For Professor Craig Ritchie, the Holy Grail in dementia research is not to try to find a cure, but to find ways to significantly delay and ultimately prevent its onset.
And he believes we are well on the way to prevention with a pioneering A$100 million European collaboration between academics and the pharmaceutical industry that he heads as Professor of the Psychiatry of Ageing at the University of Edinburgh.
"If we can delay onset by five years, that is a massive step forward," Professor Ritchie told the Wicking Trust's inaugural Public Lecture, which followed its annual symposium to present the work of grant recipients and applicants.
In fact, he said, a 5 year delay in the progressive condition could mean a 50 per cent reduction in incidence – not just alleviating much individual distress but freeing up huge resources amid massive unmet clinical need for people already living with dementia.
That’s a vital objective for a condition that is currently costing $800 billion a year globally – equivalent, he said, to all the money spent by NASA on space exploration since its inception.
Professor Ritchie leads the European Prevention of Alzheimer’s dementia (EPAD) Initiative, which promises to be a “game-changer” in better understanding the early aspects of Alzheimer’s diseases and to improve the chances of prevention.
The five year collaborative research initiative, similar to a model that has worked for the development of an Ebola vaccine, was announced earlier this year after ongoing and expensive attempts to bring new drugs for Alzheimer’s disease to the market failed to deliver any breakthroughs.
The scale of collaboration between the 36 private and public sector organisations involved mean it can speed up the whole research process, particularly around drug discovery. Using already established databases, it has accelerated the identification and referral of the study cohort and can rapidly test several treatment options within the same trial.
"We got to the tipping point where we realised we would have to do things differently," Professor Ritchie said.
Still consulting as a psychiatrist, he told the audience of his own frustration at clinicians being turned into “diagnosis factories” amid a massive push to try to diagnose early symptoms of dementia over recent years. It was mostly well-intended, he said, but ineffective when there wasn’t either the research evidence to back up diagnosis or treatment that could meaningfully change the course of illness.
And it wasn't without consequence, swallowing up funding that could have been better used to improve quality of life for people with more severe dementias. His own clinic was forced to close a day centre for people with dementia to deal with growing referrals for diagnosis.
Meanwhile people with dementia and their loved ones suffered the terrible false hope of every “cure breakthrough” that is breathlessly announced and undelivered. “Over decades, we’ve seen no new drugs, no new diagnostic tests. There have been billions, probably trillions of dollars of investment, but they have not translated into any net clinical benefit.”
Professor Ritchie believes that a cure for dementia is an "unrealistic" expectation. However, he sees real hope in looking at prevention.
Rather than rely on the individual efforts of particular researchers and pharmaceutical companies, EPAD will work with a constant cohort of 6,000 people to identify those who are at risk of dementia, to accelerate their treatment and offer a range of medical options.
"We are making a 'prognosis', not a 'diagnosis'," Professor Ritchie said.
EPAD's aim is to take a drug that works into phase three trials, but it will also look at lifestyle factors, both risks and resilience. "There's not going to be a silver bullet, it will be a combination of pharmacology, lifestyle and psychology," he said.
Linking up with similar or related programs internationally will be key to its success. "It’s a global problem, the more data we get, the more accurate the model,” he said. EPAD already looks set to expand into the United States and Japan, and Professor Ritchie hopes Australia will join in, particularly given his close links with the local research community.
The Scottish researcher has worked in Australia twice, including with Professor Colin Masters, Fellow of the Florey Institute of Neuroscience and Mental Health and a leader of the Australian Imaging Biomarkers and Lifestyle Study of Ageing (AIBL). Data from AIBL, which is also looking into dementia prevention, has gone into EPAD's initial modelling work.
Professor Masters told the Wicking audience that EPAD is a "revolution in the field" and "world's best model" of collaborating to address the problem of dementia.
“Everyone talks about prevention," he said. "This is walking the talk."
For Professor Ritchie, the first milestone will be when he signs up the first participant to drug trials, expected to happen in April 2016. And he expects it to deliver early results. "I think 5 years from now we will have some substantial findings and possibly a new drug."
Watch or listen to the full public lecture.
 The final stage before application for approval of an intervention that tests its effect on large groups of trial participants.