As part of World Alzheimer's Month, Professor Martin Rossor, NIHR National Director for Dementia Research, reflects on how the COVID-19 pandemic has affected dementia research, and how it might look as we emerge from it.
The last year has been unprecedented and there is a sense that the world will never be quite the same again. Unfortunately, those living with dementia and their carers have been hit hard by the pandemic, partly due to the fact that care homes were affected disproportionately.
This has highlighted the many challenges that we face in social care and underlines the importance of social care research and funding calls such as the NIHR Research for Social Care call.
Diagnosis rates slowed down because memory clinics were closed early in lockdown and there was a reluctance of people coming forward for investigation - a belief that the NHS was ‘too busy’. In addition, activities that we know are good for brain health such as socialising, exercising and cultural activities were made more difficult.
We also face the potential long term clinical consequences of Covid and the concern that infection might of itself lead to neurodegeneration; the shadow of the 1918 flu epidemic that left so many with post encephalitic Parkinson's disease is ever present. Hopefully this will prove not to be the case, but the burden of mild cognitive impairment with “long Covid” will be a cause for concern. The outcome of NIHR-funded long Covid studies will help to improve our understanding of the condition over time.
The pandemic has inevitably had a major impact on research, particularly laboratory research. When the lockdown was first implemented in March 2020 many young researchers had to abandon experiments that were months in the making. Clinical research fared better, especially studies that were internet-based. Participants of Join Dementia Research were able to make major contributions to studies like the IDEAL project which examines the link between COVID and dementia and the effect of isolation on dementia.
The adverse impact of social isolation on those living with dementia has been devastating. According to the ‘Impact of COVID on People Affected by Dementia’ report by the Alzheimer’s Society, nearly half of those living with dementia said that the pandemic has had a negative impact on their mental health and one in three reported having lost confidence in going out and carrying out daily tasks.
The advent of Zoom and other video platforms has proved valuable in maintaining contact although how best to employ this and how to avoid marginalisation of those unable to use the technology is an important research question. Video-linking has also changed how we do research. It has proved possible to undertake some research assessments on line thus saving time and expense. This should improve the cost effectiveness of research but also reduce pollution and thus aid in meeting our other major global challenge. Not only will this be a small contribution to reducing global warming, but there is now increasing recognition that pollution of itself is associated with an increased risk of cognitive impairment.
A major highlight during the summer conference season has been the conditional license of aducanumab in the US. The debate will be ongoing for a long time as to whether it does indeed confer clinical benefit and further trials have been mandated by the Food and Drug Administration (FDA). However, the big message has been the use of a biomarker (i.e.amyloid) as a surrogate measure of efficacy. There is legitimate concern about treating a molecule rather than a person, but it may galvanise the field and with the government commitment to double research funding we can look forward to exciting times.
If we are to achieve the ambition for the UK to be the best place to undertake dementia research we must build our young research workforce. The NIHR funded Dementia Researcher website, supported by Alzheimer’s Research UK and the Alzheimer’s Society, is dedicated to young researchers across all disciplines and with nearly 50,000 visitors of whom half are overseas acts as a beacon for UK research.
Professor Martin Rossor, NIHR National Director for Dementia Research