, and with our collaborators from HMC and WMC-Q, as it could be of great benefit to our Qatari population,” he continued. 

The Neurological Disorders Research Center at QBRI, houses a leading research group, focusing on biomarkers research in dementia.

Diabetes is considered a risk factor for dementia with some studies claiming up to 50% of type 2 diabetes patients are at risk of developing dementia. Many people with diabetes have brain changes that are hallmarks of both Alzheimer's disease and vascular dementia, and the region has a high incidence of type 2 diabetes.

Dr. El-Agnaf added: “I believe the best approach to manage any disease is to prevent it rather than treat it and I am thrilled about the prospects of this recent research. If we can start treating people at an early stage, when they are at high risk of developing dementia, it would be far more effective.”

In addition to this breakthrough, progress has also been made in relation to the treatment of Alzheimer’s disease and American multinational biotechnology company Biogen has reported positive outcomes from clinical trials of the monoclonal antibody Aducanumab, and has recently applied for approval from the U.S. Food and Drug Administration (FDA). 

Eisai Co. Ltd., a leading global pharmaceutical company based in Japan, are collaborating with Biogen to produce Aducanumab and believe that, if approved, it will make a significant difference in improving the lives of people living with Alzheimer’s disease and will be a major step towards creating a paradigm shift in the treatment of the disease.

No drug has been approved in this area for the past 17 years, so if Biogen is successful, it could provide a major breakthrough in the battle against Alzheimer’s disease.

Alongside scientific research, the social implications of this disease also require special attention. Recently in Qatar, a National Alzheimer’s and Memory Services Helpline was launched under the guidance and leadership of Dr Hanadi Khamis Al Hamad, National Lead for the Healthy Aging and Focal Lead for Global Dementia Observatory of WHO to improve the care given to the elderly. The RAHA helpline offers free confidential and caring telephone support for people living with Alzheimer’s, their caregivers and families.

Dr. El-Agnaf highlights that people can improve their own chances of avoiding developing dementia by making healthy lifestyle choices. He explained: “I urge people to lead a healthy lifestyle - not only eating well and exercising, but also getting enough sleep, and avoiding stress, as that will help to reduce the chances of them getting dementia later in life. I fully endorse the 12-step guide released by the World Health Organization to reduce the risk of getting dementia.”

These 12 steps are:

• Exercise.
• Quit smoking.
• Eat well.
• Avoid heavy alcohol intake.
• Brain training.
• Be social.
• Manage weight.
• Check blood pressure.
• Check for diabetes.
• Check cholesterol.
• Depression.
• Check hearing.