Alzheimer’s Disease (AD) has been known in the field of medicine for about a century, yet every year, amidst hearing about the growing impact from this debilitating disease in an ageing world, we have perhaps not heard enough about ways to improve the research pipeline in the quest to stem and reverse the effects of this disease.
After Dr Alois Alzheimer first described the disease in Germany at the turn of the 20th century, scientists have been on a quest to understand and cure AD, but progress has been slow – unsurprising when we consider that researchers are only able to discover the accuracy of their line of study years after commencing.
The Burden Of Alzheimer’s Disease
However, the burden of AD is fast outpacing the research, as the elderly population continues to grow worldwide.
The number of people living with dementia (PLWD) – of which AD is a major cause, is projected to increase exponentially, with the total health costs worldwide already estimated to be well over USD400 billion (RM1.7 trillion) a year currently.
By 2030, it is estimated that there will be 64 million PLWD globally, and almost doubling to more than 115 million by 2050.
With early diagnosis and management an important factor in mitigating the impact of AD, it is crucial to overcome the problem of under-diagnosis.
Currently, only about 25 per cent of people with AD are diagnosed globally, and it is similar in Malaysia. In 2006, it was estimated that 63,000 people had AD, with the current number double that and projected to reach 500,000 by 2050.
Meanwhile, according to the National Health and Morbidity Survey 2018, about one in 10 persons aged over 60 suffers from dementia, with prevalence higher among rural residents, women, people with no formal education, and people with lower income levels.
AD cases usually go undiagnosed because many family members and caregivers assume that symptoms such as forgetfulness manifested by the elderly under their care are due to ageing.
The risk factors, too, are fairly common, including advancing age, genetic predisposition, low education level, untreated depression in midlife, vascular diseases and other related unhealthy lifestyle behaviours.
Thus, it is timelier than ever to adopt the theme of World Alzheimer’s Day 2021 – Know Dementia, Know Alzheimer’s. We urgently need to shine a light on the warning signs of dementia and the importance of timely diagnosis.
With proper information, advice and support, people are better able to prepare, plan and adapt, ultimately helping to improve quality of life, social skills and future security for the patient.
The Quest For A Cure
Efforts in finding a cure have been ongoing in hundreds, if not thousands of research laboratories around the world for decades, and while progress has been incremental, with many detours required, scientists have nevertheless determined a number of factors causing AD.
The accumulation of toxic clumps of beta amyloid protein (plaque) in the vicinity of brain neurons and the formation of tau protein tangles within the brain cells are observed to lead to the inability of neurons to transmit information to and from the hippocampus – the centre of information storage and processing in the brain.
Hence, no new memory can be created and most, if not all stored memory becomes irretrievable.
In addition, scientists also discovered the potential of monoclonal antibody use, the importance of early treatment — preferably before the appearance of symptoms, and the potential of using predictive markers in blood or brain fluid as diagnostic tools.
In the complex and time consuming field of neurological research, breakthroughs can be few and slow to emerge, despite many promising leads.
While current AD treatments can temporarily improve symptoms of memory loss and problems with thinking and reasoning, they don’t stop the underlying decline and death of brain cells that cause disease progression.
We may ultimately need combination treatments, similar to treatments for cancers or HIV/AIDS. For example, we have current research focusing on using monoclonal antibodies and production blockers to target beta amyloid plaque, as well as on using tau aggregation inhibitors and vaccines to prevent tau protein tangles, and also other studies on treating brain cell inflammation and discovering the linkage between heart and blood vessel health and AD.
Collaboration Is Key
To help accelerate discovery amidst the many roadblocks, in a first-of-its-kind partnership, the Coalition Against Major Diseases (CAMD) – an alliance of pharmaceutical companies, non-profit foundations and government advisers, was founded in the United States to share data from clinical trials on AD, besides collaborating with the Clinical Data Interchange Standards Consortium (CDISC) to create data standards.
Researchers anticipate that these data standards and the sharing of data from more than 6,500 study participants will speed the development of more effective therapies.
Between underfunding of AD research compared to diseases like cancer, heart disease, HIV/AIDS and even Covid-19 — partially due to its perception as an old-age disease, and also due to dilution of funding caused by the vast array of potential research pathways and years-long research due to the chronic nature of AD, there is much that can be done to improve the pipeline.
Malaysian pharmaceutical leader Duopharma Biotech Berhad is among those who have provided much-needed funding in AD research, having invested in AZ Therapies, Inc, a Boston-based biopharmaceutical company developing novel small molecules and biologic therapies that aim to fundamentally change neurodegenerative disease progression, extend normal cognition and function and improve quality of life in the ageing population.
Currently, AZTherapies’ lead candidate ALZT-OP1 targets neuroinflammation as the root cause of neurodegenerative diseases, with the latest results of its Phase 3 clinical trial expected to be announced soon.
“The human brain is an immensely complex and a very important organ controlling every single one of our functions. We believe it is important to support any viable research to find treatments for neurodegenerative diseases. At Duopharma Biotech, as an industry leader focused on offering innovative solutions to improve quality of life, we are pleased to be part of this momentous scientific endeavour,” said Leonard Ariff Abdul Shatar, group managing director, Duopharma Biotech Bhd.
AD can potentially impact all of us, and while we depend on the scientists to offer new hope in curing this dreaded disease, let us take more preventive steps to reduce the risk among our loved ones and ourselves, and ensure that everyone impacted is diagnosed and cared for as early as possible.
As a global community, let us all also consider future access to AD treatments, especially for patients in middle- and lower-income countries. The disease harms all people, families and communities, and it will surely bring great joy if treatments are accessible and affordable for all.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.