Home Mind & Brain Prioritising Alzheimer’s Prevention Should Be Our Focus

Prioritising Alzheimer’s Prevention Should Be Our Focus

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In the UK, dementia is the leading cause of death overall, particularly for women, while for men, ischaemic heart disease remains the leading cause. Dementia is also a global issue, affecting 50 million people worldwide.

It is no surprise that a huge amount of funding is being made available to tackle the issue; the quest for a cure for Alzheimer’s disease has driven the medical industry to invest around $100 billion in research.

But they have come up relatively empty-handed with over thirty failed drug trials. While this is disheartening, there is promising news on the horizon. A simple, inexpensive test could potentially predict Alzheimer’s, enabling preventative measures that could save the NHS over £60 million annually.

The current focus in Alzheimer’s research

Historically, the focus has been on developing drugs to reduce two chemical compounds associated with Alzheimer’s and dementia: amyloid and p-tau. These proteins can form plaques in the brain and lead to tangled nerves. However, there is a third compound – homocysteine, an amino acid that becomes toxic at high levels – which has not received as much attention from the drug industry and Alzheimer’s charities.

Clinically, Alzheimer’s is diagnosed through a decline in cognitive function and the shrinkage of the medial temporal lobe in the brain. Both of these changes can be detected up to thirty years before an official diagnosis.

Current studies and their drawbacks

A £10 million study is currently investigating whether a blood test for p-tau or amyloid can predict the likelihood of developing Alzheimer’s. This initiative aims to identify those at risk and treat them early. However, this approach has significant drawbacks. Not everyone with elevated p-tau or amyloid levels will develop Alzheimer’s. Moreover, recent reports have highlighted that individuals without a diagnosis or brain shrinkage could be offered new drug treatments with severe side effects, including brain bleeding or swelling, which have occurred in over one-fourth of participants in recent trials; there have also been seven deaths. Despite these risks, many desperate patients are enrolling in these trials, hoping for the elusive cure to be found.

Alternative approaches

Are there alternatives to these risky treatments? Yes, but they are rarely communicated to patients. Diet and lifestyle changes can significantly improve overall health, including brain health, with minimal risk of adverse effects. Unfortunately, most research funding is directed towards drug treatments. Alzheimer’s Research UK (ARUK), for instance, primarily funds amyloid and p-tau research, even though high levels of these proteins may merely be a consequence of the disease rather than a cause.

Role of homocysteine

Unlike amyloid and p-tau, high levels of homocysteine are causally linked to faster brain shrinkage and cognitive decline. Lowering homocysteine levels through high-dose B vitamins (B6, B12, and folate) has been shown to improve cognitive function and slow brain shrinkage in several gold-standard, placebo-controlled trials. This approach is safe and effective but not patentable, making it less attractive to the drug industry.

Routine checks for homocysteine levels could prevent thousands of Alzheimer’s cases and save the UK economy approximately £60 million annually, according to Dr. Apostolos Tsiachristas from the University of Oxford. His research also suggests that such preventative measures could add 14 years to life expectancy.

Supporting studies

In a significant study, one-third of participants treated with B vitamins showed no clinical dementia rating (meaning they could no longer be diagnosed with cognitive impairment) by the end of the study. Participants with adequate omega-3 DHA experienced 73% less brain shrinkage compared to the placebo group when given B vitamins. In contrast, in the last anti-amyloid treatment trial, brain shrinkage accelerated by about a fifth in those getting the drug, compared to placebo and not one person achieved a clinical dementia rating of zero.

Prevention is key

Alzheimer’s, which accounts for two-thirds of dementia cases, is highly preventable. Estimates suggest that at least 40% of cases could be prevented with optimal diet and lifestyle factors. In the UK, reports on dementia prevention have overlooked homocysteine, despite strong evidence of its significance from the Oxford Project to Investigate Memory and Ageing (OPTIMA).

Given that a significant proportion of Alzheimer’s cases could be prevented, it is crucial to allocate research funding towards prevention. Currently, prevention receives minimal funding from leading charities. Effective prevention strategies must consider the interplay of various risk factors and adopt a holistic approach.

The only ongoing study and database, the COGNITION Biobank, that assesses risk factors as well as includes blood tests of four critical biomarkers: homocysteine, omega-3 index, vitamin D and HBA1c, which measures glucose control, is being run by the charity Food for the Brain. It describes itself as “citizen science” because anyone can get involved by doing a free online cognitive function test, filling out a questionnaire about their diet, lifestyle, and medical history, and sending in a blood sample from a home test kit. 

So far, over 400,000 people have been tested. It receives no funding, however, in contrast to the £10 million trial that has received support from the Gates Foundation, ARUK, and the Alzheimer’s Society. Literally, citizen scientists who contribute £50 a year and pay for their own tests fund it. Their message is simple: prevention is better than cure.


To find out more about prevention, click here.

Patrick Holford is a nutrition and mental health expert and founder of the Institute for Optimum Nutrition, VitaminC4Covid, and the charitable Food for the Brain Foundation

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