New therapies in development and simpler methods of diagnosis offer hope for dementia patients of all ages, says Professor Nick Fox of UCL and UCLH.
Professor Nick Fox has spent more than 20 years diagnosing and treating people with dementia and supporting patients, families and carers affected by the disease.
He is at the forefront of dementia research, with a focus on early onset and inherited Alzheimer’s disease.
This week he will address the Alzheimer’s Association International Conference – the biggest event in dementia science – on what we know and don’t know about early onset Alzheimer’s disease and what treatments we lack.
“This has been a neglected area of research,” says Prof Fox, a consultant neurologist at UCLH and Director of the UCL Dementia Research Centre.
“The perception is that Alzheimer’s disease is something people have in their 70s and 80s. But it also affects people much younger – sometimes 30 or 40 years younger – and can present differently, so it is not always spotted early.”
Prof Fox is among a select group of researchers invited to give a plenary address to the 2020 AAIC and the only one from the UK. Over 20,000 people from around the world have registered to attend – this year remotely.
“I’m delighted to be speaking. It’s a rare thing to be asked, so it’s a real honour and a career highlight.”
Interest in dementia research in general has gone up in recent years, and Prof Fox’s UCLH/UCL research team has grown steadily thanks to funding from the National Institute for Health Research and others. He now leads a dedicated dementia theme that is part of the NIHR Biomedical Research Centre at UCLH.
However, while research has led to a greater understanding of disease, there is still a large unmet need for treatments and for improvements in diagnosis.
“So far we haven’t found any treatments which can slow or reverse disease progression. We can only relieve symptoms.”
His team has been working on a number of potential treatments, however, including drugs that aim to reduce harmful levels of tau protein found in brain cells, which may be a cause of dementia.
He has also led analysis of immunotherapy trials for dementia – where the body’s immune system is put to work to fight the disease.
As this work continues, separately, thanks to a £5m grant from the Sigrid Rausing Trust, his team will start developing gene therapies that aim to ‘silence’ the genes responsible for dementia.
“Immunotherapy and gene therapies are particularly exciting. In the end, it may be that there is not one single treatment – we may instead be offering combination therapy.”
Prof Fox and colleagues are also improving diagnosis of dementia. Working with collaborators in Sweden they have recently shown that a simple blood test could make diagnosis of Alzheimer’s disease possible at the first sign of symptoms.
Prof Fox could easily have ended up working in a different area of medicine – or a different profession altogether.
Unsure what career path to follow after a degree in physics and physiology, he worked as a civil servant on the Soviet desk in the Foreign Office, before studying medicine as a mature student. During his medical training, he spent time at the UCL Queen Square Institute of Neurology.
“At that time I wasn’t sure which way I wanted my career to go – one area I was considering was public health.
“At Queen Square my supervisor suggested I apply for a clinical research fellowship being offered by the Alzheimer’s Society – and I became one of the first holders of that fellowship from 1993-96. My project was on inherited forms of Alzheimer’s disease – an area that has been my research focus ever since.”
“Since that time, having worked closely with patients and their families, I have stayed in neurology and remained at UCL, apart from short rotations elsewhere as I completed medical training.”
His contact with patients and families led to Prof Fox helping to set up and run Rare Dementia Support, a service for patients, relatives and carers, which was the first of its kind in the world and whose work involves face-to-face support groups.
During Covid-19, the service has moved online – and has stepped up its work in response to a doubling of calls to the service. Prof Fox and colleagues recently wrote a letter published in the BMJ about the support needed for families during the pandemic.
“Covid-19 has posed unique challenges for those affected by dementia. Some patients are more vulnerable to infection – due to their reliance on touch, for instance.
“In addition, patients don’t necessarily understand why they have had to stay at home, and carers have lost time to themselves. So we are supporting families around these challenges.”
Taking the long view, Prof Fox is optimistic about how dementia research and support will evolve.
“Our work to improve the diagnosis of Alzheimer’s disease and dementia – at any age – will mean patients and families can get the support they need at an earlier stage.
“And the number of treatments in the pipeline means there is real promise that we will be able to prevent or slow disease progression in future. I hope that offers some hope to patients and families with these devastating diseases.”
Professor Nick Fox is a plenary speaker at the AAIC on Wednesday 29 July.
Registration is open until Friday 31 July, and recordings of talks will be made available throughout the week and will be available to watch on-demand.