In an age of excessive information, we have each developed a filtering system. To compensate, we acquire our own keywords, which pierce these systems, or, in the old parlance, make our ears prick up, be they the names of favourite teams, musicians, pastimes, conspiracy theories. Brexit.
In recent years, I have joined millions of others in acquiring the more unfortunate triggers of “dementia” and “Alzheimer’s”, but these keywords are not always the harbingers of bad news. Last week, the headlines linking them with others, such as “breakthrough” and “treatment”, will have set many of us off into a frenzy of information-gathering.
Behind the headlines, a more complex picture emerges. The announcement that lecanemab, a monoclonal antibody, can slow the cognitive decline of Alzheimer’s patients is a long way short of declaring an imminent cure for this terrible affliction, but it represents a qualitative shift in the decades-long search for a treatment.
Last year, a similar drug, aducanumab, was controversially granted its licence in America, because it was the first drug shown to alter the course of Alzheimer’s by clearing the brain of deposits of amyloid-beta, a protein that is thought to be the prime mover in the disease. That was another qualitative shift, but aducanumab’s FDA approval was controversial because its capacity to alleviate symptoms is less clear.
Lecanemab seems to take matters a step further by achieving a significant, if modest, degree of clinical benefit. Multiple caveats apply here too, but they are matched by at least as many other drugs and combinations of drugs being trialled. In quiet moments, neuroscientists accept that researchers in their field have been promising breakthroughs throughout those decades, all to no avail. Now, at last, they have achieved meaningful results in consecutive years with much more in the offing. The ball is rolling.
All of which will come too late for my wife, Vanessa. She has a rare genetic form of Alzheimer’s, from which her mother died in 2006, aged 58. Vanessa did not know her mum’s condition was genetic, but she always sensed the same fate awaited her. In her mid-to-late-40s, glaring lapses in memory started to creep in. Since 2018, her decline has been sharp. She has just turned 53 and has been in a nursing home for more than a year, unable to speak, feed herself, wash or dress.
The first problems with swallowing have recently presented themselves and she clings on to what is left of her beloved walking. But, when all else has fallen away, the smile and the laugh remain, however random, however much the result of stimuli unknown in her deteriorating brain.
There is no need to pull on heartstrings any further. All terminal diseases are hideous. Dementia’s twist is the way it comes for the very soul of you, brutal and enigmatic in equal measure. Only now are we starting to catch up with it. This is where we can move from heartstrings to numbers. Governments and businesses have always responded more readily to those.
As life expectancy lengthens and science grows more sophisticated, the extent of dementia’s drain on society is revealing itself at every turn. The total cost of dementia to the UK economy in 2019 was £34.7bn, more than cancer and heart disease combined. That figure is projected to treble by 2040. Meanwhile, annual funding for research from the government has settled around the £80m mark, less than a third of cancer’s allocation. If charitable contributions are included, dementia’s total is less than a fifth of cancer’s. Its cost to the economy, however, is nearly five times greater.
This disparity undoubtedly owes itself to dementia’s historic elusiveness, in contrast to the bolder, more physical nature of other conditions easier to define, identify and treat. Now that science is unravelling its mysteries and the extent of the toll it exacts, the case for prioritising research into dementia, not to mention provision for the costs of care, which are crippling in themselves (two-thirds of that £34.7bn is met by the afflicted and their families), has become unanswerable.
The relationship between funding and technological progress is direct and uncomplicated. We have seen that with Covid and cancer. Far more than a trigger to seize the attention of those affected by dementia, may the mysterious, magical word “lecanemab” prick up the ears of those allocating budgets. At least as much as it represents hope for a future cure, lecanemab must act as a lightning rod for further funding and research. We are on to dementia now. This is the time to go after it.