14 September 2020

At the heart of the battle against dementia

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    Dementia is a deceptively deadly disease. So much so, in fact, that it was responsible for more deaths in the UK than any other illness in 2018, with 850,000 people still directly affected in this country alone. It doesn’t just cause memory loss.

    The threat of dementia is only expected to increase. This year in the UK, one person will develop dementia every three minutes and, in the next 20 years, the number of Brits living with dementia is expected to almost double – to 1.6 million.

    So, what are UEA doing about it?

    UEA researcher Professor Chris Fox is at the heart of the battle against this dangerous disease, making him one of the UK’s leading experts in dementia. In his own words, he works “in every area of dementia research there is”.

    All this work is paying off, too. In particular, his research on the harmful effects of medicines on people at risk of, or with, memory problems has influenced international health care policy.

    Professor Fox’s studies have investigated the relationship between medicines and causality for dementia, where he was able to show that death was associated with two particular classes of bladder medicines and antidepressants.

    This study proved especially popular, leading to so many calls for Professor Fox that it caused an unexpected problem…

    Professor Fox said: “We were the first group to show that death was associated with these drugs and there was significant public and health care interest. In fact, the initial story in 2012 caused more than 1 million visits to the BBC website and shut down the university switchboard due to call volumes.”

    Perhaps most importantly though, this work then entered NICE (National Institute for Health and Care Excellence) guidance in 2018, saying that the medication had to be reviewed, with the team’s scale named and work quoted, for both dementia and bladder patients.

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    Recent research

    Professor Fox’s latest research has focussed on an entirely different area however, with his latest study concentrating primarily on dementia-sufferers who fall and damage their hips, and the care they are given in NHS hospitals.

    It’s an area that feels especially personal to Professor Fox.

    He explained: “I was an NHS consultant for many years and one of my biggest difficulties was people who’ve got lots of cognitive function issues, they’re a bit muddled, and they fracture their hip.

    “Ward environments are not great and people always complained about the ones with dementia so I thought we could improve the care and help the staff manage it better.”

    As such, with funding from the National Institute for Health Research (NIHR), Professor Fox and his team devised a study focussed on significantly improving the care of these patients.

    Over the last seven years, Professor Fox’s team have observed and interviewed patients and carers before using their new treatment, named Enhanced Recovery Pathway, in a randomised control trial at 11 hospitals, with 278 patients.

    What’s next?

    The initial trial did show slight benefit, according to Professor Fox, resulting in a new intervention and training package aimed at hospital staff who manage patients with similar issues. Now he’s hoping for an even larger study.

    Professor Fox explained: “If the full study is not funded, we’ll develop some training materials, and we’ve got some funding to do that this year”.

    Reflecting again on his time as an NHS consultant, he said, “it’ll be quite nice as I can complete the circle and show benefit to the treatment - then I can retire – although I’ve still got 15 years left!”

    Future direction

    So, what will he do with those 15 years? Looking forward, Professor Fox is hoping to uncover more about dementia by using ‘big data’.

    He said: “My interest moving forward is trying to use data to get the answers that we can’t get currently from small studies. So using big data, data that patients already give to their doctors when they go and see them and trying to adjust our ideas so that they have a greater chance of success, helping people with already established dementia, or very early minor memory problems in middle age who are at risk of dementia later.

    “I have lots of colleagues, collaborations and expertise here that can hopefully help with this.”

    One way this can be used is through phenotyping, whereby the modelling of factors is collected to determine who is at greatest risk and who would respond best to available treatments.

    Professor Fox explained further: “We can get a fingerprint of the sort of patients we need to target and then either develop a potential medication intervention, nutritional intervention, or whole system lifestyle change which we could then put in, and see if it reduces their chances of developing dementia later on.

    “We also have projects involving digital solutions to improve care which will hopefully show benefit.”

     

    Sources:

    https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/articles/leadingcausesofdeathuk/2001to2018

    https://www.alzheimers.org.uk/about-us/news-and-media/facts-media

    Further reading:

    http://www.perfected.ac.uk/

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