Alzheimer’s, dementia and Parkinson’s increasingly a topic in the media

“SPIEGEL”, “Spektrum der Wissenschaft” and others: Information on prevention and research is becoming more relevant

Alzheimer’s, dementia and Parkinson’s are the most common neurodegenerative diseases of our time, affecting around two million people in Germany alone and, according to the WHO, over 65 million people worldwide. The number of patients with dementia is expected to rise to around 152.8 million by 20501 and the Global Burden of Disease Study 2019 estimates that the number of Parkinson’s patients worldwide could rise to 12.9 million by 20402. These figures illustrate the immense importance of research, prevention and social information in these areas.

Chronic and neurodegenerative diseases are already overwhelming healthcare systems

The media has long been reporting on these diseases in a variety of ways, as they are highly relevant to society. However, since the beginning of 2024 in particular, the overall topic has once again come to the fore, as the care situation and care costs alone have worsened significantly in the last two years.

In Germany, for example, the co-payments that nursing home residents have to pay out of their own pockets have risen considerably: in 2023, these increased by an average of 14 percent across Germany, resulting in an average monthly burden of €2,778 for those affected3. At the end of April 2024, Federal Health Minister Karl Lauterbach also announced that the number of people in need of care in Germany had risen unexpectedly sharply in 2023. Instead of the expected demographic increase of around 50,000 people, there were actually over 360,000 new care cases, many of them suffering from dementia and other neurodegenerative diseases. Lauterbach described this increase as “explosive”4.

This leads to a new offensiveness in the media. While these indications were previously only marginal notes, information and education on general prevention are now coming to the fore and new developments in research are also being reported on more extensively and in a more differentiated way than before.

“Clear in the head – New research: How we can prevent Alzheimer’s and Parkinson’s”

SPIEGEL Nr. 25 - 15.06.2024Prevention, for example, is the cover story of the news magazine DER SPIEGEL in issue no. 25 from 15.06.2024. SPIEGEL author Jörg Blech spoke to scientists about what prevention and a mindful lifestyle can achieve and shows in his comprehensive article that brain health does not just take place in the brain alone, but has to do with the health of the entire organism and that diseases such as Alzheimer’s, dementia and Parkinson’s do not just appear suddenly, but develop gradually over decades – even far away from the head: “Our brain works well when the rest of it works well too,” summarizes neurologist Daniela Berg, Department of Neurology at the University Medical Center Schleswig-Holstein in Kiel and Vice President of the German Society of Neurology (DGN) in SPIEGEL.

The neurologist and her team are researching how disorders in other parts of the body can influence the course of Parkinson’s disease. For some time now, they have been focusing on disrupted intestinal flora: if the balance of microbes is disturbed by poor diet, pollutants or frequent antibiotic intake, this leads to changes in the intestinal wall and inflammatory processes. These processes allow harmful substances to enter the bloodstream and further into the brain, which can lead to neurodegenerative diseases. Such connections are now considered proven not only for Parkinson’s, but also for Alzheimer’s and other forms of mental decline. External factors therefore play a decisive role in mental health in old age and many of these risk factors can be avoided.

The SPIEGEL article also deals in detail with the so-called “Big 12”. These are the 12 main risk factors for neurodegenerative diseases that 28 renowned experts summarized in a review article in the journal “THE LANCET” in 20205 : High blood pressure, smoking, obesity, low education, depression, type 2 diabetes, physical inactivity, hearing loss, social isolation, excessive alcohol consumption, traumatic brain injury and air pollution are all risk factors that together account for about 40 percent of dementia cases worldwide (see also: Alzheimer’s Prevention – How to prevent ? ).

“Our brain works well when the rest of us works well too.”

There is no question in science today that we can actively influence our health and therefore also the functioning of our brain. The excuse that these diseases are genetic is only true in a few cases, as it is assumed that only 10 percent of those affected have a genetic predisposition – conversely, lifestyle and environmental factors are also decisive for 90 percent of people and there is a lot that individuals can do for themselves.

In addition to physical and mental activity, the SPIEGEL article pays particular attention to the warning against the consumption of highly processed foods, which are associated with a significantly increased risk of dementia. These products rarely contain fiber and consist mainly of sugar, fat and numerous chemical substances such as antioxidants, flavor enhancers, emulsifiers, humectants, complexing agents and preservatives. According to SPIEGEL, our grandparents would hardly have recognized such industrially produced foods, which include fast food burgers, packet soups, microwave ready meals, compressed fish or chicken nuggets and energy drinks, as food.

The central message of the SPIEGEL article is clear: the prevention of Alzheimer’s, dementia and Parkinson’s requires a holistic approach. A healthy lifestyle, regular exercise, a balanced diet and active social interaction can significantly reduce the risk of developing these diseases. Research offers promising approaches, but ultimately prevention remains the key to maintaining mental health in old age.

Of course, SPIEGEL also takes a brief look at the new antibodies Lecanemab and Donanemab from the USA. These antibodies represent important progress, but are not yet the final breakthrough, according to Prof. Dorothee Saur from the University of Leipzig in SPIEGEL. The effects on cognition are minor and it remains unclear whether patients can benefit from them in everyday life. In addition, the drugs are unsuitable for patients with vascular dementia. Treatment with lecanemab, for example, requires a one-hour infusion every two weeks in a doctor’s office or hospital and carries risks such as swelling or bleeding in the brain. These side effects require regular MRI examinations. In addition, the treatment costs around 25,000 euros per year and per patient and would probably have to be continued for life. It is therefore much cheaper and more effective to keep the brain in good condition through a healthy lifestyle.

Spektrum der Wissenschaft: Therapy – New weapons against Alzheimer’s

SPEKTRUM DER WISSENSCHAFT - Dossier 2/2024 “Spektrum der Wissenschaft”, one of the most renowned scientific publications in the German-speaking world, which regularly publishes special publications on the topic of “Gehirn & Geist”, also reports on dementia and the current state of science in its Dossier 2/2024 in various articles. The Hildesheim-based science journalist Ulrike Gebhardt also takes a factual and critical look at the new drugs from the USA, which may also be approved in Europe.

The author offers a comprehensive analysis of the new therapeutic antibodies Lecanemab and Donanemab, which target protein deposits in the brains of Alzheimer’s patients. These drugs have shown encouraging results in clinical trials, statistically slowing cognitive decline and other typical deteriorations of the disease, albeit with modest effects. Nevertheless, lecanemab received approval from the US FDA in 2023, while donanemab is still awaiting the decision. The expectation is that both drugs could soon also be approved in Europe.

Lecanemab and donanemab not miracle cures: risks, little effect, unaffordable for healthcare systems

Despite the encouraging results, the effect of the new antibodies remains limited and is assessed differently and also highly critically by experts, according to the article. While some researchers hope that longer treatment could lead to better results, others point to the minimal therapeutic effects. In addition, antibody therapies are known to be expensive, lengthy and associated with significant side effects. In particular, they can cause brain swelling and bleeding, which in some cases can even be fatal.

The article also describes that women, still little known, appear to benefit less from the therapy than men. These gender differences are of clinical importance, but were hardly addressed in the study reports. Furthermore, the risk of side effects increases in people with certain genetic predispositions, such as the APOE4 gene variant.

The high costs and the enormous effort required for treatment raise questions about the broad applicability of the antibodies: The German Network of Memory Outpatient Clinics has calculated that the treatment costs for all suitable Alzheimer’s patients in 27 EU countries would amount to 133 billion euros per year at prices comparable to those in the USA. This would not be financially viable for the healthcare systems in these countries. In Gebhardt’s report, experts such as Linda Thienpont, Head of Science at the Alzheimer’s Research Initiative, therefore also emphasize the need to continue research in different directions and not just rely on the amyloid hypothesis. Alzheimer’s is a multifactorial disease that is influenced by a variety of genetic, inflammatory and infectious processes. And Prof. Christian Behl, Director of the Institute of Pathobiochemistry at Johannes Gutenberg University Mainz, warns: “If you follow the current hype about the minimal therapeutic effects, it seems to be less about people and more about dogmatism.”

Overall, the article makes it clear that although the new antibody therapies represent important progress, they are not magic bullets. They are a first step towards a more effective treatment for Alzheimer’s, but further research and a broader perspective are needed to tackle this complex disease.

Still under the media radar: non-invasive brain stimulation (NIBS)

This broader perspective also includes non-invasive brain stimulation methods (NIBS), which are seen within the scientific community as a beacon of hope in the treatment of neurodegenerative diseases. However, they have hardly featured in the media and thus in the general public’s awareness.

Non-invasive brain stimulation methods (NIBS) have made significant progress in recent years and some have now been included in clinical guidelines. These methods include repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). Transcranial Pulse Stimulation (TPS) is on its way to becoming evidence-based, especially in the field of Alzheimer’s therapy, and is now being used worldwide, with a focus on Germany, and is also being intensively researched for other indications.

The possibilities offered by TPS, which make it relevant for those affected, have already been impressively presented several times in reports on RTL, ORF and SERVUS TV as well as in some print media, but NIBS still leads a rather shadowy existence in the media landscape – even though scientists and institutions have long been urgently calling for non-invasive brain stimulation methods to be made accessible promptly and across the board (see also: Non-Invasive Brain Stimulation procedures: Increasingly Essential for Healthcare )

The current issues SPIEGEL No. 25 – 15.06.2024 and SPEKTRUM DER WISSENSCHAFT – Dossier 2/2024 are highly readable – even for experts – and are available in newsagents everywhere.

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