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Few diagnoses carry the devastating weight of dementia, which heralds loss, decline and inevitable death. The condition is the biggest killer in the UK, and cases are set to soar.

“One in three people born in the UK today will develop dementia in their lifetime,” says Richard Oakley, Associate Director of Research and Innovation for Alzheimer’s Society. A 2024 report commissioned by Alzheimer’s Society found that there are 982,000 people living with dementia in the UK – about one person in 70 – and that the number will rise to 1.4 million by 2040.

This poses an enormous challenge, both for biomedical research and for society. “Dementia is almost unique, in that it spans the health and the social care system in a way that I think no other disease does,” says Oakley.

Despite the impact of dementia, progress has been slow. Now, this is beginning to change. For the first time, treatments have emerged that can slow the progression of Alzheimer’s disease, a type of dementia accounting for 60 per cent of cases. A better understanding of the mechanisms underlying the different kinds of dementia are reshaping how researchers imagine the condition. Meanwhile, innovations in care – including advanced technologies such as virtual reality and artificial intelligence – are helping to improve quality of life for people with dementia and the people closest to them. “There’s never been a more exciting time to be involved in dementia research,” says Oakley.

Slowing disease

Since its founding in 1979, Alzheimer’s Society has developed into a world-leading funder of dementia research. In 1989, the charity funded research led by neurogeneticist John Hardy into the role of amyloid proteins in Alzheimer’s. This led Hardy and his colleague Gerald Higgins to formulate the “amyloid cascade hypothesis”, which outlines how the buildup of amyloid plaques in the brain can disrupt its functioning and kill neurons.

Three decades later, treatments are targeting amyloid and removing it from people’s brains in early stage Alzheimer’s disease. “These drugs have been shown to slow down progression of the disease,” says Oakley, although they don’t reverse the damage or cure the condition.

These treatments are not currently approved for use in the NHS in the UK, but it is likely that more treatments will be submitted to regulators in the coming years. A study of the Alzheimer’s disease drug development pipeline, published in June, found 182 ongoing clinical trials assessing 138 drugs. Some target amyloid, while others are aiming for other targets entirely, including the tau protein, neurotransmitter receptors, and inflammation. “About 30 of these [are] in phase three trials,” which is the last step in determining whether a medication is effective as well as safe, says Oakley.

Alongside the search for treatments, Alzheimer’s Society supports dementia research in multiple ways. The charity is actively funding over £50m in world leading dementia research, working with more than 400 researchers across the UK. Encouraging early-career researchers to choose dementia as their field of study is a key part of the charity’s research strategy. And crucially, it is supporting research that could lead to improved diagnostic methods.

Diagnosis is a major challenge in dementia. While written memory tests are enough to confirm that a person has dementia, additional tests such as PET scans are required to determine the specific type of dementia. “Only 2 per cent of people get that kind of extra, more specific diagnosis,” says Oakley. Alzheimer’s Society wants many more to get a precise diagnosis promptly.

“The thing that’s going to make a very big difference over the next year or two is the introduction of blood tests,” says Paresh Malhotra, consultant neurologist and Head of the Division of Neurology at Imperial College London. Such tests would be a cheap and noninvasive way support the diagnosis of dementia.

To enable this, Alzheimer’s Society, Alzheimer’s Research UK and players of People’s Postcode Lottery are funding the Blood Biomarker Challenge. The aim is to gather the information needed to introduce a simple blood marker to test for dementia in the UK healthcare system. Two studies are being supported. One study called READ-OUT, led by Vanessa Raymont at the University of Oxford, is looking at a large panel of potential biomarkers. Meanwhile, Jonathan Schott and Ashvini Keshavan at University College London have launched a project called ADAPT, which focuses on a single protein called p-tau217 that is known to increase in the blood during the development of Alzheimer’s disease. The hope is that measuring p-tau217 could support a diagnosis and quickly identify people who need further tests.

We already know the blood tests are reliable, says Malhotra. The new studies will help show how they can be integrated into the healthcare system.

Early and accurate diagnosis is crucial for dementia patients. Research shows that ‘disease-modifying treatments’ are most effective when given early. Early diagnosis means people can access care and support. It also means people can plan for the future. “You can play a role in determining the care you want at home, or how and when you move to a care home,” says Oakley. Such preparations make it less likely that people with dementia will reach a crisis that requires emergency medical intervention.

Family support

Alzheimer’s Society also aims to improve the lives of people with dementia and their loved ones. It offers support for families, such as online communities, telephone support lines, and social groups. It promotes wider awareness of dementia in society, enabling people with dementia to live fuller lives (see box).

The overall aim is to halt the march of devastation dementia causes. A true cure remains a distant dream, but even without one, enormous progress is possible. “If you shift back the onset of symptoms and delay how quickly the disease progresses, we could be talking a chronic condition that you manage well,” says Oakley.

In a few decades, HIV has gone from a death sentence to something that is treatable, says Malhotra. Alzheimer’s treatment could be similarly improved. “There are things that are happening at the moment, particularly around machine learning and AI, that have the potential to transform the field faster than I can imagine,” he says.

In a few decades, a dementia diagnosis may not be the beginning of the end but something to manage. “I see a world where Alzheimer’s disease is going to be like that,” says Oakley. “And Alzheimer’s Society is at the forefront of this progress.”

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