Winblad, B;
Amouyel, P;
Andrieu, S;
Ballard, C;
Brayne, C;
Brodaty, H;
Cedazo-Minguez, A;
... Zetterberg, H; + view all
(2016)
Defeating Alzheimer's disease and other dementias: a priority for European science and society.
The Lancet Neurology
, 15
(5)
pp. 455-532.
10.1016/S1474-4422(16)00062-4.
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Abstract
Alzheimer’s disease (AD) is the leading cause of dementia, and because the primary risk factor for AD is old age, the prevalence of the disease is increasing dramatically with ageing populations worldwide. Even in high-income countries, the cost of medical care and associated societal burdens of dementia threaten to become overwhelming as more people live into old age. In view of the lack of progress in developing a cure for AD and the rapidly increasing costs of dementia, policy makers and governments have a powerful incentive to provide more resources to develop AD therapeutics. The Lancet Neurology Commission was formed with the overarching aim to provide information and expert recommendations to policy makers and political leaders about the growing problem of AD and related dementias of ageing. The past two decades have seen remarkable improvements in the quality of care for patients with AD, with a research-driven shift to more personalised and integrated team-oriented care. Epidemiological and genetic studies have identifi ed many factors that increase the risk of AD. Prevention studies have highlighted the possibility of targeting risk and protective factors to delay onset, with the promise of reducing the overall prevalence of dementia. However, no treatment is yet available to halt or reverse the underlying pathology of established AD. Indeed, an eff ective therapy for AD is perhaps the greatest unmet need facing modern medicine. Basic biomedical research has provided insights into the causes and pathogenesis of AD and other neurodegenerative diseases, but improved understanding of disease mechanisms will be needed to develop safe and eff ective disease-modifying treatments. Nonetheless, several drugs are currently in late phases of clinical development. The Commission considered a range of challenges that need to be addressed to reduce the burden of dementia, and these challenges are discussed in detail in the main sections of our report: health economics (section 1), epidemiology (section 2), prevention (section 3), genetics (section 4), biology (section 5), diagnosis (section 6), treatment (sections 7, 8), care (section 9), and ethics (section 10). In panel 1 we summarise the key fi ndings of the Commission, with recommendations about how patient care and related research—from basic to clinical— in AD and other dementias should be organised in the future. A concerted eff ort to tackle dementia is needed, with a substantial overall increase in government and private investment in the care of patients and the search for AD therapeutics. Europe is well placed to take the world lead, in partnership with international organisations, to develop new approaches to prevent or cure AD and other dementias and to provide models of compassionate care for patients. As the cost of care increases, funds must not be shunted from basic research, clinical research, and drug-discovery programmes. In fact, a substantial increase in long-term funding for multidisciplinary research programmes is absolutely essential to reduce the burden of individual suff ering and the enormous societal cost of AD. Only targeted increases in research investment will provide any hope of fi nding a cure for AD or developing strategies to delay the onset or slow the progression of the disease.
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