Inside the University's ongoing fight against dementia.

Old Man

By Josie Dixon (Univ, 1983)

A recent Guardian obituary for a former Oxford Head of House and Cambridge Professor referred cryptically to her ‘later years clouded by illness’. It was a euphemism for dementia, which – by the cruelest of ironies – had robbed a great literary scholar and conversationalist of all means to participate in academic and social life. 

In an institution which values above all the life of the mind, fear of losing what most defines an intellectual is evidently very real. Dementia, it seems, is still something of a taboo, and in such contexts it takes great courage to confront the facts publically in the way that John Bayley so memorably did over his wife Iris Murdoch’s decline into Alzheimer’s, movingly played out against the backdrop of North Oxford in the biographical film, Iris. The persistent reticence to name and face a condition which – statistically – awaits many of us, is unlikely to help raise the public awareness that will be necessary to support increased funding for research into the causes of dementia and future possibilities for treatment. Last month’s Dementia Awareness Week, championed by the Alzheimer’s Society, was designed to confront head-on the issues too often obscured by what risks becoming a conspiracy of silence – even in academia – in the face of one of the most significant clinical and social problems of our time.

It is more than two years since the Prime Minister launched his Challenge on Dementia in March 2012, with the objective of delivering major improvements in research and care by 2015. This was followed by the G8 Dementia Summit in London last December, which represented huge progress in moving dementia up the social and political agenda, resulting in a pledge by G8 health ministers to commit the necessary funding to achieve new clinical models and treatments by 2025. As a result, the World Dementia Council met for the first time in April of this year, to mobilise economists and business leaders in a concerted endeavour to unlock the resources required to make the necessary breakthroughs in research. 

Speaking for OxDARE (Oxford Dementia and Ageing Research), Clare Mackay describes this new political context as ‘very motivating’. OxDARE is a working group on cognitive health, formed in response to the Prime Minister’s Challenge, and designed to coordinate the huge range of Oxford’s research activity, comprising many different departments and approaches to dementia. This coordinated enterprise gives the University a more competitive edge in bidding for the increased research funds now available for what was, until recently, very much a Cinderella subject. 

Approaches to dementia, Mackay explains, have hitherto been fragmented between the different disciplines of gerontology, neurology and psychiatry — the latter two branches of cognitive science having diverged more markedly in the UK than in other countries. OxDARE aims to enable a more holistic approach, with the emphasis on translational neuroscience. This process of ‘translation’ involves bridging the gap between research laboratories and clinical settings, bringing science ‘from bench to bedside’ as Mackay puts it. The appointment of Simon Lovestone from King’s College London, a world leader in Alzheimer’s research, to Oxford’s new Chair of Translational Neuroscience has emphasized this shift in focus. It exemplifies a vigorous ambition to develop new treatments by bringing together disparate but vitally interrelated advances in research into cell and molecular biology, genetics, genomics, animal biology, cognitive testing and imaging, drug design and new pharmaceutical interventions. 

Brain Scans

OxDARE’s role involves mapping all this research activity, facilitating collaboration and maximising the potential for progress across the board. What distinguishes Oxford’s approach, says Mackay, is the University’s essential strength in basic science, which provides ‘more tools in the box’. She points in particular to three key institutes within the Nuffield Department of Medicine: the Target Discovery Institute, the Big Data Institute, and the Structural Genomics Consortium. Mackay and her colleagues at the Oxford Parkinson’s Disease Centre, a multidisciplinary flagship project, recently announced a breakthrough in the journal Neurology: new brain scans have been developed which detect early stage Parkinson’s with 85 percent accuracy. This points to possibilities for earlier diagnosis, before symptoms become apparent, and will help to pave the way for developing treatments to arrest or slow down the progressive damage to nerve cells which in 40-50 percent of cases eventually results in dementia.

While dementia is chiefly associated with memory loss, it can involve cognitive impairment of all sorts, and ultimately describes a set of symptoms rather than a single disease. Psychologists are still debating whether there is a difference in kind rather than degree between dementia and regular old-age memory loss, which comes to us all. Since the physical differences in the brain that define Alzheimer’s or Parkinson’s disease are currently visible only upon autopsy, much research is being devoted to finding ‘markers’, from brain scans or blood tests, which will bring forward the point of diagnosis. 

For now, there remains an uncomfortable, but ultimately humanising, sense that we are all subject to those small but significant memory lapses – magnified in the endearing stereotype of the scatty Professor – that place us somewhere on the same continuum as those who suffer from conditions such as Alzheimer’s. We owe it to those who are further down that line to name and face the reality of dementia, and give the research endeavour our fullest support. 

Josie Dixon (Univ, 1983) is a publishing and research training consultant. Images by Penn State and John Lewis under Creative Commons license.