Alzheimer's disease (AD) is devastating for the millions of people who are diagnosed, as well as their families and carers. The Dementia Statistics Hub from Alzheimer's Research UK concludes that Alzheimer's is the leading cause of death in the UK and, unfortunately, the numbers are only on the rise. Globally, we can expect the number of people living with Alzheimer's and other dementias to increase from 50 million in 2018 to 152 million by 2050. AD is not - according to current research - caused by just one factor: rather, at present we know of a collection of factors that have been shown to individually increase risk of developing AD, for example genetics or repeated head injuries. Likewise, there is currently no single test for Alzheimer's, nor one to measure its progression. AD already significantly impacts population and individual health, but what if there was a way to test for the disease and develop effective treatments?
This is where philanthropist James Drake comes in. James funds scientific research that aims to illuminate the connection between repeated head impacts and neurodegenerative disease, particularly dementias in sports professionals, a population that has been shown to be at higher risk of dementia due to repeated head impacts. The Drake Foundation's research projects have already made key findings that have developed scientists' understanding of the short- and long-term impacts of concussion and head impacts. It is hoped that these studies could not only shed light on sports concussions, but also on biomarkers for neurodegenerative diseases such as Alzheimer's, which could one day accelerate the race for a treatment and possible cure for AD.
What Is a Biomarker?
A biomarker (biological marker) is a measurable factor, for example a molecule, gene or characteristic, which can be used in clinical assessments to measure physiological processes and diagnose and assess the severity of illnesses. For example, medical professionals look for biomarkers such as gene mutations to identify risk of developing some cancers. Biomarkers are particularly useful as indicators of disease risk for diseases that are preventable or manageable with a change or lifestyle or medication. For example, we know that high cholesterol is an indicator of increased risk of heart disease - with a simple blood test, we can test for cholesterol and consequently adapt lifestyle (and medication if needed) to reduce further risk. In an ideal world, we would be able to do the same for Alzheimer's and other dementias. Identifying biomarkers for disease risk and progression is a major step in the path to conquering a disease.
What Is Alzheimer's Disease?
Alzheimer's disease is the most common form of dementia in the UK. The syndrome is associated with the brain's ongoing decline, which can affect memory, processing, and other cognitive abilities. There isn't a single definitive cause, though various factors can increase the risk of developing Alzheimer's. These factors include:
● A history of repeated head impacts or injuries.
● Family history of Alzheimer's.
● Increasing age - according to the NHS, Alzheimer's affects approximately 1 in 14 people over 65 and 1 in 6 people over 80.
● Conditions and lifestyle associated with cardiovascular disease.
There isn't a single 'test' available to diagnose Alzheimer's in the same way that we can test for diabetes, HIV, or some cancers. As there is no definitive test or single definitive cause for Alzheimer's, the search for a cure or disease-modifying therapy (a treatment that affects the underlying cause of a disease, rather than just symptoms) has been difficult and so far there are no disease-modifying therapies for AD.
How Can Concussion Studies Help?
We now know that repeated blows to the head, for example concussions or even repeatedly heading a ball in a lifetime as a professional footballer, can increase a person's risk of developing neurodegenerative diseases such as Alzheimer's.
This belief was solidified in 2019 by the results of the FIELD (Football's Influence on Lifelong Health and Dementia Risk) study from a team at the University of Glasgow, which compared mortality rates from neurodegenerative disease amongst 7,627 former professional footballers. The study concluded that retired footballers are over 3.5 times more likely to die from dementia than the general population and over 5 times more likely to die from Alzheimer's.
The Drake Foundation is funding a range of studies into biomarkers that correlate with concussions and head impacts, both in the short-term (i.e., immediately after a concussion) and long-term (i.e., in retired football and rugby players). These include the BRAIN and HEADING studies, the Drake Football Study, and a study investigating concussion biomarkers in the Premier League.
It's possible that if biomarkers for concussion are identified in these studies, given that people who have a higher historic rate of concussions/head impact are more likely to develop neurodegenerative disease, some of these concussion biomarkers may also be present in people with Alzheimer's and other dementias, and may consequently be an indicator of Alzheimer's. It's therefore possible that some of these biomarkers could be present in people beforethey show outward symptoms of AD, meaning that one day these biomarkers could be used to identify people at risk of Alzheimer's so that early treatment can be given to reduce further risk and stop the full disease developing.
The idea is that by doing studies like the Drake Football Study and looking for biomarkers, we can begin to build up a picture of biochemical changes in the brain at the very start of neurodegenerative changes. One day, we could be able to defeat dementia in the same way that we can now significantly reduce risk of heart disease by monitoring cholesterol and blood pressure.
1) The BRAIN Study
The ongoing BRAIN Study (Brain Health and Healthy Ageing in Retired Elite Rugby Players) examines the association between former rugby players' history of concussions and neurodegenerative disease. Researchers are gathering concussion history and data about former professional rugby players and carrying out tests that examine the players' memory, reasoning, and grip strength. The rugby players are also undergoing clinical examinations, face-to-face assessments, and blood and urine samples for biomarker analysis.
2) The HEADING Study
The ongoing HEADING Study (Health and Ageing Data in the Game of Football) analyses the correlation between concussion or repeatedly heading a ball and neurodegenerative disease. Researchers are compiling data about the football concussion and heading histories of players over 40 and conducting a variety of extensive tests, neurological clinical examinations, face-to-face assessments and blood samples to capture physical and cognitive capabilities and biomarker analysis.
3) The Drake Football Study
The Drake Football Study offers the most comprehensive research into the evolving mental and physical health of professional footballers to date. The Drake Foundation has partnered with a host of collaborators across Europe to uncover new insights into players' health throughout their careers and retirement. The ongoing study involves collecting epidemiological data from sports professionals over 10 years to examine their evolving musculoskeletal, neurocognitive, cardiovascular, and mental health. The study will include analysis for potential biomarkers of disease.
4) Evaluating Concussion in Premier League Football
The Evaluating Concussion in Premier League Football Study aims to identify concussion biomarkers and testing methods that could allow for football pitch-side tests for concussion in the future. The researchers are collecting saliva and urine samples from footballers who have sustained a head injury and uninjured control players immediately post-match and at further intervals. The University of Birmingham and University Hospitals Birmingham NHS Foundation Trust are testing the samples for biomarkers that indicate brain injury. In future, this test could assist return-to-field decisions in sports, military, and other frontline settings.
Identifying Biomarkers
By conducting these studies, The Drake Foundation aims to identify biomarkers not only for concussion, but that will also help medical professionals to build a picture of the biochemical changes that occur in the brain at the very beginning of neurodegenerative disease. These studies could help medical professionals to defeat dementia in the same way that we can now seriously reduce the risk of heart disease by monitoring blood pressure and cholesterol levels.
About James Drake and The Drake Foundation
The Drake Foundation is a not-for-profit organisation that unites sport, science and society by funding ground-breaking research to enhance our understanding of the effect of sport on the body. This knowledge will ultimately help to inform safe sporting practices that ensure sport can be enjoyed safely by everyone, minimising the risk of long-term risks such as neurodegenerative disease.
James Drake is the founder of The Drake Foundation, which he launched in 2014 to fund studies for the under-researched sports-related concussion field. Since then, James Drake has funded seven vital studies into the links between head injuries and neurodegenerative decline. To date, The Drake Foundation has provided over £2 million to examine the diagnosis, pathology, prevalence, and management of sports-related concussions.
Read more about The Drake Foundation at www.drakefoundation.org. You can also follow the Foundation on Facebook and Twitter to see updates on research studies.
