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Alzheimers Sep 20

No time to waste: prioritising early detection of Alzheimer’s disease

iStock / Getty Images Plus / Ridofranz

Professor Craig Ritiche

Director, Brain Health Scotland

Despite extensive global research efforts, to date, there are no disease modifying therapies for Alzheimer’s disease. Detecting any disease early on gives us the best chance of intervening and halting progression.

Alzheimer’s disease begins with a long, preclinical phase, with damage in the brain building up gradually, many years before problems with memory or thinking emerge. This is often referred to as the ‘silent period’ of disease.

However, much like the high pitch chatter of a fruit bat or the soft, low moan of a blue whale, we experience silence only when we lack appropriate tools with which to listen. Just as employing ultrasonic and infrasound detectors reveal signals within nature that we would otherwise be oblivious to, we need to evolve our health services to focus on early signals of disease.

Scotland, under the stewardship of Brain Health Scotland, will become the first country to launch a national network of brain health clinics. These specialised services will be proactive about prevention and ensure we extend our range of hearing beyond the narrow frequencies tuned in to by the traditional memory clinic structure.

We need to evolve our health services to focus on early signals of disease.

Measuring brain changes

To detect the presence of early disease we need biomarkers; reliable, measurable characteristics that tell us early changes are taking place in the brain. The same way cholesterol and blood pressure readings can act as a harbinger of future heart disease or stroke, we need similar methods for evaluating brain health, allowing us to pick up on any hazardous trajectories and intervene early.

Advances in brain health research have given us a detailed understanding of these biomarkers. In Alzheimer’s disease, we can measure levels of signature abnormal proteins in the cerebrospinal fluid and on specialised brain scans. Recent developments also show accurate blood tests are set to soon be ready for clinical use.

Personalising prevention

The successful strategies for delaying or preventing progression of Alzheimer’s disease will be similar to current practice in managing other health issues; a combination of lifestyle changes and, for some people, a targeted drug. The important thing is that these interventions will be tailored to the individual, addressing the processes that are driving their own personal risk.

Brain research is driving our understanding of biological disease processes long before dementia. Now is the time to apply this knowledge in our health services and usher in the era of personalised prevention.

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