Dementia is one of the most challenging global health problems of the 21st century. It affects over 47 million people globally and this number is expected to rise dramatically by 2050 to over 135 million. The MRC Biostatistics Unit, through its partnerships in the European Prevention of Alzheimer's Dementia (EPAD) initiative and the MRC Dementias Platform UK (DPUK), is committed to collaborative dementia research with world leading experts from private, clinical and academic sectors to accelerate research through a more integrated and coordinated strategy, the development and testing of new interventions (both new drug treatments and non-pharmacological therapies) and the understanding of early aspects of the disease before mild cognitive impairment develops. The ultimate objective is to increase the chances of success in preventing the onset of dementias or delaying the progression to dementias.
The MRC Biostatistics Unit, through the involvement of its senior scientists, Dr Adrian Mander, Dr Brian Tom, Professor Fiona Matthews, its director, Professor Sylvia Richardson and other staff members will provide the statistical expertise in stratified medicine, clinical trials design, genomics and dementias research that underpins these projects.
In particular, the Unit will lead on the work to develop the appropriate methodologies for risk stratification and prediction (both baseline and trajectory-related) and adaptive trial designs, which will help identify participants who would be invited to enter clinical trials of new treatments, allow the exploration of biomarkers predictive of treatment response or the validation of proposed candidate markers. The process of building the appropriate models and adapting the trial based on these models will be an iterative one ensuring that the right participants enter into the trial as our knowledge increases over time.
Dementias Platform UK
The MRC Dementias Platform UK (DPUK) is a multi-million pound public-private partnership launched in 2014, developed and led by the Medical Research Council, to accelerate progress in, and open up, dementias research. The DPUK’s aim is to accelerate research progress and develop knowledge leading to new drug treatments and other therapies that could prevent or delay the onset and progression of dementias.
The DPUK is creating the world’s largest population study for use in dementias research, bringing together two million participants aged 50 and over, from 22 existing study groups within the UK. Included are people from the general population, people known to be at-risk of developing dementia, and people diagnosed with early-stage dementia.
By adding to information that we already know about the participants (such as their diet, exercise habits and previous infections) we hope to identify cognitive, genetic, physiological and imaging measures (biomarkers) to understand who is at risk of developing dementia and why the progression of dementia varies from person to person.
The DPUK is directed by Dr John Gallacher at the University of Cardiff, together with an executive team of investigators drawn from seven universities (Cambridge, Edinburgh, Imperial College London, Oxford, Newcastle, University College London and Swansea), including the UCL-based MRC Unit for Lifelong Health and Ageing. The clinical research infrastructure award links DPUK with further universities, Manchester and Bristol.
European Prevention of Alzheimer's Dementia
The European Prevention of Alzheimer's Dementia (EPAD) initiative involves 35 partners from academia and industry. It will establish a Europe-wide register of 24,000 people deemed at high risk of developing dementia, drawing upon the MRC's Dementia Platform UK (DPUK).
Tackling dementia is one of the Prime Minister's priorities. The research team hopes to break new ground in the understanding and management of Alzheimer's disease in people with very early symptoms, or none. By identifying molecules in tissue or blood that indicate disease, they hope to detect people with early stage dementia even if they have no noticeable symptoms. Those patients at highest risk will be invited to join trials of new preventative medicines.
All data collected from the cohort and trial will become publically available for analysis to improve disease models in the pre-dementia phase of Alzheimers' disease. This should lead to more accurate stratification for trial selection, improved measurements of outcomes and a greater understanding of Alzheimer's disease processes before dementia develops. This project has numerous advantages over current approaches. These include: excellent pre-trial characterisation of subjects to inform selection and reduce screen failure; establishment of the highest possible quality Trial Delivery Centres (TDC's) across Europe; rapid decision making on the likely success of a drug (or combination of drugs) in subsequent confirmatory trials and access to a shared placebo group.
Edinburgh University's Professor Craig Ritchie, a member of the DPUK leadership team, described the project as "a genuine game-changer in the fight against dementia."
EPAD is led by the University of Edinburgh and includes partners from the Universities of Cambridge, Leicester, Oxford and Cardiff.
- For further information on the EPAD initiative and Dementias Platform UK please visit the websites www.ep-ad.org and www.dementiasplatform.uk.
Global action against dementia
March saw the first World Health Organisation (WHO) Ministerial Conference on Global Action Against Dementia. Over 80 countries joined experts from the research, clinical and advocacy communities in a global call for action, the most significant expression of commitment to date.
The event held in Geneva (16-17 March 2015) was the largest meeting of high level government representatives and recognised the size of the problem of Alzheimer's disease and other dementias, and served to discuss how, collectively, they could move forward action on dementia at the global level.
At the WHO-hosted Ministerial Conference the Government of the United Kingdom of Great Britain and Northern Ireland announced that over US$ 100 million will be invested in a pioneering new global Dementia Discovery Fund. Major pharmaceutical companies have committed in principle to investing in promising research efforts for dementia through the project, along with the nongovernmental organization Alzheimer's Research UK and the United Kingdom Government. The announcement was welcomed as the type of innovative mechanism that could bring about a breakthrough in treatment.
There was clear consensus on the need for coordinated efforts to track evolution of the disease burden, create policies to address the impact of dementia, and conduct research for treatment and improved, cost-effective care.
At least 19 countries1 already have a national dementia policy or plan. According to WHO, priority actions in such plans should include raising awareness of the condition and its risk factors, building capacity for timely diagnosis, commitment to good quality continuing care and services, caregiver support, workforce training, and research.
At the outcome of the Conference, participants called for action to strengthen global efforts against dementia. “We have been running behind the curve with dementia for a long time,” said WHO Director-General, Dr Margaret Chan, "but several recent events tell us that we are catching up. We must weave these multiple new initiatives into a comprehensive plan that can work in all countries. Government commitment will be key".
A Call for Action was adopted today by the participants of the First WHO Ministerial Conference on Global Action Against Dementia. The participants included 80 Member States, 80 philanthropic foundations, 45 NGOs and 4 UN Agencies (Information taken from WHO website)
- Further information on the WHO Call for Action.
1 Australia, Belgium, Costa Rica, Cuba, Denmark, Finland, France, Ireland, Israel, Italy, Japan, Luxembourg, Mexico, Netherlands, Norway, Republic of Korea, Switzerland, United Kingdom of Great Britain and Northern Ireland, and the United States of America.
Note to editors:
This note has been produced with information provided by Dr Brian Tom, Programme Leader at the MRC Biostatistics Unit; and already available details on the Medical Research Council, EPAD initiative, Dementias Platform UK, and WHO websites.