Simoa (Single molecule array)

Thai Red Cross Emerging Infectious Diseases Health Science Center, Faculty of Medicine, Chulalongkorn University has researched a blood test for markers of Alzheimer’s that can give a 10-year warning, so people can be prepared to slow down the development of dementia in old age.

Alzheimer's is a disease that many people pray that they or their loved ones do not experience. But looking at today's social context, there's no denying that the disease is more relevant to us than it seems because it usually manifests itself when we are 60 years old and above. The fact that we are in an aging society, dementia, therefore, becomes more common. 

Currently, 50 million people are suffering from dementia around the world. In Thailand, there are 700 thousand of such patients, 500 thousand of which suffer from Alzheimer's. Without individual and social measures to slow or prevent dementia, the number of cases will increase. It is estimated that the global population of elderly people suffering from dementia will increase threefold within thirty years! 

Dementia and Alzheimer's are incurable, so it's best to prevent them from developing or slow them down as soon as possible.

Poosanu Thanapornsangsuth, M.D., lecturer of Neurology, the Department of Medicine, and head of the Neurodegenerative Disease Biomarker Project at the Thai Red Cross Emerging Infectious Diseases Health Science Center, Faculty of Medicine, Chulalongkorn University, discusses the approach to Alzheimer's prevention: "Alzheimer's has an incubation period of 10 - 15 years before the onset of symptoms, and can be called latent Alzheimer's. Patients do not show any symptoms. They can work normally.  By the time the disease has progressed to the point where symptoms manifest, the patient would have already lost a lot of brain cells, and rehabilitating or salvaging the brain is difficult.  Now, we have a medical technology allowing us to detect the presence of the disease ahead of people's retirement age so that we can take care of ourselves and stay away from dementia before the symptoms appear."

Older adults at risk of dementia

Dementia can be caused by many reasons and many diseases, but the most important culprit is Alzheimer's and the second being vascular diseases. The cause Alzheimer's is not known, however, there are many contributing factors, including genetics, the environment, pollution, stress, etc. 

Dementia and Alzheimer's often occur in the elderly aged 60 and older, with 1 in 16 people over the age of 60 having a chance of developing Alzheimer's disease, while in those 80 and older, the ratio increases to 1 in 6.

"The longer a person lives, the greater the likelihood of dementia."

Dementia begins with forgetfulness about past events. As symptoms grow, patients become less and less able to help themselves until they are unable to perform their daily activities on their own, as they used to, requiring constant supervision. And when the disease has reached the final stage, they are at risk of dying from infections. 

"This disease is a nightmare for the patients as it erases the patient's identity that was forged over time. Living is filled with challenges, affecting loved ones in the family," Poosanu said.

Predicting dementia before symptoms appear

In general, there are two ways to check for Alzheimer’s disease before the symptoms show: 

PET Scan (Positron Emission Tomography) is a nuclear diagnostic technology that uses imaging to evaluate the function of organs and tissues within the body. The cost of examination is quite high and takes 2-3 days to complete. 
Spinal tap and subsequent measurement of the level of Alzheimer's-causing protein in spinal fluid.  In Thailand, this procedure must be done only by a physician. This method has been used sparingly because many people are afraid of possible pain.                          
Dr. Poosanu reveals that currently, the Emerging Infectious Diseases Health Science Center uses immunological techniques to perform blood tests instead of lumbar puncture, and analysis is done by Simoa (Single molecule array) or LC-MS (Mass spectrometry) to detect phosphorylated Tau in the blood which can indicate the presence of latent Alzheimer's, and Neurofilament light chan, a brain cells loss test. The project is funded by the Institute of Health Systems Research Institute (HSRI).                      

This approach offers a more affordable solution with a less complex and less painful procedure yielding more accurate results. 

"Alzheimer's protein detection with a blood test is a new and cost-effective procedure that can yield up to 88 percent accuracy.  Similar to the techniques used abroad, the cost of the test is low compared to the traditional methods. Importantly, it also increases accessibility to the service," said Dr. Poosanu elaborated. "The test is simple and safe. The test subject does not need to fast before the blood draw.  Only 10 cc. of blood is needed for a single test and analysis takes 2 months to get results."

The subjects will also be required to take a cognitive test to assess their "brain reserve". 

"Alzheimer's or other latent illnesses don’t always manifest, especially in those with good brain reserve," said Dr. Poosanu. 

The blood test result has to be analyzed in conjunction with the cognitive test result. The whole process, especially digesting the results, is complicated and must only be carried out by an expert!

Take care of yourself today to reduce the chance of latent dementia

For people with risk factors for dementia or Alzheimer's, whether due to genetic, environmental, pollution, or aging factors, good self-care will reduce the additional risk factors and the likelihood of dementia by 40 percent. Dr. Phusanu further recommends a course of action to prevent dementia:

Take care not to have non-communicable diseases (NCDs) such as diabetes, high blood pressure, etc., or if you do have NCDs, treat and control them well.

People who suffer from deafness, are hard of hearing, their brain doesn’t get stimulated, and this can easily lead to dementia. Seek doctor's treatment.

Eat nutritious foods, especially foods that help prevent dementia such as fruits and vegetables. Meat should be seafood. Refrain from desserts, salted foods, and fried foods. Eat vegetable fats such as olive oil or nuts oil, etc. No smoking. Reduce or stop drinking.

"Most importantly, exercise every day for 30 minutes to 1 hour.  Exercise can reduce dementia because it helps the body to produce the brain-regenerating substance," Doctor Phusanu concluded.

However, in addition to the risk factors that each person can take care of to maintain their physical and mental health, there are other social risk factors involved, such as air pollution, depression, and social isolation that come from living alone. These risk factors require the collaboration of people in society to take care of their environment and relationships so that we can stay away from Alzheimer's.

Those interested in blood testing to detect latent Alzheimer's can follow up on the news and updates on the Emerging Infectious Diseases Health Science Center's Facebook page: https://www.facebook.com/trceid.