Alzheimer's Can't Be Cured, But Delayed

'Think of the brain like a machine, and Alzheimer's is like rust.'
'Like a rusty machine breaks down, a rusty brain also breaks down. And when it breaks down, you have memory loss, cognitive issues and so on.'

Alzheimer's disease accounts for roughly 60% to 70% of all the dementia cases.

According to Alzheimer's Disease International, someone in the world develops dementia every 3 seconds!

In fact, the entire world is steadily aging. 36% of the population in Monaco is aged 65 and above. Japan has nearly 30% of its population above the age of 65. Japan also has more than 120,000 citizens aged 100 and above.

The elderly demographic is rising in India also with around 98 million people above the age of 65.

A country that is talking about 'demographic dividend' is next only to China in the number of the elderly.

This also turns our attention to the dementia cases associated with the elderly.

In the case of dementia, it is not the patients alone who are affected, but the immediate family members, caregivers and even the state itself are affected.

Today, Alzheimer's is diagnosed by an MRI scan, an expensive test available mainly in big hospitals.

It is against this background that the research conducted by Professor Deepak Nair, a neuroscientist based at the Indian Institute of Science, Bengaluru, becomes significant.

His research discovered that Alzheimer's can be detected by a simple blood test.

And if detected early, the onset of Alzheimer's disease can be delayed by 10 to 15 years.

It is to make the test affordable and accessible to all, that Dr Nair co-founded eNLife, a start-up at IISc, along with Lieutenant Colonel Jojo Jacob (retd) and Anish Mathew.

"There is a kind of stigma associated with dementia. The stigma is in its silence and helplessness. That's why families find it hard. Nobody wants to see the person they love fragmenting in front of their eyes," Professor Deepak Nair tells Shobha Warrier/Rediff.

Your research on neurodegenerative diseases like Alzheimer's started after you came to IISc to deliver a talk...

In 2013, I came to IISc to give a talk on neuronal cells communicating using tiny machines within synapses. We had found this by the end of my post doc fellowship in Europe.

Synapses are these tiny connections between brain cells where information from one cell is passed on to the other.

For years, people thought that a synapse is one single entity, which is about one by hundredth of the width of your hair strand.

We found that it is not a single uniform entity, but there are small molecular machines inside, each about one by thousandth of the width of your hair strand that are important for synaptic communications.

After the talk, the Institute offered me a position as an assistant professor at the Centre for Neuroscience to conduct further research on the topic.

The Centre was started by Dr Vijayalakshmi Ravindranath, Padma Shri. The year I joined, she convinced the Tata Trust to fund on research to understand the early onset of neurodegenerative diseases.

When I was trying to explain my research to my parents, grandmother and aunts, they asked me, what are you going to do with the research? Will people benefit from it?

These questions had a deep impact on me.

When I interacted with people whose family members have Alzheimer's disease and dementia, they said, 'If we knew about the disease early, if we could diagnose early...then we could plan, we could give dignity of life to the person'.

If Alzheimer's disease is detected early, can it be cured? Can it at least be arrested?

It can't be cured. But it can be delayed.

Even a 5 to 10 year delay is a big thing for the caregivers because life of an Alzheimer's patient, or a dementia patient affects all the members in the family like the son, the daughter, the wife, the grandchildren and the caregivers. It affects an entire ecosystem.

So, if you can push the onset by 5-10 years, you are actually bringing down the socioeconomic burden on the family.

India has almost 9 million people with Alzheimer's disease in India which is expected to double by 2036. It going to be a huge burden on the family and society...

The number is actually more than that. I'll just put it like this, when you cross 80, 1 in 4 to 1 in 5 or 6 people will have some form of dementia, and almost half of them or one third of them transition to Alzheimer's.

That's going to be a huge number.

Is it because life expectancy has increased?

That's correct. Life expectancy has increased.

We also diagnose the disease better.

Reports say that only 1 in 10 patients get early detection. Is it because early detection is not available? Or are people unaware?

I think there are two angles to this. Angle number one is, there is no early detection test available right now.

The test that is available is the classical MRI scan that looks at your brain, then look at the markers and try to image your brain.

Then they will say whether you have Alzheimer's or not.

By then, the disease must have already started.

Think of the brain like a machine, and Alzheimer's is like rust.

Like a rusty machine breaks down, a rusty brain also breaks down. And when it breaks down, you have memory loss, cognitive issues and so on.

If you oil a machine regularly, you can prevent it from rusting. Is there something like that for the brain?

What our research is looking at is, when the rust starts appearing in the machine before it breaks down.

Our body leaves chemical traces in the blood when the disease starts. And these traces can be detected in the blood.

Today, we are catching these traces using brain scans or spinal taps, which are available only in big hospitals.

What we want to do is, we want to build something very simple, a blood test that can be available in any primary care health centers.

We want to make it accessible to everyone, and even a primary health care clinician should be able to do the test like a cholesterol test or a blood sugar test.

AI-Powered Biomarker Detection

How exactly do you find out by testing the blood?

It is very simple.

Any change that happens in the brain is reflected in blood. Though blood and the brain do not mix, they interchange a lot of materials like nutrients, minerals, and proteins.

Some of these are biomarkers. These biomarkers are biomolecules that change during the onset of a disease.

When a disease like Alzheimer's starts today, you will see the symptoms only 10 to 15 years later. But if we look for the biomarkers in the blood, you can pick it up today itself.

This is 100 to 10,000 times more sensitive than the current testing strategies.

Do tests like this are done anywhere else in the world?

Yes, it is an approved test to detect Alzheimer's early.

But those are tests are built for Western healthcare systems, and they only rely on one or two biomarkers in symptomatic patients.

These tests are not better than the brain scans right now, partially due to sensitivity and partially due to the limited use of biomarkers as they use only two biomarkers.

On the other hand, we use five to seven biomarkers now, and this can go up to any number.

Our test is different on two fronts, we have a broader multi-marker panel aimed at catching the disease early, and a design that is affordable and deployable in our conditions.

The technology based on AI is built for us.

Do the biomarkers change depending on ethnicity?

Yes, they do change with ethnicity.

So, is your test designed only for India?

Not for India alone, it is applicable to all human beings.

Yes, we want to do this for India because India needs it badly because of the number of people who are ageing.

And why should we rely on other countries?

The beauty of our technology is that it is AI driven.

In what way does AI help you in testing?

When you look at one or two biomarkers, it gives you a noisy number.

But when you look at a panel of markers, the pattern between them carries a signal. And that pattern is subtle. And we are teaching AI to detect the pattern.

Interestingly, the more the number of people we test, AI will become more precise in its result.

If I am trying to check 1000 people, AI's accuracy will be lower. But if my sample data is a million, the AI result will be much better. The more we test, the more precise it will become. That is the beauty of AI.

As we progress, we will move from the current 7 biomarkers to 25 or 100.

With AI, we can also go for ethnicity specific. For example, we can have a Sweden specific panel versus India specific panel versus South Africa specific panel.

It's a tool built on accuracy so that doctors can make accurate predictions.

Affordable Healthcare Innovation

When will you be able to make the test available to people?

We are at a stage where we are building three different technologies.

One is the technology for the binder, creating the highly sensitive molecules that will bind the biomarkers.

Second is the AI platform to improve accuracy.

Third is the small photocopier like machine.

We are raising money to put all the three verticals under one umbrella.

The pace at which we are going right now, in 18 to 24 months, we will be able to have the first beta testing version ready. This is my most optimistic vision.

Then, we will have to apply for approvals.

I am a scientist and not a businessman. I am looking at this from a scientist's point of view. I want this to be useful to the community.

There is a kind of stigma associated with dementia in India as well as across the world.

The stigma is in its silence and helplessness. That's why families find it hard. Nobody wants to see the person they love fragmenting in front of their eyes.

Once the test is available for people, at what age should people test for Alzheimer's?

The early onset of Alzheimer's is seen at the age of 55. That is because many of them may have genetic variances of the disease. Then, it is easier to detect as you have to look at whether the mutations are there.

But 95% of the cases are sporadic. There may not be any mutation. It just happens because of various reasons like the way you live, your food habits, etc. Co-morbidities like diabetes, vascular issues also contribute.

But when Alzheimer's starts, it has very common signatures coming from the brain which we can pick up early using the biomarkers.

India is also a country that has the maximum number of diabetic patients in the world....

That's why we want to make it affordable and accessible to everyone. We want to de-centralise.

This kind of a test can help the government come up with a policy in care.

Then, it can help scientists and pharmaceutical companies come out with the right kind of drugs needed for the patients.

What is the point in having a medicine in hand when you do not know the right time to use it?

Globally also, the world is aging like never before..

Yes, the entire world is aging. Look at Japan...Look at almost all the European countries..

Look at Kerala. Look at most of the southern states in India. They are aging; the birth rate is coming down and the number of elderly people are increasing.

And this is going to be a tough nut to crack for the government in another 10-20 years.

While Western giants are designing for a Western reimbursement system while our focus is an entirely different market like India and similar countries where affordability and accessibility are more important.

A different product for a different reality.

You feel if we detect dementia early, we can give the person better quality of life?

Exactly. If we can delay the onset of dementia by 10 years, that will be very helpful because you will only live up to a certain age.

The more you delay the onset, it is beneficial for not only the patient but also the caregivers.

Feature Presentation: Ashish Narsale/Rediff