31 May 2013

This June, leaders from the globe’s eight richest countries, the G8, will assemble in Northern Ireland to discuss major issues related to the world’s economy—among them, the rising threat of dementia in aging populations. U.K. Prime Minister David Cameron announced on 15 May 2013 that he will use his country’s turn in the rotating G8 presidency to push for an international agenda on dementia research. This coming September in London, he will convene a summit of world government officials, industry leaders, and other experts to promote collaboration on the issue. “While the details of any global plan are yet to emerge, we hope that by combining international efforts, we can make faster progress on this complex challenge,” wrote Eric Karran in an e-mail to Alzforum. Karran directs research at the not-for-profit Alzheimer’s Research U.K. in Cambridge. Experts who spoke with this reporter speculated the summit agenda would include funding of research, data collection, cooperative new drug approval, and sharing of healthcare approaches.

Today, more than 35 million people worldwide have dementia, and that number is expected to reach 115 million by 2050. According to a press release from the prime minister's office, the global cost of healthcare for old people with dementia was estimated at US$604 billion in 2010—about 1 percent of the global gross domestic product. “If we cannot do something about these degenerative diseases, it will place an enormous economic burden on all countries,” said Ronald Petersen of the Mayo Clinic in Rochester, Minnesota. “It is almost irresponsible not to pay attention to this.”

Potential Topics in London
While the G8 is just starting to address Alzheimer’s and dementia, individual nations have already taken on the challenge. In France, then-prime minister Nicolas Sarkozy implemented the Republic’s National Plan on Alzheimer’s in 2008 to improve diagnosis, provide better treatment and support, and accelerate research. In 2011, he announced the Plan had funded more than 100 research projects (see ARF related news story). In the U.S., the National Alzheimer’s Project Act called for a national plan, released in 2012, to fight AD (see ARF related news story). Also in 2012, Cameron initiated the Dementia Challenge, which aims to increase research funds and improve the care and comfort of people living with dementia. Several other nations, including South Korea, have also developed dementia strategies. In Europe, more than a half-dozen nations have dementia plans in place, while a handful of others, such as Italy, have committed to developing them, according to the non-governmental organization Alzheimer Europe . The German Alzheimer Association, Deutsche Alzheimer Gesellschaft, is campaigning to have a national plan.

What can a G8 platform offer in addition to these individual efforts? For one, joining forces across country lines could boost the number of participants in longitudinal studies, many of which remain within national borders today. International collaborations might allow researchers to take a divide-and-conquer approach, Petersen suggested. For example, some nations might focus on biomarkers, others on clinical aspects of the disease. This would limit overlap among projects.

“The genetic studies we are doing now are limited by sample sizes,” noted Zaven Khachaturian, editor of the journal Alzheimer’s & Dementia, in Washington, DC. “We need to have very large samples because the genetics and the complexity of the disease is enormous.” This kind of “big data” analysis would be an excellent element in international AD efforts, agreed George Vradenburg, who chairs the advocacy group USAgainstAlzheimer’s based in Washington, DC. Combining the genomes, blood chemistry profiles, and brain images of a large number of subjects should help researchers understand who is at risk for dementia and what biological pathways to target with treatments, he said.

However, Vradenburg noted that sharing data across borders raises legal and policy issues (see ARF related news story). For example, nations have different rules about the privacy of research data. Combining datasets that were not collected in precisely the same way poses logistical challenges. International collaboration will require standardized protocols, such as the Alzheimer’s Disease Neuroimaging Initiative’s work to align image collection, or Clinical Data Interchange Standards Consortium efforts to develop standards for the healthcare industry (see ARF related news story and ARF news story).

All of this costs money, and research funding represents a major challenge that a G8 initiative will have to address. The dementia problem, and its associated tab, is much larger than any current AD research budget, said Vradenburg. The U.S. has committed to $550 million each year; the U.K. has pledged to put $100 million toward dementia research annually by 2015. “We need to see that investment continue to increase if we are to make significant inroads to tackle the diseases that cause dementia,” wrote Karran. “We need a long-term commitment to funding for research from all quarters.”

The G8 might also coordinate nations to work together on drug regulation, Vradenburg posited. “The current system is sluggish because you have to clear [a new treatment] in every jurisdiction,” he said. While a single, global regulatory system seems unlikely, he suggested that other measures could streamline the drug application process. For instance, if the G8 adopted a common data standard for drug applications, that could expedite approvals because companies could submit similar applications to many agencies.

Nations could also learn from each other’s experience in healthcare. France has built diagnostic centers and assisted living facilities, and implemented adult daycare programs and in-home care. Healthcare officials from the G8 could study those programs as they consider the issue.

Following in Prior G8 Footsteps
Cameron’s dementia initiative will not be the first time the G8 has gotten involved in a health issue. Discussions at the 2000 G8 meeting in Okinawa, Japan, and the 2001 G8 summit in Genoa, Italy, were a major factor in the creation in 2002 of The Global Fund to Fight AIDS, Tuberculosis, and Malaria. This fund supports research projects and direct efforts to contain the spread of infection—for example, distributing mosquito nets. Funding comes primarily from supporting governments, although private donors also contribute. New HIV infections are on the decline, many countries are on the way to eliminating malaria, and by 2015 tuberculosis deaths are expected to reach half of the 1990 level.

In the U.K., Cameron’s Dementia Challenge offers another example. The initiative has already made some inroads in addressing care since its start in March 2012. One goal was to better identify cases. Half of all people with dementia go undiagnosed, said Petersen, so raising awareness is crucial. By doing so among doctors and hospitals, the Challenge’s efforts have increased dementia diagnoses by 10 percent in the first year of the project, according to a 2013 government report. That could pay dividends. “The paradox of this disease is that treating people well, and from the beginning, is cheaper than ignoring it,” wrote Marc Wortmann, executive director of Alzheimer’s Disease International, a federation of Alzheimer’s associations based in London, U.K., to Alzforum.

Dementia Challenge has inspired more than 50 U.K. cities, towns, and villages to become “dementia friendly.” This includes setting up local alliances to help people with dementia and training people to be “dementia friends” who are ready to assist folks with the disease. For example, a dementia friend might help a neighbor tend his or her garden without using dangerous power tools.

Through the U.K. National Institute for Health Research, Dementia Challenge granted US$33 million for 21 clinical research projects in the first year.

South Korea has enacted a similar “War on Dementia,” training people to understand the disorder and consider how they can help. For instance, schoolchildren attempt to open doors while wearing weights and fogged-up glasses so they can learn what it feels like to be old and frail. Others work in nursing homes to help and cheer up elderly individuals (see The New York Times news story).

The global challenge of dementia comes down to a choice between “pay now” by investing in research and infrastructure to beat the disease, or “pay later” and suffer the economic burden of rising dementia rates, said Petersen. “I think G8 just recognizing that is a major step forward.”—Amber Dance.

G8 to Set Sights on Dementia

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