The challenges of ageing

Southampton’s unique role

“Trials of the original vaccine were stopped because of unanticipated side effects, which has meant that despite great efforts and expense, disappointingly, the field has been stuttering for quite a few years,” continues James.

“However, our unique angle is that we have brain tissue donated from patients that have been vaccinated, and can do studies in a way no-one else can. We have identified that the side effects are likely to be related to the blood vessels in the brain. We have found that while the plaques can be cleared from the brain, they then seem to build up in the walls of the blood vessels, with an increase in amyloid protein in the cerebral vasculature leading to serious side effects including an increase in cortical microhaemorrhages (micro bleeds in the brain).”

James is also investigating the brain’s vascular system, the distribution of blood flow within the brain, and why treatments to prevent vascular diseases seem to be helping with rates of dementia.

“It seems that treatments for diabetes, reduction of blood pressure, and lipids are also contributing to a reduction in the rate of dementia. It implies that blood vessels in the brain play an important role in cognitive function,” says James.

A third main area concerns the role of inflammation in the brain in Alzheimer’s, a line of interest that has been boosted by recent genetic studies, allowing for a view of the entire genome and the identification of genetic risk factors for disease which has highlighted genes in inflammatory processes as being important in Alzheimer’s.

One challenge facing researchers is the length of time taken before results can be seen. “Despite more than 40 clinical trials over 16 years involving many thousands of patients, we know that the vaccine approach alters what goes on in the brain, but not yet whether it will be a useful treatment. It seems it might not be useful in Alzheimer’s once the problem is established, but a more interesting idea for very early stages or prevention of the disease. But because the progression of dementia happens relatively slowly over a number of years, it inevitably takes many years to conduct the studies.”

Ruth is also co-Director of Southampton’s Doctoral Training Centre sponsored by a £430k Alzheimer’s Society funding grant for students to research aspects of enabling risks through a care and citizenship lens. “There can be a tendency to wrap people in cotton wool once they have dementia. A citizenship approach is about weighing up the pros and cons as to what risks it would be safe for people to take,” explains Ruth. Research areas include mobility within a hospital environment and risk taking in care homes. The supervisory team, including Ruth, is based across Health Sciences and Gerontology and has close connections with NIHR CLAHRC Wessex, which has adopted ageing and dementia as one of six research themes.

Because of the growing complexity in this area, collaboration and strengthening capacity is becoming increasingly important. “We have a growing cohort of students and academic staff doing research around improving care and quality of life for older people, in particular people with dementia. Everyone is part of the Health Sciences’ newly established research group on ageing and dementia led by Professor Jackie Bridges. ”

The University also offers an MSc in Complex Care in Older People. “There is recognition that there is a growing ageing population, many of whom will have complex care needs related to dementia and other health conditions. The MSc programme is for those people working with older people who need specialist skills and knowledge to respond appropriately to those complexities.” As the challenges of ageing become increasingly complex, the greater the need for better education and research.