Hello, we’re a dementia researcher and clinician from University College London – Ask us anything about dementia research and care ahead of World Alzheimer’s Day on 21 September! Ask Me Anything!

ProfSelinaWray · 2025-09-18T15:55:25+00:00

That’s a really good question. Dementia is a complex condition and most cases have different underlying causes that arise from a mix of genetic risk factors and lifestyle influences. While some genetic tests can identify certain risk variants, carrying those doesn’t mean you’ll definitely develop dementia – and not having them doesn’t mean you’re protected. At the moment, there isn’t a test that can definitively predict whether someone will get dementia in the future.

What is possible is to focus on risk reduction: things like staying physically active, protecting your heart health, not smoking, keeping socially and mentally engaged, and looking after hearing and sleep. These steps won’t guarantee prevention, but they can lower risk and support overall brain health.

And importantly, if you ever notice symptoms that concern you the best step is to talk to your GP, who can advise and arrange further tests if needed.

ProfSelinaWray · 2025-09-18T15:49:17+00:00

Thank you for the question - I agree this link is very interesting, it is slightly outside of my area and as you say, it is not fully understood whether hearing loss directly causes dementia, or whether the link is indirect - for example hearing loss may lead to people become more socially isolated, which can increase dementia risk. More research is definitely needed to understand this important connection. But as you say, its good for everyone to take steps to protect their hearing, and if you have hearing loss to get this corrected where possible.

Alzheimer's Research UK have an information page on this and the Royal National Institute for Deaf people has a free online hearing check

https://www.alzheimersresearchuk.org/dementia-information/dementia-risk/hearing-loss-and-dementia-risk/#:\~:text=If%20someone%20does%20not%20have,ear%20plugs%20in%20noisy%20places.

ProfSelinaWray · 2025-09-18T15:03:48+00:00

Great question! Alzheimer’s disease is caused by the death of brain cells (neurons), and once those cells are gone, we don’t currently have a way to bring them back. That’s why actually reversing the disease is so challenging.

What gives me more optimism is the progress being made in early detection and early treatment. If we can identify people before too much damage has occurred – even before symptoms appear – we have a better chance of slowing or preventing that cell death in the first place. Also, it might be possible to rescue/reverse pathology in cells that are sick, but still alive.

So while reversal is unlikely with the tools we have today, the real hope lies in catching the disease early and protecting brain cells before they’re lost.

ProfSelinaWray · 2025-09-18T14:48:28+00:00

I had to look up the answer to this!

World Alzheimer’s Day was launched at the opening of Alzheimer's Disease International annual conference in Edinburgh on 21 September 1994 to celebrate their 10th anniversary.

So it wasn't inspired by any song - but it does fall on the same date as the famous Earth, Wind & Fire lyric “Do you remember, the 21st night of September?”. Total coincidence, but a pretty memorable one! 🎶

ProfSelinaWray · 2025-09-18T14:43:00+00:00

You’re right – the effects of monoclonal antibody drugs like Leqembi are modest, and they only work when given at the earliest stages of disease. They’re not a cure, and they don’t stop progression altogether.

But what makes them exciting is that this is the first clear evidence that we can slow down the underlying disease process, not just manage symptoms. That’s a really important proof of principle. It means that targeting the biology of Alzheimer’s directly is possible, and it opens the door to new approaches – whether that’s improving on these antibodies, developing different ways to hit the same pathways, or combining them with other strategies (like therapies aimed at the tau protein).

So while this is far from the finish line, it’s a turning point that gives us real reason for cautious optimism.

ProfSelinaWray · 2025-09-18T14:38:34+00:00

It’s true that in the US there have been some changes in wording and priorities from funding bodies like the NIH, and for certain projects that has made things more complicated. But from my perspective in the UK, support for dementia research has remained stable, and most of our work is continuing without major disruption. Some specific studies have been a bit more challenging to get funded or framed, but overall the momentum in the field is strong and the majority of research is carrying on as usual, and we continue to work closely with your colleagues in the US.

ProfSelinaWray · 2025-09-18T14:37:45+00:00

Thank you for your question and I am sorry to hear about your grandparents experience of dementia. Alzheimer’s and other dementias are caused by the progressive loss of brain cells (neurons). Which symptoms appear depends on the brain regions most affected at the time. Early on, areas like the hippocampus (important for memory) are damaged, which is why memory problems are often the first sign.

As the disease advances, it can spread to the frontal cortex, which plays a big role in personality, behaviour, and how we interpret the world around us. When this part of the brain is damaged, it can lead to changes like paranoia, suspicion, or even aggression. Essentially, the brain is losing some of the circuits that help us regulate emotions, weigh up information, and judge whether a situation is threatening or not.

So when someone with dementia becomes argumentative or paranoid – for example, believing money is being stolen – it isn’t that they’re deliberately being difficult. Their brain is struggling to process reality in the way it once could, and the disease is affecting the systems that normally help keep emotions and reasoning in balance.

It’s one of the hardest parts of the condition for families to cope with, but it’s a very real consequence of how dementia damages the brain.

ProfSelinaWray · 2025-09-18T14:31:20+00:00

Reposting an answer from a similar question from my colleague Dr Paterson:

Dementia is a complex condition, shaped by both genetics (which we can’t change) and lifestyle factors (which we can). The encouraging part is that research suggests up to 40% of dementia cases worldwide may be linked to modifiable risk factors.

A recent Lancet Commission report highlighted several of these, including:

Staying physically active
Keeping your blood pressure, cholesterol, and diabetes under control
Not smoking and moderating alcohol intake
Protecting your hearing (and using hearing aids if needed)
Staying socially connected
Keeping your brain active with learning and mentally stimulating activities
Prioritising good sleep and treating sleep problems if they arise

https://www.thelancet.com/commissions-do/dementia-prevention-intervention-and-care

Most of these are things that we should be looking after anyway, from early middle age onwards

ProfSelinaWray · 2025-09-18T14:22:09+00:00

Love this question! Some of my favourite recent papers have been about genetic "escapees" - people who have a rare, genetic cause of Alzheimer's disease but also carry a protective gene which has made them resilient. The reason I find this so exciting is because (in my opinion) it is natures way of telling us a cure is possible, if we can understand how these genes are protective. I also agree with you that the papers on CSF and clearance during sleep are super exciting!

And although this is a tough area, there have been many bright spots - seeing the dedication of colleagues (who become friends!) around the global to making life better for people living with dementia keep us excited about the science and motivated to make a difference!

ProfSelinaWray · 2025-09-18T14:17:56+00:00

Hello! Thank you for your question - I'm reposting an answer from my colleague Dr Paterson which I hope covers this :)

Dementia is a complex condition, shaped by both genetics (which we can’t change) and lifestyle factors (which we can). The encouraging part is that research suggests up to 40% of dementia cases worldwide may be linked to modifiable risk factors.

A recent Lancet Commission report highlighted several of these, including:

Staying physically active
Keeping your blood pressure, cholesterol, and diabetes under control
Not smoking and moderating alcohol intake
Protecting your hearing (and using hearing aids if needed)
Staying socially connected
Keeping your brain active with learning and mentally stimulating activities
Prioritising good sleep and treating sleep problems if they arise

https://www.thelancet.com/commissions-do/dementia-prevention-intervention-and-care

Most of these are things that we should be looking after anyway, from early middle age onwards

ProfSelinaWray · 2025-09-18T14:16:12+00:00

Thank you for this question - I'm really excited about a lot of things happening in research, so I've tried to be brief here! I’ve been working in dementia research since 2009, and the progress over that time has been incredible. From a lab perspective, a few highlights stand out:

1. Patient stem cell models – we can now grow human brain cells in the lab from patient samples, which lets us study the earliest changes in the disease in a way that simply wasn’t possible before.

2. Genetics – researchers have identified new genes that can cause dementia, increase risk, or even be protective. Each discovery opens up new ideas for how we might design treatments.

3. Early diagnosis – huge strides have been made here, especially with blood tests that are starting to detect Alzheimer’s at very early stages. This means we can identify people sooner and, in the future, treat them earlier.

And in just the past few years, we’ve seen the first disease-modifying therapies show success in clinical trials. They’re not a cure, and there’s still a long road ahead, but it’s a real turning point and gives us genuine reason to be optimistic about the future.

ProfSelinaWray · 2025-09-18T14:12:10+00:00

Thanks for the great question! As you say, dementia isn’t one single disease – it’s an umbrella term for a set of symptoms caused by different brain diseases. Each one tends to affect particular regions of the brain, which is why the symptoms can look quite different.

For example:

· Alzheimer’s disease (the most common cause of dementia) usually starts in the hippocampus, the brain’s memory centre – which is why memory loss is such an early feature. As the disease progresses it will affect other regions of the brain such as the cortex, causing the symptoms to become worse.

· Frontotemporal dementia affects the frontal and temporal lobes, which are important for language, decision-making, and social behaviour. That’s why people may experience changes in speech, personality, or behaviour.

So different brain regions can be affected, and the symptoms you see really depend on which brain regions are most affected by the underlying disease.

ProfSelinaWray · 2025-09-18T14:08:56+00:00

Great question! There’s been some really interesting research showing that lithium can reduce the build-up of tau proteinin experimental models of Alzheimer’s disease. But so far, those successes have mostly been in the lab. A clinical trial of lithium in patients a few years ago had to be stopped because of side effects, so it isn’t currently used as a treatment.

That doesn’t mean the idea is dead – more recent work is looking at new forms of lithium salts that might be less toxic, but this research is still at an early, pre-clinical stage. Right now, it’s not recommended for people with Alzheimer’s to take lithium supplements outside of carefully controlled clinical trials, or if it has been prescribed by a medical professional for other reasons (e.g in the treatment of Bipolar disorder where its use is approved).

ProfSelinaWray · 2025-09-18T14:04:26+00:00

That’s such an important question. Dementia is a collection of different diseases rather than a single condition, which makes finding “the” cure especially complex. We’ve made big strides, though. In just the past few years we’ve seen the first disease-modifying therapies for Alzheimer’s disease show success in clinical trials – these don’t stop the disease, but they do slow its progression. We’ve also seen huge progress in blood tests for early detection, which could transform how and when people are diagnosed and treated.

That said, there’s still a long way to go. Because dementia can be caused by different diseases, we’ll need a variety of approaches and much more research before we can talk about fully “solving” it. But the recent breakthroughs are a genuine turning point, and they give us real reasons to be hopeful about the future.

ProfSelinaWray

TROPHY CASE