Dementia The Truth About...

It's a very beautiful view.

It's one that I never tire of looking at.

That's the granite outcrop where my parents' ashes are.

Here we go.

Six years ago, my mother died as a result of dementia.

That's one of my favourite photographs.

I still come to her house in Devon where I helped look after her

until she had to go into a care home.

Before my mother got dementia, I knew diddly about it.

When she started to show the early signs,

I just thought that she was getting a cantankerous old woman.

She became very short-tempered,

very difficult at times.

And one day, she was particularly unpleasant,

and I said to her, "Mummy, why would you possibly say that to me?"

And she said, "Angela, I'd never say that to you!".

Gone, completely.

My mum used to say to me, "Angela, what's happening to me?"

And I used to have to try and gently say to her,

"It's all right, Mummy, it's just that bits of your brain aren't

"working the way that they used to."

You learn to be very, very patient, very understanding.

And in your quiet moments on your own, you mourn,

as the person that you've known is dying in front of you.

'There are 850,000 people diagnosed with dementia in the UK.

'A number that's set to double in the next 20 years.'

Bob! Look who this is!

'Some of my closest friends already have it.'

Hello!

'It's one of the biggest scientific challenges of our time.

'So, I want to find out what the latest research

'is revealing about dementia.'

How extraordinary.

Good morning, class.

'And the surprising ways in which we can all protect ourselves.'

Wo jiao Angela.

'I'll meet people who are having to face the disease

'at a very young age...'

I might cry now...

'..and discover just how close scientists are to finding a cure.'

If they've got the genetic mutation, they will get the disease.

They are our best hope for finding a treatment and potentially a cure.

'I'm going to undertake a battery of scientific tests

'to see if I have any signs of the disease.'

These areas are called white-matter lesions.

People can get them in dementia.

'And I have to decide whether or not to go ahead

'with a genetic test that will reveal my future risk.'

If you do have the E4 form, your risk is probably ten times greater.

There's always that anxiety. Is it genetic?

Is it something they've passed on to me?

# I remember you... #

It's not until you've looked after the someone with dementia

that you really understand what it's like.

Today, I'm on my way to visit a couple that I've known for 30 years.

Ida has got a birthday today.

She's 85.

And Bob has dementia.

Hello, darling.

Bob! Look who this is.

Oh, dear! Oh, dear...

-Hello.

-She looks lovely, doesn't she?

Oh, great to see you.

You're looking lovely.

Oh, thank you, sweetie. Thank you.

When I met Bob, he had a successful job in the City of London,

and was looking forward to enjoying his retirement.

Do you know it's her birthday today?

Whose birthday? Ida's?

-Ida's birthday!

-Oh, yes. It's Ida's birthday, yes.

She's 85 today.

Five years ago, in his early 80s,

Bob was diagnosed with Alzheimer's,

the most common form of dementia.

Come here.

Is that her birthday kiss?

Is that my birthday kiss?

Is it your birthday today?

-Did I get you a present?

-No.

-Didn't I?

For Ida's birthday, I'm going to look after Bob

while she goes to get her nails done.

And, despite recovering from a broken leg,

she's determined to make her own way there.

-Just make sure he has a drink every hour.

-Will do.

-Thank you, darling.

-I can't imagine you cooking, you know.

-Why not?

-Well, you're a glamour girl, aren't you?

-No! Of course, I cook.

So, are you pleased the way that Ida's getting better now?

-She's getting better?

-Yes, with her leg.

-At least she's out of plaster now, isn't she?

-Mm.

-Yeah.

You say that, I can't even remember that.

-You don't remember her breaking her leg?

-No.

She did. It was a really, really nasty break, too.

'Bob's Alzheimer's has badly affected his memory.'

She'll be back very soon.

-Where's she gone?

-She's gone to have her nails done.

-Oh.

Where did you say she's gone?

She's just popped round the corner to have her nails done.

It's just like being with my mum again.

She had not just forgotten something,

she kept asking things,

and that I can see in Bob.

He must have asked me on at least six occasions

where's she gone, and what's she doing,

and I've had to say, "She's having a manicure.".

Of course, the really important thing

when people with dementia keep doing that, you can't say,

"Oh, for crying out loud, how many times do I have to tell you?!"

It has to be as if it's the very first time

you're answering that question.

There we go, and then I'll bring the buggy up for you. Right?

-Thank you. Are you all right? Wait to see me, look.

-What have you done?

-Have you seen her nails?

-Have you seen my fingernails, look.

There it goes!

There we go, Bob.

Happy birthday to the birthday girl.

Thank you, Angela.

'The average life expectancy after a diagnosis of Alzheimer's

'is eight to ten years.'

-When's your birthday?

-Today.

'Bob seems happy, but I know how hard it is for Ida.'

It's just like having a child.

But they don't grow up.

I just take every day as it comes.

You're very special.

Well, you know...

SHE WEEPS It's all right, poppet.

-Some things break my heart.

-I know they do.

When I think of the man he was.

But I'm lucky.

And I've got so many good friends,

and the neighbours.

Yeah, and you've still got him.

-That's what I said, it's a bonus, isn't it?

-It is.

-Every day is a bonus.

-Yes.

Happy birthday then, Ida, and many, many more, darling.

-Thank you, it's a lovely cake.

-Merry Christmas!

BOB CHUCKLES

You've still got that to come!

'He's still got the basic Bob.'

That is still there, that sense of humour

and the person she loves is still there.

But it is tough on carers.

They're watching the person that they love

and that they've known for a lifetime just gradually slip away.

And that's tough.

I'm 71, and although I feel fine,

I do sometimes worry about my own risk.

Apparently, people over 55 now fear dementia more than cancer,

and I'm not altogether surprised.

Because there's no cure for dementia, it can seem like

a death sentence, but some people are now challenging that idea.

I've come to a retirement community in Devon to find out

about some fascinating research that's being put into practice.

Wow! Oh, have you got any more?

Familiarity...

..breeds contempt.

The research suggests that simple mental exercises

can transform the lives of people with dementia.

That's a nice simple one for you, Mary, if you can't see.

Twice a week, Dr Jennifer Bute runs a memory group for the residents

to challenge and stimulate their brains.

Is that all right?

So, we've got three left.

Jay, swallow and chaffinch, for these three. Which is the swallow?

That's right, well done.

As you can see, there are all kinds of people here.

Some are in the early stages, some are in the later stages of dementia.

But the fun is we can all do the same thing.

Where did you get this idea? You call it your Japanese Club.

Yes, it's because I met a professor, Professor Kawashima,

who showed me evidence that writing, reading and arithmetic, together,

on a regular basis, makes a difference.

The Japanese research shows that brain training can slow down

memory loss, and may even reverse some of the effects of dementia.

What sort of reaction are you getting from the people

-who are doing this?

-They love it, you can see.

They think it's fun.

-And also, it helps to break down the stigma, I think.

-Yes.

Because when I first came, nobody here had dementia.

But they obviously do, don't they?

'Jennifer isn't just helping this community.

'She's part of it.'

Lovely to see you in your home. Where are we going?

'10 years ago, she was diagnosed with Alzheimer's.'

-Oh, what are you knitting?

-Knitting is one of my coping strategies.

I forgot how to knit. I used to do Fair Isle and Aran, but I forgot,

but the folk in the community taught me how to cast on again.

-Ah, perfect.

-You can always relearn.

'Jennifer spent 25 years as a GP

'before the disease struck in her 50s.'

You must have recognised in yourself the symptoms

that told you you had, or were getting, dementia.

-I knew I had dementia long before.

-Did you?

-Oh, yes.

-What was the trigger?

-I started getting lost.

I couldn't find my way to the surgery.

I thought, "You've been going there for 25 years!"

I couldn't find my way.

I'd be coming home and I'd phone at my husband

and say, "I don't know if I go right or left here."

He was like, "Don't be so s..." He loved me dearly, but it was,

"Stupid woman, of course you know which way to go!" But I didn't.

One day I didn't recognise my husband.

He said he'd never forget... Well, he's dead now.

He'd never forget the look of horror on my face.

I didn't know who he was.

Terrifying for him and you.

It was terrifying, yes. It was terrifying.

You see, what is interesting, seeing you at work,

nobody would necessarily recognise that you have dementia.

I know, and that can be quite difficult at times,

when people don't think I have dementia.

What are your symptoms, then, for the dementia that you have?

I can't remember things.

I can't remember whether I eat or not,

so the only thing that works for me

is I put my dirty washing up in the sink.

So, I can see what I've had.

So, today, for example, I can see that I've had some cereal.

I've had two cups of tea.

I've had my medication.

And then, at the end of the day,

I'll know whether I've had any lunch, or whatever.

Because there have been days

when I haven't eaten or drunk all day.

'It is having coping strategies like this that means Jennifer

'can continue to live independently.'

Any chance you could make me

-a cup of tea or something?

-Of course, of course.

Now...

I've got water in there, haven't I?

I have these things on the wall... Do you know about these things?

-Have you seen them before?

-How to make a cup of tea.

It reminds one how to do it if one forgets.

-Some days are better than others. Shall I show you how it works?

-Yes.

I'll just get my iPad.

Then I have to just tap to scan.

'In this video, I'm going to show you how to make a cup of tea.

'Step one, you need to get your equipment. You will need a cup...

'A teabag.

'And make sure you leave enough room to add your milk.'

-That is so clever, isn't it?

-It's great, but remembering to drink it -

the number of cups of tea I find that I haven't drunk.

Forgotten about.

And there are a whole lot of others.

How to lock the door,

how to make a ham sandwich,

how to flush the toilet...

-All basic things.

-Yes.

You see, the general public will think,

"Why do they need that?"

But you do. You stand in front of...

..something and you think, "How on earth do I use this thing?"

It can be very embarrassing

-if you don't know how to flush the toilet.

-Absolutely.

And how to make cheese on toast. So... It's wonderful, I think.

-Very helpful.

-Yes.

For me, every new thing that happens that's not right

is a challenge, and I love challenges.

So, I then have to find a new coping strategy.

So, when everything falls apart, and sometimes I do sit and howl,

but I say, "Pull yourself together, girl",

and I work out how to do it better, how to make it work.

How do you actually feel about the fact that the disease

that you have in your latter life is dementia?

Well, we all have challenges as we get older, don't we?

Some people get cancer, some people have strokes.

I mean... We all have things that we have to deal with.

I was brought up, and I brought up my family,

it's not what happens to you,

it's how you cope, how you respond to what happens to you.

We all have choices, don't we?

We can curl up in a ball and die, and turn our face to the wall,

but what a waste of time, and what a waste of opportunity!

So, for me, this is my challenge.

But I get to help other people at the same time.

Hello, Brenda, nice to see you. Come and sit down.

It's astonishing that Jennifer can do the work she does,

and yet sometimes she's unable to make a cup of tea.

It really does show how unpredictable this disease can be.

Knowing how you are going to cope yourself

if you suddenly are diagnosed with dementia

is one of those impossible questions to answer because,

while you are not affected by it,

you can be as positive and upbeat as you like,

and say, "Of course I'm going to fight it!"

But that doesn't mean to say

that if you suddenly find that you are affected by it,

that you really do know

how you're going to... how you're actually going to react.

I hope that I would do what Jennifer has done

and not allow the disease to take over my life.

'I've decided I'd like to find out whether I have any signs of it.'

Hi.

'The first step for anyone worried about having dementia is

'something called a cognitive test.'

Thank you. Well, come in.

'This is how my mum was first diagnosed.'

'Today, psychiatrist Dr Claudia Wald is going to take me

'through the test.'

I know lots of my friends,

if they can't find their glasses or their keys, they'll say, "Blimey,

"that's dementia setting in," but it's not necessarily that, is it?

Well, forgetfulness, we have to remember,

is actually a normal part of ageing.

We become slower and slightly less

efficient about retrieving information,

so our short-term memory does weaken a little bit.

So, what actually is dementia?

Dementia's a collection of symptoms - memory problems,

language problems, changes in a person's judgment, personality...

So, if you wanted to know whether or not, for instance, I had

the possibility of having dementia, what would you ask me to do?

OK, so I would ask you to repeat a name and address to me.

So, Harry Barnes, 73 Orchard Close, Kingsbridge, Devon.

Harry Barnes, 73 Orchard Close, Kingsbridge, Devon.

That's right. And it's repeated again.

Harry Barnes, 73 Orchard Close, Kingsbridge, Devon.

Harry Barnes, 73 Orchard Close, Kingsbridge, Devon.

Thank you. So, would you be able to tell me what that is?

That's a pencil.

A wristwatch, kangaroo, penguin...

If someone were to be developing a memory disorder,

they would struggle.

They may say, "You know,

-"that thing that you wear on your arm that tells the time"...

-Mm-hm.

..for a watch. So, I would then assess your comprehension

by asking you to point out which one is associated with the monarchy.

-Crown.

-And which one is found in the Antarctic?

-Penguin.

-Exactly.

-Yes.

'Claudia runs me through the whole test, which takes about 20 minutes.'

And then I would come back to your memory,

and I would ask you,

can you recall that name and address that we repeated three times?

He's Harry Barnes at 73 Orchard Close, Kingsbridge, Devon.

Perfect. Bravo.

OK, so, exactly.

But again, if someone were having a memory problem,

they might struggle there.

'I feel quite relieved.

'It's good to know that being occasionally forgetful isn't

'necessarily the first sign of dementia.'

I think probably all of us would have had slight difficulty

remembering the absolute detail of that address.

Can you remember it now?

Harry Barnes, 73 Orchard...

Is it Place, Avenue, or Road?

No, it wasn't. Grove. Kingsbridge, Devon.

One of the things I learnt from my mum's illness is that

dementia isn't a psychological condition.

It's a disease that physically attacks the brain.

This is going to be noisy, isn't it?

It is a bit noisy, but I'll give you headphones.

Last year, I had my whole body scanned as part of a TV

programme about ageing.

The brain scans could reveal if I have any early signs of dementia.

So, I've arranged to have them sent to a neurologist.

While I'm waiting for the results, I want to find out what

physically happens to the brain of someone with Alzheimer's.

I'm on my way to one of the country's biggest brain banks,

where brains donated to medical research are kept and studied.

Welcome to Queen's Square Brain Bank.

Well, what have we got here?

'Professor Janice Holton spends her life studying the effects that

'diseases like Alzheimer's have on the brain.'

-This is a brain from a normal person.

-So this is a healthy brain?

This is a healthy brain, yes.

And if you turn the brain over,

you'll see that it has a very rounded, smooth surface,

and you can see that these folds are very close together.

There's not very much space in between them.

-It's very compact, isn't it?

-It's very compact.

I want to show you half a brain from a patient who had Alzheimer's

disease, and compare it with half a brain from a normal patient.

Oh, I can see already the difference.

-I thought you would see the difference straightaway...

-Goodness.

-..when you compare.

-It's immediate, isn't it? Look at that.

You see, the size of these brains and the difference in the weights.

This one is almost half the weight of that half a brain.

But it... I mean, it's the appearance of it

that is so different.

-Yes, completely.

-This is still sort of quite smooth and compact.

And that looks diseased.

It looks completely abnormal.

Alzheimer's disease usually begins deep inside the brain,

in an area called the hippocampus.

And to see it, you have to slice the brain open.

This brain is very delicate,

so I need to do it with a great deal of care.

This is the hippocampus here in the normal brain.

And here it is in the diseased brain.

And you can see, it's very much smaller here.

The nerve cells have died. It has shrunken.

This is a very small hippocampus.

The hippocampus is responsible for what?

The hippocampus is important for memory.

-So, that's usually the first thing to go.

-That's right.

So that's why many patients with Alzheimer's disease start

with memory problems, and then, as the disease progresses,

and the changes in the brain spread to other regions,

they begin to have other problems.

Many of the nerve cells have died in this brain.

'Janice wants me to see

'a piece of the diseased brain under a microscope...'

OK. Let's have a look.

'..so that I can see what might be causing all this damage.

'Using a fluorescent green dye,

'Janice reveals something lurking amongst the brain cells.'

It's like green snow.

-That's right.

-There's so much of it.

-Yes.

What actually is that substance?

That's a protein called amyloid beta.

It's very sticky, so it will clump together,

and there it is, sitting outside of the cell

and it's damaging all the processes and the networks around the cells.

We all make amyloid beta in our brains.

But in some people, it sticks together in clumps called plaques.

Scientists believe these plaques are responsible

for the damage that is seen in Alzheimer's disease.

-It's strangling the cell.

-It is.

It's causing those cells to not function properly

and will contribute to their death.

No-one knows exactly why some people develop Alzheimer's

and others don't.

But the biggest risk factor is

something that none of us can avoid - our age.

Having a healthy brain is something I've always taken for granted.

But, at 71, I'm aware that my risk of dementia

is increasing every year.

By the time I'm in my mid-80s, there's

a one-in-five chance I'll have it.

Today, I've got my appointment with the neurologist to

analyse my brain scans.

I rather hope when the neurologist takes a look inside my head, that he

finds a nice healthy brain with everything firing on all cylinders.

Obviously, the last thing I want him to say is,

"Oops, there's something not quite right there."

Everything seems to be working all right, but who knows?

I've come to Charing Cross Hospital to get the results.

Hello. I'm here to see Dr Angus Kennedy.

OK.

-Thank you.

-Hello.

-Oh, hello. You're Dr Kennedy?

-Very nice to meet you. Hello.

-Nice to see you. I'm Angela. Hello.

-Good to see you.

-Come on through.

-Thank you.

-Before we look at your brain...

-Yes.

..we need to have a bit of a chat to get

a bit of information about your brain and how it works.

So, the first thing to say is, can I be rude enough to ask you how

-many years young you are? How old are you?

-71.

-71.

And have you noticed any trouble with anything - words,

speaking, memory?

No. I mean, I do the things that I think a lot of people do.

You know, put things down and can't quite remember where I put them.

-Absolutely.

-Walk into a room... If I'm busy doing something,

I'll walk into a room

and I'll think, "What the devil did I come in here for?"

-And do you drive?

-Yes.

-Your driving skills are fine?

Absolutely. Well, as far as I know.

And nobody else in your family has commented about your memory

-or your words, no?

-No.

And what you said does not indicate by any shape or form

that there's any memory symptoms that I would be worried about.

But my brain scans could reveal signs of damage before I'd even be

aware of any memory problems.

We can detect dementias of different sorts before they are apparent

in the individual.

So, this one is a sort of side-on view of you.

That shows us the lobes of the brain

and the sort of mountains

and the valleys and they look as normal as they should be.

Let's just have a look at this one here.

This one is sensitive to blood vessels

and it shows that there's some reaction in the white matter,

and these little white areas are called white matter lesions.

As you get older, from about 30 and 40, you start to develop them.

People can get them in dementia.

But that's just ageing?

You know, we're all allowed to have some

and they do not necessarily mean bad things.

'I know from what I've seen at the brain bank, that Alzheimer's

'usually starts in a part of the brain called the hippocampus.'

This is the hippocampus, which is

the sort of crucial memory structure.

So, what would we see on a scan if there was a problem?

So, if you had Alzheimer's disease, we would be looking here

to see that there was shrinkage of this part of the brain.

And that all looks pretty normal to you, does it?

It looks fine.

I wouldn't be worried.

Yours looks absolutely beautiful, as it should do.

Well, I'm very pleased with what you've told me.

Thank you very much indeed.

Because my mother had dementia, there's always that anxiety.

Is it genetic? Is it something they've passed onto me?

So, it's just very comforting and very reassuring

to have spoken to a neurologist who's had a look inside at what

is actually going on in my brain to tell me that everything is fine.

Yes. It gives you a bit of peace of mind.

There's nothing to indicate that I currently have any

signs of dementia.

So, I now want to know what I can do to protect myself against it.

I've heard about some intriguing new research in the United States

that suggests that the amount of sleep

we get could affect our chances of developing Alzheimer's.

So, I'm heading to Portland, Oregon, to find out more.

Hidden away in this hotel is a sleep clinic, run by Oregon Health

And Science University.

And I'm checking in for the night.

So, I want to look at the central region of your brain

that's really precise where these electrodes go.

I'm being wired up with a series of electrodes

and sensors that will record my brain activity while I sleep.

And monitor everything from my eye movements to the

amount of snoring I do.

All right. Everything looks great on my end. Have a good night.

Thank you, John.

You're welcome.

We spend about a third of our lives sleeping.

And the team here believe it may play a vital part in keeping

Alzheimer's at bay.

KNOCKING

Hello?

-Hi.

-Hi. I'm Dr Singh.

-Hello. How nice to see you.

'The following morning, my results are through straightaway.'

You actually slept remarkably well and almost too well, so...

-"Too well"?

-Too well, yes. You fell asleep very quickly.

We have a measure called sleep latency, which is

how quickly you fall asleep and you slept in 4.5 minutes.

Wow.

So, have you been sleep-deprived lately?

I don't think I've been deprived of sleep,

but my body clock has been all over the place.

And do you have any other sleep complaints, so snoring or...?

As far as I know, I don't snore.

OK. We detected some mild snoring.

Some mild vibration from the snoring channel.

It sounds like that doesn't ever wake you up, snoring arousals,

-gasping for air or choking for air, anything like that?

-No, no.

You slept for just over six hours total.

So, it makes me wonder if you need to try to sleep a little bit more,

-actually.

-Thank you very much indeed. Thank you.

'To find out why this matters, I catch up with neuroscientist

'Dr Jeff Iliff in the control room next door.'

All of us know that if you don't get a good night's sleep,

you wake up the next morning and your brain is murky

and you can't think correctly and you make some bad decisions

and your reflexes are slow.

But what we haven't really known in

neuroscience is necessarily why that is.

Why does sleep itself seem to refresh the mind

and sort of clear your brain so that you can function properly?

'Jeff thinks that he may have found the answer.

'He's been imaging the brains of mice

'and he's discovered something remarkable.

'The brain physically cleans itself during sleep.'

We can actually image inside the brain of a mouse while it's awake.

While the animal's awake, it doesn't do anything.

But then if that animal goes to sleep,

you see that something totally different is happening.

Fluid from the outside of the brain is actually moving into the brain,

and then it begins to wash through the spaces between the brain cells.

So, it's actually cleaning away

the waste and the proteins in between the brain's cells.

One of the proteins that's being cleared away during sleep is

the protein amyloid beta,

the protein that builds up in the spaces between brain cells

in people with Alzheimer's disease.

That is extraordinary.

The basic message here is get a good night's sleep.

I think the science isn't yet in a place where we can say

if you sleep better, you won't get Alzheimer's disease,

but it's possible that, you know, just getting a good night's sleep,

it may well be one way to change the course of the disease.

I've never had a problem sleeping

but perhaps I've not been getting enough of it.

For years now, I've worked on six hours' sleep

so maybe it's time to change some of my habits.

I think we all know that if we exercise and eat well

and don't smoke or drink to excess

that our physical bodies are going to last that little bit longer.

Do we really think about our brains?

Something as simple as how much sleep you get!

It's just given me a whole new way of thinking

about lifestyle possibilities as a way in which we can fight dementia.

There are lifestyle choices we can all make that will

reduce our risk of getting dementia.

Eating a good diet and getting plenty of exercise

have been shown to help keep our brains healthy.

But I'm concerned that there may be other risks

that are out of my control.

Like many people,

I sometimes worry that dementia might run in the family.

It may not have been just my mum who had it.

I suspect that my father

was beginning to show the early signs of dementia.

In that last year before he died, he would suddenly lose his temper,

get very, very cross about things, which was so unlike him...

..and I recognise that as one of the possible early signs of dementia.

There is now a genetic test that can look at a person's

risk of getting Alzheimer's.

I'm in a position where I can find out,

not whether or not I'm going to get it,

but what the risk is that I MIGHT develop it.

The test has only been around a few years

and it's not available on the NHS.

'There is no cure for Alzheimer's

'so a test like this can cause a lot of anxiety.'

-Thank you very much indeed. Hello, Dr Perry.

-Richard Perry.

Nice to see you.

'Dr Richard Perry wants to make absolutely sure

'I know what I'm getting into.'

Is it family history that's sort of made you concerned about it?

-Is that what's sort of brought on thinking about a genetic test?

-Yes.

-My mother was diagnosed. I suspect my father had the symptoms.

-Right.

So, I suppose it's a kind of fail-safe for me.

-I would rather know than not.

-Right.

For people who have a family member in their 80s

who've suffered from a dementia,

particularly if it's Alzheimer's disease,

that doesn't really increase the risk greatly

for one of their children.

The main risk for developing Alzheimer's disease is age,

getting older.

This particular test is a blood test

and it looks for a gene called APOE.

And the gene test comes back as saying

whether or not the person is carrying different forms

of APOE, whether it is what's called an E4, an E3 or an E2.

And the difference between them is...?

The difference between them is that E4 increases your risk

of Alzheimer's disease and E2 decreases your risk.

If you do have the E4 form,

then your risk is probably

ten times greater than average.

So, what we have to do now?

You know, the important thing about all tests

is that you're going to use the information to do something with it,

otherwise why would you do the test?

It gives you an opportunity to make one or two lifestyle changes

which would actually help the situation, presumably.

Well, yes, but then on the other side you could say,

"Well, why not make those lifestyle changes

"without knowing any of the risk?"

-Anyway...

-Yeah.

-I would still probably want to know, I think.

But the test isn't going to tell you.

No, it's going to tell me if there is a increased possibility of it

and I would rather be prepared for the unknown

rather than find that it comes up and bites me on the bum.

Have a little think about what we've talked about today and just sort

of trust your instincts on what you think's the right thing to do.

'Before I leave, I give a blood sample.'

It's a good, healthy colour.

'I agree that I will phone Dr Perry in a few days' time

'with my decision about whether or not I want the sample tested.

'If I do decide to take the test,

'it still won't tell me if I'm going to get Alzheimer's,

'only the risk that I might.'

But there's a small group of people who know for certain

that they will develop the disease.

About 400 families around the world

carry an incredibly rare faulty gene.

It causes a form of Alzheimer's that strikes people as young as 30.

Chris Graham is from one of those families.

His brother inherited the faulty gene

and developed Alzheimer's at the age of just 37.

For the last six months, Chris has been cycling 16,000 miles

around North America to raise money for Alzheimer's research.

Morning, all. Hope all is well.

Everyone back in the UK and around the world, quick update.

Hopefully the weather will hold out but, as you can see,

it's cloudy and I'm expecting some rain.

I've come to Baltimore to meet him on his epic journey.

Chris, hi. Gosh, that was a bit of a tough climb up there, wasn't it?

-Nice to meet you.

-Hi! And you, too. Well!

-This is me and my brother, Tony.

-Yeah.

-This is on his 40th birthday.

-Yeah, so he had some signs of it, yeah.

-Yeah.

How has his condition deteriorated?

Now, he's bedridden, in his bed,

he's fed through a drip in his stomach.

He can make small, small noises,

but that's it, he's not in a good way.

Yeah.

Can you talk to him?

'Chris and Tony's farmer died of Alzheimer's at the age of 42,

'when Chris was just a child.'

Was it recognised? Was it diagnosed in your dad?

I'm not sure. I was so young I literally do not remember.

I remember one incident where he was in the house

and he went for a drink but he was drinking washing-up liquid.

-And then they took him away and that's all I remember.

-Yeah.

I remember nothing else.

Do you know anything about how the gene is passed down?

I believe literally when my mum and dad were making me,

it was literally potluck, a 50-50 chance.

Chris has also inherited the gene

and knows for certain that he will get Alzheimer's.

He already has the early symptoms.

At the moment, you wouldn't notice I'd got it

but I have got some memory issues.

But I do a lot of things, like if I was to give your shopping list,

you'd write a list down, wouldn't you? Well, I do exactly the same.

I might just do it more than you.

If you give me some directions, I might not remember all the ones

you remember but, again, I use notes.

Whether I go left, right, you know.

So, they're the little things at the moment I'm seeing,

but I'm just trying to be positive.

And, you know, you live in hope.

In December 2015, Chris finally completed his charity bike ride.

So far, he has raised £40,000 towards scientific research.

And it's research that can't come soon enough for his family

because Chris may have passed the faulty gene on to his son.

Dexter was born ten months ago, after an unplanned pregnancy.

To find out I was expecting

it was just a complete and utter shock, to be honest.

He might have it, he might not. He's got a 50-50 chance.

But we won't even get him tested. You're not allowed to. So...

-He has to make that decision when he's 18.

-Yeah.

-He's got a 50% chance of being healthy.

-Yeah.

-That's the way we had to look at it.

-Yeah.

-And...

-If he's got it, you know, before it kicks in,

which is, in my family, promptly around the mid-30s,

modern medicine would be light years ahead of what it is today.

You know, we don't know if a cure's going to come in time for Chris,

but we're pretty hopeful there'll be one in time for Dexter if...

IF he carries the gene, as well.

Families in this awful situation face an uncertain future,

but they could also be the key to finding a cure for Alzheimer's.

Here at the National Hospital For Neurology And Neurosurgery,

families affected by the faulty gene are taking part

in a ground-breaking drug trial.

Name and date of birth, darling.

Sophie Leggett...

-And no allergies.

-Lovely.

Sophie also comes from a family that carries the faulty gene

and she's part of the test on the experimental new drug.

I've met a lot of people in the same situation as me.

Nobody wants to be involved in research more than we do.

It matters so much to us,

cos it is for the next generations of our families.

And we believe that something really incredible will come from it,

not just for us but for anybody who might develop Alzheimer's.

Nothing would stop us from taking part.

This is the first trial of its kind. It's really exciting.

What we're doing is trying to prevent the onset of symptoms

in people that have a high risk of Alzheimer's disease.

People who have inherited the faulty gene

are perfect for testing new Alzheimer's drugs.

We know if they've got the genetic mutation,

they WILL get the disease, 100%,

and we know exactly when they will get it

because if their parents have it at a certain age,

for example 39, then they are going to get it very close to that age.

Dr Catherine Mummery is using experimental drugs to try and target

the amyloid that builds up into the plaques found in Alzheimer's.

We know amyloid builds up 15 years or more before people get symptoms

so we're trying to prevent that

by removing the amyloid before it causes the plaques.

How vital to your research are people like Sophie?

Without people like Sophie, we couldn't do this research.

They are our best hope for finding a treatment

that we can give early enough to make a significant difference

and potentially a cure in the future.

'Everyone in the trial has a parent with the faulty gene.'

Sophie, hello.

'They've all been tested to see if they have it, too.

'But Sophie has decided not to know the result.'

Why won't you ask them to tell you

so that you know one way or the other?

Because I...

I don't know how I would live if they told me that I had it.

I really don't know.

I don't know that I would ever get out of bed again.

To me, being told you've definitely got it...

I know myself very well

and I know I would not cope with that information at all.

-That was my mum.

-Oh, she's beautiful.

That was when she had her wedding blessed

so she would have been about 36 or 37, something like that.

-Beautiful.

-Yeah.

Sophie's mum developed Alzheimer's

just a few years after this photo was taken.

She had to go into a care home and died in her 50s.

When Mum was ill, I really, really struggled with coping with it.

I couldn't bear seeing my mum like that and I also couldn't bear...

picturing my future, I think, if that makes sense.

I know that sounds really horrible but...

Isn't it awful that, as family and carers, we feel guilt?

I think loving someone with Alzheimer's

is just riddled with guilt.

When did you know that

there was a chance that you had also inherited the gene?

How did you find out?

I think it was probably... I think I googled.

I really think that's what happened.

So, nobody actually told you? You had to find out for yourself?

Yeah, and I read this thing that said, "Child of someone who

"carries one of these mutations will have a 50-50 chance of getting it."

And I might cry now...

I think what made it worse for me

was that I had a daughter and I think...

I think, in relation to all of this, I think I can cope with it,

I can take whatever would happen to me.

I cannot cope with the possibility in my head

of it happening to my daughter.

It will be four years before scientists know

the result of the trial.

Sophie is hoping for the best but, at the same time,

preparing for the worst.

She's written a letter to her potential future carers.

"If you're reading this then I've developed familial early-onset

"Alzheimer's disease, like my mum and many of my relatives.

"First things first, thank you!

"You do an amazing job and your role in caring for me

"will very much relieve the pressure from my family,

"who will be struggling not only with my illness

"and the disappearance of the real Sophie Leggett...

"but also the fact that my amazing daughter...

"..now knows for sure that she also...

"..she also has a 50-50 risk of getting early-onset Alzheimer's

"in her mid-life, too.

"My greatest hope is that you can understand how difficult

"my illness will be for my family.

"Please reassure them that however they are feeling

"and whatever they are able or not able to do is absolutely OK.

"I know how hard it was for me

"when my mum was ill and the guilt and fear ate me up.

"I don't want that for my family."

'I am just full of admiration

'for what Sophie and those like her on the trial are doing.

'She demonstrates an extraordinary level of courage.'

The idea of writing the letter

I thought was...

a very courageous thing to do.

But also a very practical thing to do,

because she's saying, "This is me.

"And if, when you're reading this letter, I have dementia,

"I want you to know who I am."

It's a great way of maintaining your identity,

and saying, "Look at me, the person, don't look at the disease."

It's a week since I met Dr Perry to discuss a genetic test

that could reveal my risk of developing Alzheimer's.

I've had to decide whether I want to go ahead with it.

Hello, Dr Perry, it's Angela Rippon.

-ON PHONE:

-'Angela, how are you?'

I'm very well, thanks, yes.

'Did you have a chance to have a think about our chat the other day?'

Yes, I've been thinking about our chat.

Well, I think that we've come this far,

we might as well, just go ahead and do the whole thing.

So, go ahead and do the test, yes.

INDISTINCT REPLY

OK, so in about two weeks' time?

'I suppose it comes down to your mental attitude

'towards the disease.'

Anybody who says, "I don't want to know what the risk is,"

they have their own reasons for doing that.

Erm... I would like to know what my risk is, but not everybody does.

If I know what to expect,

at least I can plan for it.

Whatever the test reveals,

I'm determined to do everything

I can to keep my brain healthy.

Scientists believe that speaking a second language

could actually delay the onset of dementia.

Good morning, class.

-ALL:

-Good morning.

'So, I've come to a class that

'will REALLY challenge my brain.'

-TEACHER:

-Chinese is a tonal language.

If you want to call your mum, which is "maaaaa", the first tone,

if you mistakenly say...

-LILTING:

-"Ma-a", then that means "horse".

-LAUGHTER

-So, you've got to be careful

with the tones.

Now, can you tell me your names?

Wo jiao Thomas.

Wo jiao Angela.

'Sat next to me in class is

'neuroscientist Dr Thomas Bak.'

How do you find learning Chinese? You've done a bit of it already?

Yes, but I still find it very difficult.

How many languages do you speak?

Well, I speak, kind of, four on a daily basis.

-"Four on a daily basis"?!

-Yeah...

-Which ones?

-Well, Polish, German, English and Spanish.

Right. And on a non-daily basis?

Well, I can teach in seven.

Thomas has been studying the effect

that speaking a second language has on dementia,

and he's discovered something quite amazing.

What we found was that people who spoke two or more languages

develop dementia over four years later

than those who spoke only one language.

So, that means that people

who are bilingual, or multilingual,

have four more extra years before

the symptoms of dementia set in.

That is a HUGE effect.

Drugs that we have at the moment cannot come

anywhere near such an effect,

so that means that speaking

different languages might be more efficient,

more effective, than all the drugs

that we have at the moment.

ALL RECITE

Here in the UK, 14 million of us

can only speak one language.

So, the number of people who could potentially

benefit from learning another is enormous.

What is it about learning a language

that has that effect on the brain?

Well, simply, it's a kind of exercise.

I compare learning languages with what, let's say, with sport,

let's say swimming, does to our body.

If you go swimming regularly, we'll be fitter.

I think using more than one language

is a good mental exercise.

But what's it physically doing to the brain?

Well, what we believe is that it practically

leads to more connections.

It make...

It makes brain more interconnected,

and therefore more stable,

and more resilient to damage that

can come from different diseases.

It will take longer time for a disease to damage it.

What about age?

I mean, I'm now 71 -

have I left it too late?

It's never too late. And in order to benefit from languages,

you don't have to be perfect.

So, the benefits are not dependent on speaking the language perfectly.

-TEACHER:

-OK, so walk around and

say your name to the person you meet.

Wo jiao Angela.

Wo jiao Thomas.

It really does come down to the basic,

"If you don't use it, you lose it."

And I think that is great news for all of those people

who genuinely fear the possibility of the onset of dementia -

that there are all sorts of things

that we can actually do ourselves...

to delay it.

The truth of the matter is that the older we get,

the greater the risk of developing dementia -

and we're all living longer.

So, is it inevitable that one day

dementia will catch up with us?

'Not necessarily,

'according to Professor Claudia Kawas

'from the University Of California.'

INDISTINCT

'Claudia is studying the fastest-growing age group

'in the United States - the over-90s.

'She's hoping to discover the secret

'of growing old without dementia.'

Hello, Miss Patton.

-How are you?

-Oh, fine.

'One of the people and Professor Kawas' study is Millie Patton.'

-I think we started seeing you in 2008.

-That's what I thought.

12 or 13 visits, so that's pretty good.

Twice a year, Millie is tested

to see how her brain is working.

Now, I'm going to give you a pen.

What I want you to do is start with the number one,

and then go to the first letter, which is A...

..and then the second number, and

then the second letter, alternating.

-Right?

-Yeah.

And I'll tell you when to start, OK?

Go.

Ooh!

Well, that didn't take long. SHE LAUGHS

So, that's excellent, as always.

Now, let's try this one.

Millie, tell me how old you are now.

100...

and six months.

Maybe it's seven - get a...

Get the calculator out?

THEY GIGGLE

Millie decided to become part of the study after her husband died.

My husband had Alzheimer's.

I saw the look on his face when he couldn't remember to do something.

He knew, you know, that it...

-It's...

-Mm.

And then any work they're doing

to find something to stop that would be...

..worth anything.

'Millie's contribution to the study

'is more than doing just a few tests.

'She's agreed to donate her brain

'to research when she dies.'

So, I guess...

'It'll give Professor Kawas the opportunity to compare

'Millie's mental performance with

'what's happening inside her brain.

'So far, Professor Kawas has studied hundreds

'of the participants' brains.

'And she's discovered something remarkable.'

Here we have...

a picture, and this is actually brain tissue,

-and what it looks like under the microscope.

-Mm-hm.

And this is actually from one of our 90-year-olds,

who died with no dementia.

-And, a very nice-looking brain.

-Yeah.

OK?

This...

this is also one of our 90-year-old participants,

who died with a diagnosis of Alzheimer's dementia,

and did have problems with their memory and thinking.

As you can see there's a lot of brown spots.

And these brown spots we refer to as plaques,

and they're made of amyloid.

And then, this individual...

Gosh, that's VERY brown, isn't it?

-That is very brown.

-Yeah.

-That's a lot of amyloid there.

-Yep.

These are all amyloid plaques that you see.

And this person the pathologist thought had

a very high likelihood of having Alzheimer's dementia.

And this person's thinking was completely normal.

How extraordinary.

So, they had no signs of dementia at all?

I had no way of predicting that I would find this.

Professor Kawas has discovered that many elderly people

have brains full of plaques.

And yet, they have none of the outward signs of dementia.

I realised that 40% of people in this age group

who do not have dementia will have this in their brain.

The real question is, "What's going on here?"

Well, one possibility is that they have some kind of reserve -

some kind of cognitive reserve -

that is protecting them from getting the bad effects of these.

When you talk about "cognitive reserve", what do you mean exactly?

So, maybe it's a bigger brain?

Maybe it's additional training of the brain.

Maybe it's how much you've used your brain as you age.

So, for example, the more educated individuals,

it does appear that they're protected to some extent.

The more education you have, the lower your risk of dementia is.

-This is why we're being told to challenge our brains?

-Absolutely.

Learn Japanese, or do something entirely different?

-Absolutely. Absolutely - use your brain.

-Yeah.

It's like a muscle - if you use it, it works better than if you don't.

'And Millie is doing just that.

'At the age of 100, she uses e-mail

'to stay in touch with family and friends,

'meditates twice a day,

'and makes sure that she keeps up with current affairs.

'It's a far cry from what we might imagine the life

'of a centenarian to be.'

Millie's a reminder that you can grow old,

and you can still have all of your cognitive functions,

and still be perfectly happy, and live a terrific life.

Yes, people will get dementia as we get older, but not everybody.

Back at home in London, the results of my genetic test are ready.

My brain scan was fine.

But this is about what the future holds.

And I'll admit, I am feeling just a teeny bit nervous.

It's...

it's a test on risk,

and nothing more. I've done the test,

I shall be interested to see what the results are,

but it will be what it will be.

KNOCKING ON DOOR

-Angela.

-Dr Perry, hello.

-Nice to see you.

-You, too.

-Come and have a seat.

-So, I've got your results here...

-Right.

..and what they show is that you are E3,E3.

Which means?

So your APOE tests show that

you're the same as about 50% of the population -

no increased risk of Alzheimer's disease from that blood test.

OK? So, I think that's a very reassuring thing,

-and I think you can put that one behind you.

-Thank you.

-OK, it's a pleasure.

-Thanks.

-OK.

I'm convinced that our scientific understanding of dementia

is at a turning point.

I may even see a cure for Alzheimer's during my lifetime.

But until then, there are lifestyle choices we can all make

to help keep dementia at bay.

And just as important is our

attitude towards the disease.

None of us know what's going to happen as we get older, we don't.

Anything could suddenly just come out of the blue.

But at least I know that I can do things like

make sure that my will is up-to-date.

I can talk with my godchildren

about the kind of care that I might like.

I can take responsibility for my future, and put things in place,

which is a sensible thing to do anyway,

even if I don't get dementia.

But if I do, at least they won't ever have to agonise about what

to do with Auntie Ange, cos Auntie Ange will have already told them.

# There may be trouble ahead

# But while there's moonlight and music and love and romance

# Let's face the music and dance. #