ST VINCENT’S TEAM LEADING THE CHARGE TOWARDS DEMENTIA CURE

Dementia could be one of Australia’s – and increasingly the world’s – most devastating conditions.

Dementia is the term used to describe the symptoms of a group of illnesses, including Alzheimer’s disease, that cause a progressive decline in a person’s memory, intellect, rationality, social skills and physical functioning.

It steals our memories, the very essence of who we are, and is the leading cause of death of women in Australia and the second cause of death overall.

More than 500,000 Australians are living with it today and it affects about 1.6 million loved ones, families and carers.

This week – Dementia Awareness Week – it would be great to hear a cure is in the offing, but while it is some way off, St Vincent’s Hospital Sydney researchers are hot on the case.

Bryce Vissel is the Head of the Centre for Neuroscience and Regenerative Medicine at St Vincent’s Hospital Sydney (SVHS) and a professor at the University of NSW.

Professor Vissel says dementia can begin insidiously, and without symptoms, in people in their 40s, but our amazing brains can cover it up.

“For many people, way before symptoms start, the disease is beginning,” he says. “The
amazing thing about the brain is that its plasticity allows it to adapt following illness or injury

“So while we may be getting small losses of brain function, the brain is able to compensate for a long time, before dementia truly sets in, usually 20 or more years later.”

Dementia Australia says there are an estimated 28,800 people with younger onset dementia, but otherwise dementia is more common after the age of 65. More than two-thirds of aged care residents having moderate to severe cognitive impairment.

“These days, 65 years of age is still regarded as young,” notes Professor Vissel

He cites a number of risk factors that are now proven or under consideration as causes or contributors to dementia, including: brain infection; COVID (possibly); metabolic conditions such as diabetes; hormonal issues including parathyroid dysfunction; poor diet; alcohol; smoking; cardiovascular issues; high blood pressure; air pollution; head trauma; sleep disturbance; and even deficiencies in vitamins such as B6, B12, and Folate.

Meantime, he says, SVHS researchers are pursuing a number of aspects of the disease including its underpinnings, that is, “what is going in the brain that leads to nerve cell loss and brain damage”.
And he has been concerned for many years of the dominance of prevailing theory that the main culprit is a substance called amyloid.

“Many scientists for many year have said Alzheimer’s Disease is caused by amyloid, something in the brain that is present in the plaques in the brain,” he says. “Consequently, an inordinate effort has gone into developing treatments designed to remove amyloid, but none have had the dramatic benefit for memory that is so urgently needed.

“In the US alone they have spent more than $US95 billion for dementia research since 1995 to research and solve the disease and so far that hasn’t succeeded.

“I think that’s because science hasn’t got the answer right yet, and we need to rethink the disease.”
Professor Vissel says the huge money and world commitment involved has meant the amyloid theory has become “too big to fail”. But, while amyloid probably contributes to the disease, there may be ways of treating dementia that aren’t based on it at all.

“Amyloid may be only a part of the answer, and we need to look at different ways of slowing brain damage that occurs in Alzheimer’s,” he says.

“So at St Vincent’s Hospital Sydney, we are now trying to find the underpinning molecular and cellular mechanisms that cause the disease and work out how to reverse these mechanisms.”

“At St Vincent’s we may have discovered a way to achieve that. We have found evidence for a molecular ‘switch’ in the brain that regulates brain health.

“A lot of factors that are known to cause Alzheimer’s can affect this switch.”

Professor Vissel says St Vincent’s researchers are also looking at other approaches to the disease.
One is a personalised precision medicine, where researchers and clinicians look at every individual – and their unique risk factors from their genes, lifestyles, physiology, to their unique injuries – to come up with an individualised treatment plan.

The SVHS Neurology Department is in process of setting up a clinic to establish this approach under neurologists Dr Elisheva Vissel and Professor Bruce Brew. This clinic will work closely with researchers in the Centre for Neuroscience and Regenerative Medicine to also research new and better ways to treat patients.

“At the end of the day we must get better at understanding the cause of the disease so we can come up with meaningful therapy,” he says.

“There are clinical trials, including at St Vincent’s, of therapies and some look more promising than others.
“But I believe St Vincent’s is well placed to play a world-leading role in defining what the disease is and finding new therapeutic approaches to deal with it.”

Professor Vissel is available for queries by emailing Bryce.Vissel@svha.org.au