Last week a research story about lithium and dementia from Denmark caught the attention of the UK press and I have since been asked by a number of families about potential trials after I commented in the press.
Dementia is no stranger to the media with scientific papers of varying quality appearing in the news weekly, often with brash headlines over stating the real findings. In this case, the study was large and carefully designed, involving 800,000 people. Researchers looked at the natural variation of lithium in drinking water in different regions of the country and found that people exposed to the highest natural levels had a small reduction in dementia risk. This type of study can only show that higher lithium levels are linked to dementia reduction; it can't tell us how or why.
"It's almost too good to be true that something as cheap and plentiful as lithium might have a role in future prevention of Alzheimer's disease. However, more research including clinical trials are needed..." - Alzheimer's Society comment on the original research
A number of UK experts agreed with Alzheimer's Society about the high quality of the study and that clinical trials in people are needed. Such trials would be the only way of testing whether lithium can be used as a treatment for Alzheimer's disease, or even better as a way to prevent dementia in the first place. Lithium has been widely used in the treatment of bipolar disorder for over 50 years, and whilst not without some side effects and need for monitoring, is relatively safe and well understood by doctors. Certainly we need to balance the risks of giving someone an experimental drug with the potential benefit of the treatment, but on the backdrop of this new study lithium could enter trials almost immediately to see definitively if it could work in dementia.
What wasn't covered in the news articles is that the possible benefit of lithium in Alzheimer's disease has been known since the late 90's and Alzheimer's Society funded research showed the positive effects of lithium on neurones grown in the lab in 2004. Since then there have been over 400 scientific publications about lithium and Alzheimer's, several involving small numbers of people but the majority based in laboratory science.
Why does it take almost 20 years and hundreds of scientific papers before we move to testing a potential treatment in people with dementia? For drugs like lithium with limited commercial value, finding funding for definite clinical trials is a tremendous challenge. In our experience, clinicians with the expertise to run these trials become exasperated and despondent with the years it can take to get funding, often leading them to shifting their attention elsewhere. Organisations like the Alzheimer's Society and Alzheimer's Drug Discovery Foundation in the US make specific funds available for this but not all promising avenues can be followed up. These trials are not trivial sums of money, but with the annual cost of dementia estimated to be almost $1 trillion worldwide, each trial represents the equivalent value of just a couple of minutes of the global cost of dementia.
The UK Life Sciences Industrial Strategy published on Wednesday this week makes welcome commitments to keep UK life sciences at the forefront of global research, despite the potential implications of Brexit removing research funding and skilled researchers. There is much to like about the new strategy, including a call to improve the delivery of clinical trials in the UK. This opportunity should not only address the testing of new drugs from the pharmaceutical industry but also deliver trials of drugs like lithium, or lifestyle interventions such as exercise, that are unlikely to generate profits if they work. Given that there hasn't been a dementia drug approved for 15 years, the potential benefits to people affected by dementia and to society are immeasurable.
This isn't just a call to see a proper clinical trial of lithium conducted in dementia. It is also a call that when the next scientist, and the next after that, shows something potentially works as a therapy that there is a more urgent, prioritised and funded way to rapidly start testing the approach in people. In reality many things that have looked promising won't work, but we shouldn't have to spend decades talking about the possibility to find out. People with dementia deserve and need more from science.
To find out more about Alzheimer's Society funded research and to donate, visit: https://www.alzheimers.org.uk/research