Podcast – AAIC 2018 Day One

Voice Over:

Welcome to the Dementia Researcher Podcast, brought to you by dementiaresearcher.nihr.ac.uk, a network for early career researchers.

Adam Smith:

Hello, my name is Adam Smith. Welcome to the first of our podcast recordings for the NIHR dementia researcher website on location from the Alzheimer’s Association International Conference, in Chicago. This is the first podcast I’ve hosted and the first one we’ve ever done remotely, so you’ll have to account for the fact that there might be a few mistakes along the way, but hopefully it’s still interesting for you anyway.

Adam Smith:

This week we’ll be recording podcasts at the end of each day reflecting on what we’ve discovered at the AIC and sharing for those early career researchers who haven’t been able to get out here to Chicago. Today, I’m joined by a fantastic panel who have all kindly skipped the last session of the day of the conference to talk with us.

Adam Smith:

Firstly, I’ve got Dr Aoife Kelly, who works as a research communications officer at the Alzheimer’s Society. Hi Aoife.

Dr Aoife Kiely:

Hello.

Adam Smith:

Next. I’ve got Dr Jack Rivers-Auty, who’s a research fellow at the University of Manchester working in Neuro-inflammation. I believe.

Dr Jack Rivers-Auty:

Yeah. Good day.

Adam Smith:

Hi Jack. And finally, I’ve got Ri McArdle who’s a PhD student at the University of Newcastle, working on gear analysis and wearable technologies.

Riona McArdle:

Hello.

Adam Smith:

Okay. So, before we get stuck into discussion about the conference, I’m just going to go around our panellists and get to know you all a little bit better. So Aoife maybe you could go first in just telling us a little bit about yourself.

Dr Aoife Kiely:

Yeah, definitely. I should have made you practice the pronunciation of my surname as well.

Adam Smith:

Did I say that wrong as well?

Dr Aoife Kiely:

Kiely.

Adam Smith:

Kiely not Kelly.

Dr Aoife Kiely:

Well, there we go.

Adam Smith:

Sorry.

Dr Aoife Kiely:

It’s all right. So yeah, I’m Research Communications Officer for Alzheimer’s Society. So I’ve been working there for about 10 months now and I’m at AIC to basically get information on the biggest new stories that are coming out of the conference, and meet our researchers and spread the good news about Alzheimer’s Society and the work we’re doing.

Adam Smith:

Fantastic. I mean it’s really important as well and I know that the membership’s key too. Let’s get back to that. So Ri, sorry. Tell us a little bit about yourself.

Riona McArdle:

Hi. So again, my name is Riona McCardell. I’m a final year PhD student who’s a psychologist by background. I’m working in the Brain and Movement Research Group, which is led by Professor Lynne Rochester in Newcastle University. And I’m also an Alzheimer’s Society funded researcher. So I’m at AIC to present the results of my PhD because I’m writing it up at the moment. So it’s pretty much the breaking research for my PhD. And I’m here to also try to find out more about wearables and technology usage in Dementia.

Adam Smith:

Thank you. And that was because there was, of course we’re not going to talk about it today, but yesterday there was a pre-conference day looking at technology in Dementia. Maybe we can look at that in a future one or maybe you could write a blog for us on what you learned from that day. [crosstalk 00:03:10]. Just not that I’m pinning you down or putting you on the spot right now. So finally, Jack, tell us a little bit about yourself.

Dr Jack Rivers-Auty:

Yeah, I’m never sure how much detail you want. I’m a Kiwi. I was born 1986. I like long walks along the beach but I’m married. Sorry and I’m a research fellow at the University of Manchester. I research Neuro-inflammation in Alzheimer’s disease. So but how when your ankle, when you roll your ankle playing football, when it swells up, we think something similar is going on in the brain and that’s contributing to the disease. I’m recently transitioning into Epidemiology, which is the study of population statistics to see if we can pick out inflammation signals in population statistics. So I’ve been going to some great sessions today, all about Epidemiology and all the mini posters today were about Epidemiology. So I’m here to sort of acquire new skills and make collaborations and stuff.

Adam Smith:

Fantastic. And sorry, did you say this is your first AIC as well?

Dr Jack Rivers-Auty:

Yeah, this is my first AIC.

Adam Smith:

Excellent. So we’ll look forward to hearing what you made of the opening ceremony in a little bit because it’s always an experience for everybody. So before we get into that, today Jack and Ri, I know you’re also presenting, Jack later on in the week and Ri, you presented yesterday and tomorrow?

Riona McArdle:

Yesterday, today and tomorrow.

Adam Smith:

Fantastic. So would you like to just get a quick plug in for your poster presentation? Tell us what were you presenting on?

Riona McArdle:

So today I was presenting on looking at gait analysis in laboratory conditions across different Dementia subtypes and seeing if different Dementia subtypes, Alzheimer’s disease and Lewy body disease, have unique patterns of gait impairment that can help aid differential diagnosis. Tomorrow and yesterday at the technology conference, I’ll be presenting on how we can monitor gait inside the home environments over a week continuously. So we do that using wearable technology and from that we can derive information about gait, activity, which is for example, how long a person is walking and how many walking gaits they take per day. And also gait patterns like how fast someone walks or how much they change their footsteps as they’re walking. And from that we’re trying to understand as much as we can about Alzheimer’s disease and Lewy body disease and how wearable technology could be a useful clinical tool in the future.

Adam Smith:

That’s really interesting. And are you the only person at your university that’s working on that topic, or are there others?

Riona McArdle:

It’s beginning to surge with Dementia. So I’m one of the first researchers in my lab group that’s working with wearable technology in Dementia. But there was a pilot study done to assess the feasibility of using it in Dementia just prior to me coming into the field. And now we’re about to start another big project. Well it’s an ongoing multicentre project in the UK and we are leading the wearables piece of that, which is looking at using wearable technology to see if there’s gait patterns in people before they go on to develop Dementia. So prodromal, stages of the disease.

Adam Smith:

Fantastic. And have you tweeted a picture of your poster?

Riona McArdle:

I probably have. Yeah.

Adam Smith:

Great. So what’s your Twitter name? So people could have a look at your Twitter feed and see that.

Riona McArdle:

It’s Riona McArdle, which is R-I-O-N-A M-C-A-R-D-L-E.

Adam Smith:

Fantastic. So I think I strongly encourage, I know I saw Riona’s presentation yesterday at the technology in Dementia and I’d strongly encourage anybody to have a look up on Twitter and take a look at that poster.

Dr Jack Rivers-Auty:

Can I just ask, did you get any pilot data about differences in walking patterns when they did the original sort of-

Riona McArdle:

For the feasibility study?

Dr Jack Rivers-Auty:

Yeah.

Riona McArdle:

The feasibility study only look at Alzheimer’s disease so that we didn’t have any controls in this study unfortunately. From my own research, we are seeing clear patterns of gait impairment between Dementia and controls and also between Lewy body disease and Alzheimer’s disease. When you look at it in the lab and at the moment, I’m trying to see if we’re seeing similar patterns in home environments.

Dr Jack Rivers-Auty:

Cool.

Adam Smith:

And of course, Society are funding this research as well- [crosstalk 00:07:16].

Riona McArdle:

Yeah Alzheimer’s Society funded research. Excellent.

Adam Smith:

And so do you obviously really encourage people to disseminate those findings too? Did you present this back to the conference Alzheimer’s Society Conference earlier already or?

Riona McArdle:

Yeah, I’ve presented the free living stuff this year at the Alzheimer’s Society Conference and last year, I was part of a hosted workshop, talking about differential diagnosis and I talked about the lab based of that and I’m also quite involved in dissemination generally throughout the public.

Adam Smith:

That’s fantastic. Yeah, I noticed this.

Dr Aoife Kiely:

I believe she’s won awards over [inaudible 00:07:46].

Adam Smith:

Oh yeah, I saw that. You did. Congratulations.

Riona McArdle:

Thank you.

Adam Smith:

Jack. You’re obviously presenting, you’re presenting on Tuesday-

Dr Jack Rivers-Auty:

Tuesday 1:00 PM.

Adam Smith:

So why don’t you give us, talk us through, what are you presenting?

Dr Jack Rivers-Auty:

Okay, so in cells we screened a bunch of existing drugs. So drugs off patent that no drug company would investigate because they can’t make any money because they’ve been around since the seventies, to see if they inhibit a specific kind of inflammation that we think is involved in Alzheimer’s disease. And this inflammation is triggered by particles. So we know that this kind of inflammation is triggered say for example, during gut because of the uric acid crystal particles that are in there and also triggered during Atherosclerotic plaques in your blood vessels. It’s also triggered during asbestos in your lungs. And we’ve recently found that it’s also triggered an Alzheimer’s disease by the plaques which are acting like a particle in your brain and they’re inducing this inflammation.

Dr Jack Rivers-Auty:

So we’ve shown in cells that some common drugs that people use every day, inhibits the specific kind of inflammation. And then we took our best one of those, which was called Mefenamic acid. It’s just a common pain relieving drug and we moved that to an animal model of Alzheimer’s disease. And we showed that it significantly improved memory performance in the mouse model of Alzheimer’s disease and it completely calmed the brain down. We saw no inflammation in the brain and brains of these mice.

Dr Jack Rivers-Auty:

So today I’m presenting on the next step of that research where I took public data, which tracked Alzheimer’s disease progression because these are existing drugs, people are already taking it. So I built statistical models to model the cognitive decline of these people and checked whether it was slower in the people that happened to be taking drugs that I knew inhibited this kind of inflammation. And what we saw was a significant slower progression in people that just happened to be taking these drugs that reduce this kind of inflammation, which is really strong evidence. So hopefully we can build up a case to get a clinical trial funded. It will have to be funded by the government because obviously there’s no money to be made on a drug that already exists.

Adam Smith:

And relicensed, I mean you’ve seen studies like the radar studies. Is the radar study from Bath with Pat Keogh, that’s repurposing. Isn’t that one repurposing an existing medication as well? I think. [crosstalk 00:10:14].

Dr Jack Rivers-Auty:

Yeah, that’s Angiotensin-converting enzyme inhibitor. Pat Keogh, actually he really helped me with the epidemiology of this study. So we saw what Pat Keogh’s done, out of Bristol and we’re trying to copy that because that’s how he got his drugs into clinical trial and they’re in stage two clinical trial right now.

Adam Smith:

Yeah. So well fantastic. Really interesting work as well and fantastic to see because we know that there’s so much opportunity for repurposing other drugs as well, if only we had the wherewithal to go away and look at these. So thank you very much again Jack. That sounds really exciting. I’ll make sure I come along to your presentation.

Adam Smith:

So moving on then, let’s talk about day one here at the conference. So there’s already been so much going on. I suppose the first thing to talk about, was the big welcoming ceremony, right at the start in the first plenary, which we had the Chicago Boyz Acrobatic group. Have they been on X Factor or something as well?

Dr Aoife Kiely:

They’ve been on America’s Got Talent I think. Yeah

Adam Smith:

Because there was a big intro at the Star Wars and there was less of making noise. So that was an exciting kicking off start. So what did you make of that?

Dr Aoife Kiely:

Well, this is also my first AAIC and I’m used to quite serious like academic conferences. So even walking into the ballroom where this plenary talk was going to be. I was expecting a massive auditorium and then a professor steps up to a podium and delivers a presentation in a monotone for maybe an hour. But instead here you walk into the ballroom and there is flashing lights and they’re playing every song from the band, Chicago that they possibly could. And it builds up to, like you said, suddenly this video comes on by the Chicago Boyz. And I honestly thought they’d made some mistake or it was just some ads to fill the time and stuff about Chicago. But I would say it was quite surprising but also very, very American. Good introduction to Chicago. Quite unusual. Quite different from, I think-

Adam Smith:

It was quite a bit, wasn’t it? I mean I think we were called upon to make some noise at several times I was tempted. I did start clapping when he said, “Come on, clap.” I did stop but I was the only one. I looked around me and I was the only one. [crosstalk 00:12:38]. So I really quickly, put your hands down like you do. What about you guys? Did you-

Dr Jack Rivers-Auty:

I’d like to play the fifth on answering that question. I don’t want to incriminate myself.

Adam Smith:

Oh come on. It was a bit, it was uplifting as a great star- [crosstalk 00:12:54]

Dr Jack Rivers-Auty:

It was a lot of fun. Yeah, it was a lot of fun.

Adam Smith:

In London. They had a marching band last year, didn’t they? It was- [crosstalk 00:13:00]. They had bare skin hats and I don’t think they were actually the army anymore. They might have been retired soldiers that had a soldier band. So that was quite… What about you Aoife?

Dr Aoife Kiely:

I thought that I walked in accidentally to a fitness conference. Yes, you did just say my name wrong.

Adam Smith:

You’re well Aoife.

Dr Aoife Kiely:

Yeah, I thought I walked into a fitness conference or that we were going to be doing aerobics and I was like, “I’ve got a sprained knee, I can’t get involved in this.” But yeah, it was definitely very interesting. And it has not helped me sell the fact that I’m not on holidays. I have my family who now firmly believe that I’m not doing any work at this moment.

Adam Smith:

Yeah. When I was tweeting pictures instantly going kind of people think you’re just having fun now, particularly after tonight. Of course because I should say this is five o’clock in Chicago now. And as soon as we get finished with this podcast, we’re all going to be heading off to the Navy Pier for the welcome evening as well, where there’s more entertainment again. Okay, so more serious things. And so immediately after that, we had the talk from Leonard Mooky from the Gladson ensue on urban network activity in Alzheimer’s disease, preclinical investigation to clinical trials. That’s a bit of a mouthful. So, I mean I found this one quite interesting but I’m not an expert in that field so I wasn’t quite sure what to make it out. What about you Aoife? How did you…

Dr Aoife Kiely:

Oh, I find this really fascinating and for me it was a typical plenary talk from an expert in their field that they’ve so much information to share in such a short amount of time. So you’re frantically writing notes. So he was telling us basically that there are far more incidents of kind of epileptic like seizures, in Dementia than have been reported and that then people are aware of and that it’s kind of an under researched area of the condition, which I think is fascinating to hear about. And he was telling us, I thought like Jack mentioned before we started that it was quite nice that he gave a lot of context to the field as well. So he wasn’t just talking about his own research, he was talking broadly about the area of research

Dr Jack Rivers-Auty:

And he didn’t try pack every slide with a whole bunch of data, which is what sometimes these plenaries do just to really show. He really just told a really clear story about the prevalence of seizures and how it’s contributing to the disease. I particularly liked it because I use an animal model of Alzheimer’s disease, that involves expressing a lot of amyloid and then that creates memory deficits in the mouse models. And they’ve always been criticized because you don’t see tau tangles, which is one of the other key features of Alzheimer’s disease. But he showed that if you knocked down tau in these animals, you actually prevent the disease progression showing that these mice were getting tau pathology. They may not be getting tau tangles and that tau pathology was contributing to the disease. And these mice do have seizures. I’ve seen them and it is always at night time and so it was interesting that he back up what he was saying with my own observations.

Dr Aoife Kiely:

Yeah, I wish he’d said more about why it’s at night time that they have the seizures. Because I think that, that’s quite interesting for people who are affected by the condition to understand that…

Dr Jack Rivers-Auty:

Now I actually wonder if its links interpretative Lee’s research because Alzheimer’s disease, we know one of the symptoms is described as evening wandering, so just before they go to bed they tend to start walking lots and sometimes walk out. And I wonder if this is a manifestation of hyper excitability like overactive neurons.

Riona McArdle:

Yeah, that could be quite interesting. It’s something that we are hopeful to look at within the research that we’re doing as well at the moment. With the wearables we can kind of break down things by time of day and see if that’s a specific pattern that is occurring within different kinds of Dementia subtypes. And then I guess we could use that and also map it onto other studies that will have huge multidisciplinary studies that will kind of help get more information about a lot.

Adam Smith:

So I don’t know if that presentation’s going to be online. I’d suggest having a look on social media or subscribing to the #AIC 18 to see if there’s a link to where the presentation might be on that. But I agree it was really interesting. So moving on from that, there’ve been so many oral sessions today, so I’m just going to open up the discussion now just to… I’ll just go around the table and ask you, what you’ve seen today and what you found particularly interesting. So why don’t we start with why don’t we start with Ri, why don’t you go first?

Riona McArdle:

I’m so sure I saw this morning, as a really, really interesting presentation by [Erin Brooklyn 00:17:50] in the epidemiology section and he’s from Rush University and he was talking about wearables. So obviously, it was right up my alley and he was just describing, they can do quite a lot of things, but you wanted to know about what a person can do and what a person actually does. Rush university seemed to have run two very large projects that they’ve got this information from them and they also seem very keen to collaborate with other people to share this research with people and they’ve used actigraphy which is a form of wearable sensors to measure both the total activity of people. So how much daily physical activity they do and how this relates to kind of icons such as neuro loss and micro infarcts in the brain.

Riona McArdle:

And they’ve also looked at gait, which he’s doing with [Jeffrey Heister 00:18:38] at the moment, who’s quite a big name in the wearable fields. So I thought his information was really interesting. He was showing that gait and decreased activity can predict adverse health outcomes such as mild cognitive impairment in Alzheimer’s disease, which is showing again that cognition and mobility are overlapped and actually it’s important to look at both.

Riona McArdle:

He was also talking about future research that they seem to be trained to develop, which seemed really cool, where they’re trying to develop a smart pen for doing the clock test, which if you do a lot of cognitive testing, one of the problems with cognitive testing is that it’s very hard to pull apart the different elements of cognitive testing. And one of the problems with doing something like that, particularly if you’re moving with someone with a motor problem like Parkinson’s disease, is that it’s hard to choose apart where the cognition is failing or where actually they just can’t do the task anymore because the motor symptoms. So seeing things like that coming out, it seems to be really, really cool actually.

Adam Smith:

And that was pretty good because honestly one of my next questions was, how did the talks today kind of have any relevance to your own work? But that’s fantastic, that was actually-

Riona McArdle:

Yeah, it was, it was literally spot on exactly what I needed to hear but-

Adam Smith:

There’s so much going on here isn’t it? I mean if you wanted to go off and look at something that’s completely new, you could or you could entirely just stick every day to your own fields, to your own interests and just follow that around. There are four, if anybody’s never been, there are four huge books that come with this five books, one for every day. That just goes, goes through. Is there anything else particularly that you draw attention to or?

Riona McArdle:

Just that there seems to be quite a few talks as well going on that they were very much promoting their idea of, making sure that researchers work together and also having databases online that people can access so that research and the data that we collect gets as far as it possibly can get and I think that’s been quite good to see that highlighted and quite important as well. One of the speakers today, James McNally from Michigan, he kind of highlighted to the point that when we do sort of studies, we only got a very narrow picture and he said that we basically look at, we need to see the entire elephant rather than just looking at the trunk or the leg of the elephant, which is what most of these currently do. And by combining research between many different projects, we’re actually getting further and further into trying to find out how to prevent and understand Dementia and I think that’s quite an important idea to highlight. I know that the UK themselves are currently trying to set up their own databases to promote that kind of open access.

Adam Smith:

And we did a podcast, I don’t know, it’s probably a couple of months ago now. Jim Stachela from Durham, I think, you ever know Jim? So I know he’s been a kind of big advocate for these collaborations in different diseases. They’re working with the heart… Are they working with the Heart Found… They’ve got work going on with research in heart disease as well?

Dr Aoife Kiely:

Yeah, they really collaborate fantastically. That group because the work that they’re funded by the Alzheimer’s society is about social withdrawal. But that’s kind of one area of expertise. But they’re brilliant at a kind of networking and working with different groups like the Cardiac study. So we need more of that in the UK I think.

Adam Smith:

So that’s fantastic. What about you? Aoife what jumped out of you today?

Dr Aoife Kiely:

Well, so I was running around trying to be in four places at once, most of the day. So I’m trying to catch as much as possible. And in the morning, I was catching up with some of the recent clinical trials on some of the drugs that have been coming out. So unfortunately, spoiler alert, there wasn’t any massive breakthroughs from this morning. They were the type of pharmaceutical presentations that I find quite odd. But anyway, basically because the first one I went to see was a drug beautifully named solanezumab and it was part of the creed study. So this is a drug that’s come from Rush and Genentech and it’s a drug that targets one of the toxic proteins in Alzheimer’s disease called amyloid. And it’s an immunotherapy and it’s at the stage… The presentation that they were giving was basically what’s called a baseline presentation for a phase three trial.

Dr Aoife Kiely:

So by the time you get to phase three, you’ve definitely shown that the drug is safe, which isn’t much news because this just means it’s safe and that’s wonderful. Water is also safe, but it doesn’t cure Dementia.

Dr Jack Rivers-Auty:

That’s phase one. Right. And then phase two [crosstalk 00:23:17] they should have a proxy measure.

Dr Aoife Kiely:

So in phase two, what they found was that this drug in their words trended towards efficacy. So anyone who’s familiar with statistical analysis will know that the word trend is used sometimes a little bit too often. And that means that basically the efficacy or how effective this drug was in showing any improvement in Dementia wasn’t statistically significant. But it was just enough to justify to their funding department I guess, that they could go ahead with the phase three trial.

Dr Jack Rivers-Auty:

Phase two trials aren’t supposed to put show efficacy, that one’s supposed to be a secondary mechanism that’s supposed to investigate some sort of proxy for what the drug is actually targeting. So if this is anti-amyloid drug, they would measure the levels of amyloid and shows that the drug did lower it and then that also hope maybe they get like a P value of 0.08 or something on the actual Dementia rating scores like the MMSE score. So this is probably what happened. Then they went into the stage three and what happened next?

Dr Aoife Kiely:

Yeah, I just find they tend to over hype an efficacy and they think they tend to sell it as, “This is genuinely effective.” I think because they have to pass these six monthly points to keep on getting money going into it. And I can understand why that’s challenging. Another similar drug that was basically a baseline presentation for how they were going to set up their phase two trial, was a drug that’s targeted to the other toxic protein in Alzheimer’s disease. And this one’s called AbbVie 8E12 and so this is the stage where they’re just describing what they’re going to do and how they’re going to set up the study. So this study is going to be in 66 different sites around the world, but they’re only going to have 400 participants, which I find a bit strange for those numbers.

Dr Aoife Kiely:

And they were just describing how they’re going to test it and what they’re hoping to find. And I think the reason as a former biomedical researcher, I find it quite strange when pharmaceutical companies get 15 minutes to say what they plan to do. Whereas a biomedical researcher can’t really go and say, “I’ve planned to do this and it’s going to be wonderful.” But yeah, there is more clinical trial presentations over the next couple of days, particularly some exciting ones on Wednesday. So I think we should see some interesting late breaking results coming out of AIC this year. Some other interesting research that I went to see in the afternoon sessions was to do with the effect of head injuries.

Dr Aoife Kiely:

So this was Lee Goldstein’s presentation and he was talking about some work that he’s been doing looking at both American footballers and veterans who’ve experienced head trauma from blasts while on active duty. And it was quite interesting because he said that in his cohort of American footballers, up to 20% of them that had the symptoms of chronic traumatic encephalopathy had never had any record of having any form of concussion. And he was really trying to stress that the damage that you get to your brain from concussions is different from chronic traumatic encephalopathy when you have repeated blows to the head. And it’s that and not necessarily a concussion. So it’s something that we kind of need to look out for maybe a bit more in, in sport-

Dr Jack Rivers-Auty:

But I do wonder because they want to stay on the field. How much reporting is there of concussions? Yeah, you try and hide it, so you can stay on the field and keep playing.

Dr Aoife Kiely:

Yeah. But even in, he was using animal models to show this and the mouse was kind of, had the trauma to the head, it wasn’t concussed and they showed the changes in behaviour and it went from this mouse exploring a field and being really active to literally just lying in the middle of the space. And then three hours later, he was up and he was fine and he was exploring. But there was still-

Dr Jack Rivers-Auty:

And that wasn’t described as a concussion.

Dr Aoife Kiely:

No because he was still lucid and he was still responding to stimuli and he’s still aware of the environment. Not sure.

Adam Smith:

Fantastic. Thanks Aoife. We’re running out of time a little bit. So no pressure Jack. Not all the time. So, but tell us what have you seen today Jack?

Dr Jack Rivers-Auty:

So I was just saying that AAIC is the biggest conference on Alzheimer’s disease and as you get bigger, you get a distribution of results. So there was some at the great end of the scale and there was also a couple at the lowering of the scale. We found out that a hops’ extract cures Alzheimer’s disease in mouse models.

Adam Smith:

A hops’ extract, that’s beer, right?

Dr Jack Rivers-Auty:

That’s beer, that is beer, so drink your bud lights but that was funded by a Hops company, so you might want to hold back on sculling beers to cure Alzheimer’s disease.

Dr Jack Rivers-Auty:

But at the good end of the scale, I had Laurie Chapnick, if that’s how to pronounce her name, she’s a Harvard professor and she was presenting on the decline in Alzheimer’s disease incidents. Now that might sound a bit weird, if we’re constantly telling everyone that Alzheimer’s diseases is going up and it’s increasing and that is 100% true, but this was about per age group. So we’re living longer and therefore more people are getting Alzheimer’s disease. But the question is, if we were to look at the age bracket, say 85 to 90 which approximately 40, 35 to 40% of people have Alzheimer’s disease, is that percentage, the 30 to 40% is that declining?

Dr Jack Rivers-Auty:

Is that declining now? Is it lowering down? So maybe only 30%, 25% of people over the age of 85 have Alzheimer’s disease. And she did a multi cohort consortium. She combined loads of studies from several different countries and she found it was about per decade as we go along. So in the 90s, 2000s, 2010s, we’re seeing a 17% decrease in Alzheimer’s disease incidents. So basically the rate of Alzheimer’s disease is curving off, which is really surprising. When I asked her about what could possibly be the mechanisms of it all, she said it might be the way we keep managing our cardiovascular risk factors better. So we’re taking statins, we’re taking bigger blockers so we’re keeping our blood pressure and blood cholesterol down even though we’re more obese than we have ever been. And that has been linked to, having high cholesterol and high blood pressure has been linked to Alzheimer’s disease.

Adam Smith:

I’m sure I’ve heard that before. Was it either, because two people that jumped to mind that work in the same area is obviously Martin Prince and Carol Bryne. I’m sure I saw a presentation last year maybe of the same. I remember really well seeing the diagram because it was a bath tub showing that the taps were coming in but the water wasn’t coming in as fast as the water was going out.

Riona McArdle:

Yeah, I think that’s [crosstalk 00:30:27]. I think that’s coming from the CFR study because Connor Richardson’s presented on that as well.

Adam Smith:

Have you seen the same one? Because people are getting diagnosed earlier. They’re living longer, which is another reason why the overall prevalence stays high. But incidence rates, I’ve definitely heard that before.

Riona McArdle:

Can I just ask is she speaking about Alzheimer’s disease specifically or is she talking about Dementia as a more whole group?

Dr Jack Rivers-Auty:

So interestingly in the whole epidemiology session, everyone was grouping Dementias because they weren’t separating them. And one of the reasons that they said why they were doing that is it’s very hard in a living patient to distinguish between Alzheimer’s disease, Vascular Dementia and the other kinds of Dementia. Most of the stuff was being grouped.

Riona McArdle:

Yeah and it is quite hard to… It’s very difficult to distinguish between them but we have gotten a lot better at distinguishing between them over the years and particularly with Lewy body disease as we increase criteria and we use biomarkers in Alzheimer’s disease and Lewy body disease. And just kind of what I was wondering now is, is the incidents of Alzheimer’s disease dropping off because actually we’re getting better at diagnosing cases that are not Alzheimer’s disease but are actually different Dementia because at the moment Alzheimer’s disease is the most common type of Dementia. But when you look at post-mortem, the rates that we clinically described as Alzheimer’s disease are not the same rates that we clinically described post-mortem or that we post-mortem described.

Dr Jack Rivers-Auty:

So this is probably good that she grouped them because otherwise it might have just been a shift from Alzheimer’s diagnosis to Vascular Dementia, which is happening very much so. Because they’ve all gotten, a lot of them had micro infarcts and we’re starting to find that, what we thought was Alzheimer’s disease was more likely-

Adam Smith:

Yeah, there was something else that she had, she had something like 20% of diagnoses changed if they applied additional testing on this diagnosis. That was something from last year. Again, was there anything else that particularly drew your attention?

Dr Jack Rivers-Auty:

Just some little surprising things like, I saw several studies including Professor Rob Stewart from Kings in the United Kingdom, talking about the number of eras in epidemiological data and how you have to keeping an eye out for it and it was actually really, really surprising. Some as high as 20% increase scoring as deaths and [inaudible 00:32:38] and how you need to control for that going in.

Dr Jack Rivers-Auty:

He also found that he went into the UK public dataset, the NHS dataset and he’s trying to translate it into something that we can use and he found that only 10% of MMSE scores and the scores that we use, what we sometimes use to diagnose Alzheimer’s disease or as a measure of Alzheimer’s disease. Only 10%, were in the correct data column. And here to use sophisticated algorithms to extract where the MMSE score was actually placed? And often it was in the comments section rather than in the MMSE score section or in the Alzheimer’s diagnosis section there’s a little sub note, they did in the MMSE score. So he had to use a complicated set of algorithms to actually extract that to find the rest of the 90% and he said if you’d had an initial look, you might’ve only thought we had a small data set, but we actually have a really large data set. You just need to know how to look for it.

Adam Smith:

That’s, yeah. Fascinating. Okay, so we are running out of time now. So just before we wrap up today, can I just ask, come back to you Aoife. Obviously, is there anything particular today that we feel is going to be of interest to people with Dementia? Anything that we can translate and put back to the community?

Dr Aoife Kiely:

I think there’s been, some interesting things. People always get in touch with us wanting to hear about the latest drug trials, so we always try and stay up to date with those. I think people would have found Leonard Mckie’s work very interesting about Epilepsy and the relationship between a [inaudible 00:34:20] and even just walking around the exhibition centre. Like Jack said, there was some great research being presented, some fantastic posters and some terrible stuff.

Dr Jack Rivers-Auty:

Go on, tell him, tell him what you found.

Dr Aoife Kiely:

I found a nutritional supplement that even said on the bottle that it’s not proved or approved to be used, but apparently it clears out 40% of plaques in the brains of 40% of people who take it, with no evidence whatsoever.

Adam Smith:

We should add that, that’s like 99% of everything on here is fantastic, ethically about research. [crosstalk 00:35:03]. We’ve got world leaders from across the research in Alzheimer’s disease.

Dr Aoife Kiely:

The thing is, it’s the sore thumb that sticks out, in that field of fantastic research. And that’s why people would stop and look at it because the rest of the things you’re looking at are in the exhibition hall in particular, are fantastic new methods of research, state of the art things and new ways for researchers to tackle Dementia in new ways, but also fantastic methods of care and assisted living. And also I got to meet Paro, the seal. So I was very excited about that and-

Riona McArdle:

Was that the real seal or robot?

Dr Aoife Kiely:

Yeah-

Riona McArdle:

I stared at the [inaudible 00:35:45], they were so cool.

Dr Aoife Kiely:

Go open them and cuddle them, they’re fantastic.

Dr Jack Rivers-Auty:

Are they warm? I wanted to know if they are warm.

Dr Aoife Kiely:

They’re not warm, but they’re quite heavy and they do coo and chirr and look at you.

Dr Jack Rivers-Auty:

I feel like there is no warmth in me petting a dead cat.

Adam Smith:

That’s so me.

Dr Aoife Kiely:

You’ve ruined my experience.

Adam Smith:

But I take your plan and I think it’s sadly those kinds of products and those newspapers, those studies that we find in the media that attract the attention are mean because they are quite bit of marketing.

Dr Aoife Kiely:

Yeah. Because it’s such good news and it’s such a fantastic statistic to see that it takes advantage of people who are desperate and want good news. And I find that the most distressing of all. I find it’s very cynical to treat people like that.

Adam Smith:

Completely agree. Well thank you very much everybody. I’m not going to keep you anymore because it’s now half past five and I’m conscious that everybody wants to get ready and go off to the reception on Navy Pier. Is there any final thoughts for the day? Anything you particularly looking forward to tomorrow that we should be paying attention to? Have you not looked at the program that far ahead yet? I have to say I look in the morning for what I’m going to look –

Dr Aoife Kiely:

So many spreadsheets, I can’t remember-

Riona McArdle:

As a pitch. I’m looking forward to presenting my poster tomorrow 2:00 to 6:00.

Adam Smith:

Of course. Well this podcast all being well, should be released about nine o’clock in the morning Chicago time. So, in about 14 hours’ time. So if people are listening to this here at the AIC, you can tweet using the #AIC18. What about you Jack? I saw you looking at your schedule. Have you picked something out?

Dr Jack Rivers-Auty:

I was trying to use the app. This is a good app and-

Adam Smith:

The app’s really good, isn’t it? I like the app. It’s useful rather than having to carry the books around.

Dr Jack Rivers-Auty:

Then, so tomorrow I should be able to just click this button and hopefully I’ve saved a whole bunch of stuff. Yeah, there’s quite a bit of research about inflammation coming out tomorrow. There’s a whole session on it and so I’m very excited about that. That’s right on my wheel house. So it’s always very exciting to see that kind of research.

Adam Smith:

Fantastic. Okay, thanks listeners. Please don’t forget to visit our website to check out the profiles on all of our panellists. So you can also find links in there to all their Twitter feeds. You can also post questions and comments on our panellists and in the section there and interact directly with them.

Adam Smith:

So don’t forget to follow them on Twitter. So that’s it for today. I’d just like to thank all of our panellists, Aoife, Ri and Jack.

Dr Jack Rivers-Auty:

You got it.

Adam Smith:

Thank you very much for joining us today. Again, please do push comments on the forum, on our Dementia research website, and that’s dementiaresearcher.nihr.ac.uk or you can also drop us a line on Twitter at Dem_researcher or use #ECRDementia. Thank you very much for listening and we’ll be back tomorrow with AIC day two and a new panel. Thank you very much.

Voice Over:

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