Combining research with hands-on patient care

The pressure to find effective treatments for dementia is intense. Currently, more than 50 million people around the world suffer from this condition, with the majority affected by Alzheimer’s disease. Worse yet, these numbers are projected to triple by 2040 if nothing is done.

In 2000, Dr Philip Scheltens founded the Alzheimer’s Centre Amsterdam (link to Dutch website) as a solo project – the same year he became a tenured professor in neurology. Today, the facility employs over a hundred people and interacts with an almost countless array of academic researchers, healthcare organisations and MedTech businesses.

Dr Philip Scheltens

Dr Philip Scheltens

For Scheltens, helping the sick, whether it’s through direct patient care or conducting ground-breaking studies, is simply what he does. “My job as a neurologist means that I take care of people’s brains and nerves – while combining this care with research and teaching,” he says. “We want to make dementia treatable through applying science and care at the highest level – and basing it on open communication and maximising quality of life. And naturally, it’s also about finding a cure.” 

Amsterdam: a global leader in neuroscience 

As part of the Amsterdam UMC, the centre undertakes clinical research on various aspects of dementia, including its appearance in younger people and the developing of new diagnostics, therapies and potential cures. The centre also has the largest patient and research output in the Netherlands – if not the world. “The way we combine treatment and research is what makes us unique,” says Scheltens. “We have patients and researchers together in the same part of the building. The patients are intimately involved in the research, while the researchers – biologists and all the rest – also help with the care.”

Scheltens gives Amsterdam much credit for his centre’s success. “We have two universities, along with the two medical centres that are now one. We are embedded in Amsterdam Neuroscience, the largest neuroscience campus in the Netherlands – with over a thousand neuroscience researchers on one campus.”

Scheltens originally founded the centre with the help of the Alzheimer’s Stichting, the patient advocacy group. “And since that time, we’ve made huge progress – unthinkable 20 years ago – in terms of diagnosis and treatment. Back then, we started to identify Alzheimer’s through MRI imaging and seeing the loss of brain volume, which was still fairly late in the process.”

Making it easier to diagnose Alzheimer’s

Currently, Alzheimer’s can be diagnosed long before any symptoms appear. “We know a lot. Today, we are developing blood tests that can be used by a regular GP to define the underlying pathology. We also have molecular imaging that can visualise the proteins that form early warning markers for dementia,” says Scheltens.

“We know that the disease appears in the brain 15 to 20 years before there are any complaints. We know that it’s caused by misfolding of the amyloid and tau proteins. We know that there are genetic factors that may not be the cause, but certainly increase the risk. We know the gut microbiome can have an influence. However, we also know that the disease will never be cured by a single pill.”

 Alzheimer Centre neurologists

Though that may be true, the centre is very much focused on a multifaceted approach to treating dementia that includes medication. Over the years, it has been involved in the development and testing of promising drugs – including aducanumab, gantenerumab, PQ912 and many others – that may block the disease’s progression.

Keeping an eye on AI

Like many medical research centres in Amsterdam, Scheltens and his team are focusing on how artificial intelligence can help them achieve breakthroughs in the coming years. This might take the form of creating algorithms that analyse vast quantities of information to determine the best plan for an ailing patient or using a computer to perform an incredibly detailed analysis of a scan. Scheltens also hopes it can help with conducting genetic research to uncover why certain people are resistant to the disease.

“As we look at biomarkers in the brain, we’re collecting so much data,” he says. “So, we’re looking into how we can collaborate with those with more knowledge on this – on how we can develop a data-driven, unbiased approach in the cleverest way possible.”

Recreating offline connections online

Though Scheltens and his team have a lot to be happy about, it’s not all good news. Due to the coronavirus crisis, global research collaborations are being disrupted. Specifically, research data integrity has been compromised due to protocols resulting from the “new normal”.

In addition, the Alzheimer’s Association International Conference was set to take place in Amsterdam in July, welcoming 7,000 delegates to the city. It’s now been forced to go online in face of the outbreak. Scheltens, who is head of programming for the event, is disappointed that it won’t take place as originally planned, though he’s committed to doing the best he can under the circumstances.

“After 20 years, it was finally coming to Amsterdam – the association is now deciding whether it might happen here next year. But meanwhile, we are figuring out how to best do it virtually. With all the involved time zones, a lot of it will have to be pre-recorded with only some live interactions.”

Continuing, he says, “We actually have more collaborations and alliances outside the Netherlands than inside – and that’s largely thanks to congresses and conferences. You get to hear someone talk who [has] similar ideas. You have a chat and decide to work together. So, these kinds of events are always very fruitful. Now, we must see if we can recreate this in more virtual ways. As the Dutch expression goes: ‘under pressure, everything becomes fluid.’”

The rise of telemedicine

When asked on how he has seen his sector evolve during the “intelligent lockdown”, Scheltens says that, “Of all the changes, one thing is clear: telemedicine is here to stay – everyone likes it a lot. This would have all happened anyway over the next decade. But we’ve had the incentive to make it happen now.”

“It works great for the patient,” he explains. “In March, when the lockdown went into effect, we called our patients and said sorry, ‘you can’t come’. Everyone was very understanding. We started having our appointments via video conferencing. We’d go over their chart together. Spouses and children could join in, and we would all have a nice conversation about what mattered. It’s actually quite intimate. Plus, most calls saved at least a couple of hours in travel time.”

“If I can use another Dutch expression – niet bij de pakken neerzitten – this isn’t the time to give up.” We couldn’t agree more.

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