The first G8 summit on dementia was held at the end of 2013 in London, UK, bringing together health ministers from the G8 nations, as well as scientists, researchers, pharmaceutical companies and charities, in order to address how best to tackle the global burden of dementia. The summit aimed to help drive forward dementia research to aid prevention and treatment, and improve the quality of life of those with dementia.
We asked a global panel of experts in dementia research, all of whom are members of the Editorial Board for Alzheimer’s Research & Therapy, three key questions arising from the summit: How achievable is it to identify a cure, or disease-modifying therapy, for dementia by 2025?, what objectives would you propose for the international research action plan?, and how would you summarise the outcome of the first G8 dementia summit, in one sentence?
Our panels of experts
How achievable is it to identify a cure, or disease-modifying therapy, for dementia by 2025?
Martin Rossor: It is notable that a cure is for dementia and not Alzheimer’s disease. It is most unlikely that there would be a single treatment of all dementia diseases – but a cure for a dementia is feasible by 2025.
Sandra Black: In order to achieve such a goal, as a field, I think we need to embrace the heterogeneity and complexity of the different dementias including the reality of co-morbid disease pathologies, which is the most common substrate of the dementia syndrome, especially in the elderly. Even in the frontotemporal degenerations, pathology studies are increasingly suggesting that co-morbidity is the norm so this is not only applicable in Alzheimer’s disease.
I believe that heterogeneity must be better understood in order to personalize the approach to management of these disorders, which in the future will be guided by a combination of imaging and fluid biomarkers and genomic profiling. Neuroinflammation and vascular pathologies will likely turn out to be pretty crucial to the evolution of these syndromes.
The thrust toward attacking the earliest stages of disease that we can reliably detect and safely intervene on seems the most promising, but we will still need to be able to provide more effective ameliorative therapies for patients at the dementia stage, whom we still commonly face in tertiary memory clinics and in primary care.
Carol Brayne: We already have modifying therapy in the beta amyloid trials, what we don’t have is anything pharmaceutical which improves outcomes in the longer term. It would seem reasonable to expect some of the work being done might be effective for the early onset specific dementias. An approach that radically changes outcomes in ‘usual’ dementia might be more challenging. The mantra of finding a cure seems more driven by the need to support drug development and keep neuroscience research in the UK at the international forefront, in an area that might be highly profitable for Europe and the UK in particular.
Bengt Winblad: By 2025, we will have an answer to whether anti-amyloid drugs (immunotherapy, BACE inhibition) will work in familial Alzheimer’s disease. However, I do not think we will have disease modifying drugs for sporadic Alzheimer’s disease by this time.
What objectives would you propose for the international research action plan?
Nick Fox*: It is vital that we find ways to delay the onset or slow progression of dementia, and deliver care and manage symptoms in radically different ways. We need research in these areas and we must also address barriers to research progress, which range from our incomplete understanding of basic disease mechanisms to the challenges of undertaking increasingly costly and time-consuming clinical trials.
Jinzhou Tian: I would propose biomarker research involved in imaging, etc in the early stages of Alzheimer’s disease (AD), screening and diagnosis for the early stages of AD, and longer term trials of potential therapies in AD across nations.
Bengt Winblad: Strengthen research efforts to elucidate the basic biology of Alzheimer’s disease and find ways to identify patient groups with homogenous etiology.
Martin Rossor: I would prioritise the plans for rapid open access.
Sandra Black: I do believe that sharing of information and data from research studies across countries and different disease states would be useful and we should encourage open access. However, in order to encourage participation on the frontline, including increasing the number of doctors and other professionals conducting clinical trials and patients involved in clinical trials, there need to be ways to reward and make worthwhile the enormous efforts to do this well.
There could also be a global action work plan with division of labour from different countries and populations so that evidence is obtained more quickly, so known drugs can be repurposed faster, and healthy brain protective lifestyle choices can be promoted from birth, guided by incentives and discouraging industry from manipulating addictive vulnerability and human psychology to make money resulting in a greater burden of illness.
Carol Brayne: Research ways to help younger populations live lives that are optimal in terms of exposures and health so that they reach 65 as healthy as they can be. These might be educational policies, health policy research, social and behavioural science, built environment, optimising interventions and treatments.
Taking stock in a systematic way of what we already know would be good as there is a lot of reinventing the wheel – from someone who has been researching for nearly 30 years I am seeing abstracts which cover exactly the same ground I was covering in the late eighties.
Thinking about what we can do most effectively for those living with dementia now, and for the generations coming after including economic and social research.
How would you summarise the outcome of the first G8 dementia summit, in one sentence?
Sandra Black: The first G8 summit finally begins a long and difficult journey by bringing world attention to the implications of population aging, which is a threat to healthcare and social welfare throughout the world.
Carol Brayne: It raised profile of dementia internationally in a reasonably positive way providing the promise of a better quality of life for those living with dementia, as well as those who may be at risk in the future.
Jinzhou Tian: The best return from the best strategy!
Martin Rossor: The very fact that it happened at all is a great success and will provide much needed political support.
The summit concluded with the publication of a declaration of agreements reached by the participating countries, signifying a commitment to support an international effort to tackle dementia. Find out what Alzheimer’s Disease International’s Executive Director, Marc Wortmann, made of these outcomes here.
*This quote from Nick Fox was reproduced with his permission from the comment article by Fox NC & Peterson RC (The Lancet. Dec 2013, 382, 9909, 1968-1969)