A Roundup of the Latest News From This Year's International Alzheimer's Conference
Researchers looked at the impact of COVID-19 on the brain and the mental health of long-term care residents, plus potential therapies and ways to boost clinical trial diversity
Two themes dominated this year's Alzheimer's Association International Conference (AAIC 2021), which ends today: New reasons for concern and expanding reasons for hope.
Held virtually in Denver, AAIC 2021 brought together attendees from more than 100 countries, with roughly 3,100 presentations.
"It is a chance to take a step back and look at the big picture of what's happening in dementia research," says Claire Sexton, director of scientific programs and outreach for the Alzheimer's Association. "The pandemic had a huge impact, and we're only at the first stages of understanding that impact."
COVID-19 is especially shaping these areas of Alzheimer's work.
Potential Impacts of the Virus On the Brain
An exhaustive review of scientific papers worldwide since March 2020 reveals "convincing evidence" that SARS-CoV-2, the virus which causes COVID-19, can affect the nervous system in lasting ways that contribute to the development — or worsening — of Alzheimer's disease, especially in older adults, according to Seshagiri Veerapaneni and Mukaila Raji of the University of Texas Medical Branch in Galveston.
For example, a study of blood biomarkers of 310 patients over 60 who'd been admitted to NYU Langone Health in New York City with positive SARS-CoV-2 infection found about half the people experienced new, infection-related neurological symptoms like confusion; the other half didn't. The former group showed brain inflammation and neuronal damage "to a significant degree," says Thomas Wisniewski, professor of neurology, pathology and psychiatry at New York University School of Medicine.
The pandemic had a huge impact and we're only at the first stages of understanding that impact.
His team plans to monitor these patients more closely for dementia development.
"Those with pre-existing disease are both at greater risk of neurological complications with COVID and of possible acceleration of disease," Wisniewski says. Other researchers presented similar concerning findings whose Alzheimer's impact they say only time will tell.
The Impact of Lockdowns and Related Policies
French researchers led by Philippe Amouyel at the University of Lille looked at the impact of social isolation on retirement home residents' cognitive reserve during the pandemic stemming from lockdown policies. The disruption of social relationships meant less brain stimulation, they say, posing a risk to brain health.
But the research also presents an opportunity for targeted prevention programs likely to continue post-pandemic, such as telecare, telehealth and Zoom. Dementia care researchers from Hong Kong, Israel, Canada and the U.S. shared best practices about how they pivoted to technology to deliver services.
COVID-19's Impact on Alzheimer's Research Methods
Other Alzheimer's researchers described shifting gears to collect data during COVID-19, from using telephone cognitive screenings to reach Aboriginal Australians to attempting self-administered cognitive assessments in the U.S. and videoconferencing for neuropsychological assessments in the U.K.
"These changes will have lasting effects on how research goes forward," says Sexton.
More Not-So-Good News
The sheer scale of Alzheimer's disease and other dementias was another focal point of this year's conference, with these findings:
A rise in younger-onset dementia. Cases of younger-onset (before age 65) dementia have not been well tracked, but a new meta-analysis of international studies shows an increasing incidence rate of 11 per 100,000, says Stevie Hendriks of Maastricht University in The Netherlands. That corresponds to 360,000 new cases per year. Alzheimer's disease was the most common type of young-onset dementia, according to Hendriks, followed by vascular and frontotemporal forms.
A forecast of a huge increase in dementia. Global cases of dementia are expected to triple by 2050, to more than 152 million, according to the Institute for Health Metrics and Evaluation at the University of Washington School of Medicine.
On one hand, global access to education would be expected to decrease overall cases, despite an aging population. That's because less education is a risk factor for Alzheimer's disease. But increased rates of smoking, obesity and high blood sugar worldwide will likely offset those gains, researchers say.
The highest increases are projected for sub-Saharan Africa, North Africa and the Middle East.
A sharp rise in the mortality rate for Alzheimer's in America in the past 20 years. The mortality rate increased by 88% from 1999 to 2019. The rates ranged widely by area, with the highest incidence in the rural East South-Central part of the country (which includes Kentucky, Tennessee, Mississippi and Alabama), with roughly three times more deaths than those in the lowest region, the urban Mid-Atlantic.
Access to health care, socioeconomics and the growing number of older Americans may be behind the discrepancy, says Emory University's Ambar Kulshreshtha.
Reasons to Hope
While some of the news to emerge from this year's conference was disheartening, there were also potentially brighter findings:
For instance, an expert panel announced use recommendations for the recently (and controversially) Food and Drug Administration-approved Aducanumab (brand name Aduhelm) for Alzheimer's, to further advise doctors on how to use the medication, they say.
Among the recommendations:
- Restrict use to those with mild cognitive impairment (MCI) and mild Alzheimer's disease
- Use the highest dose to improve outcomes
- Monitor the medication safety with MRIs before therapy and at several possible points throughout usage
Beyond Aduhelm's target: amyloid (a protein associated with Alzheimer's disease that can form plaque), scientific findings were also presented on potential therapies targeting other avenues, including the protein tau (which can form damaging tangles inside neurons), the immune system and the vascular role in dementia.
The future is that not one single drug will lead to a cure.
"The future is that not one single drug will lead to a cure," Sexton says. "Multiple targets need to be understood and complemented by targeted modifiable risk factors and lifestyle, at the same time."
Preventative strategies continued to be a loud part of the disease-eradication conversation. Several new studies suggested that air quality improvements are associated with lower dementia risk. Other study results validated cognition-improving approaches that are more within an individual's control.
Researchers also said you can expect to hear more about precision nutrition, cardiorespiratory exercise, expanding cognitive reserve and FINGER-HLI, a Healthy Living Index tool under development to monitor the effectiveness of lifestyle changes. In 2015, the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) was the first large trial showing the effectiveness of multiple lifestyle interventions in preventing cognitive decline.
The quest to better reach traditionally underserved populations for clinical trials is being addressed by a new tool called Outreach Pro, introduced at the conference by the National Institute on Aging (NIA).
Outreach Pro provides templates for general dementia education, general awareness about clinical trials and specific clinical trials that researchers can customize with a library of extensively-tested messages, photos and text. The current content is geared towards Black Americans and Latinos, with content in English and Spanish. This fall, resources for Asian Americans and Pacific Islanders will be added, followed by American Indian and Alaska Native-related materials in 2022.
"It's critical that clinical trials have appropriate representation to ensure we have a complete understanding of how well different therapies or approaches to dementia care work in different populations," says Holly Massett, NIA senior adviser on clinical research recruitment and engagement, in a release.
To illustrate this point, Black, Latino and American Indians were more likely than whites to volunteer for a clinical trial if invited by a member of the same race, according to the "Voices Heard Survey" of more than 400 Wisconsin residents. This shows how tailored messaging can help, says Dorothy Farrar Edwards, faculty director of the University of Wisconsin Collaborative Center for Health Equity, which conducted the survey.
"As we get better at recruiting diverse populations, it will increase the urgency to get the conduct of clinical trials right," Farrar Edwards says.
And that, in turn, will help inform not only future AAIC findings, but perhaps the direction of the fight against Alzheimer's disease.