KI researcher Maria Eriksdotter is standing up for the elderly
You are the same person inside, although your body is ageing and your memory failing. Professor Maria Eriksdotter hopes to add to our knowledge of Alzheimer’s disease. But she also wants to fight ageism. “The status of the elderly needs to be raised,” she says.
Text: Cecilia Odlind for the magazine Medicinsk Vetenskap no 1, 2022
Just under 100,000 people in Sweden are suffering from Alzheimer’s disease. It is uncertain exactly what causes the disease but we know that plaques of the protein beta-amyloid and collections of the protein tau are formed and that this prevents signalling between nerve cells in the brain. At the same time, cells also die in areas that have to do with memory and attention. These cells communicate using the signal substance acetylcholine, and cholinesterase inhibitors are one treatment that has been available since the mid-1990s. Here the drug inhibits the breakdown of acetylcholine so as to retain communication between the brain cells. Maria Eriksdotter’s research has focused on finding new treatments for Alzheimer’s, especially looking at the cholinergic system.
“In my doctoral studies in the 1980s, I realised you could stimulate the survival of the cholinergic cells in rats by adding the growth factor NGF. This made me interested in the ageing brain and the possibility of treating Alzheimer’s disease with NGF,” Maria Eriksdotter explains.
After spending a number of years working as a doctor in geriatric medicine, Maria Eriksdotter returned to research.
“My years of clinical experience meant I was able to ask relevant research questions,” she says. “We took things further and ran a clinical trial at Karolinska University Hospital where capsules containing cells that release NGF were surgically placed in the forebrain of ten Alzheimer’s patients. The capsules functioned as a local protein factory. Memory capacity stabilised in half of the patients, which is hopeful, but the technique needs further development.”
Maria Eriksdotter thinks it would have been more successful had the treatment been able to be started earlier; it is known that Alzheimer’s disease begins about ten to twenty years before symptoms emerge.
Package treatment in the future
In recent years she and her research group have been working on refining the method, including attempting to better understand how the cells that produce NGF work and are affected by substances in the surrounding brain tissue. They are also looking for substances that are able to stimulate NGF receptors and produce the same effect without invasive neurosurgery.
“We are also studying combination treatment with NGF and other growth factors in animals,” says Maria Eriksdotter.
She does not believe in waiting for one single miracle drug that will solve the whole problem of Alzheimer’s.
“In the future, we will see package treatments bringing several aspects together, such as amyloid vaccination to inhibit plaque formation, cholinesterase inhibitors to increase acetylcholine levels, growth factors to halt cell death and lifestyle changes such as more physical activity and brain gym,” she says.
However, even so, it is likely that the disease actually consists of several different sub-types that we cannot currently distinguish between.
“We still need to fine-tune our diagnostics. Different types of treatment might be needed at different phases of the disease. I think we will soon be talking about precision medicine also in the field of Alzheimer’s, with treatment tailored to each individual,” she says.
Maria Eriksdotter also developed and chairs the Swedish registry for cognitive/dementia disorders, SveDem, which follows more than 100,000 patients with different dementia diagnoses through the entire care chain.
“The idea behind it is to ensure high quality dementia care nationwide. The registry follows up on different quality parameters and identifies areas for improvement,” Maria Eriksdotter explains.
Compiling data from the registry and linking it up with other registries enables researchers to learn more about treatment outcomes, comorbidities, prognoses and care, for example.
“One of the things we’ve done is compare Alzheimer’s patients who received cholinesterase inhibitors for five years with matched patients who did not receive this treatment. The results showed that cognition is somewhat improved and is retained over a long period in the treated group. But the clearest outcome, rather surprisingly, was that mortality fell by 27 percent, probably due to impact on the cardiovascular system and anti-inflammatory effects,” says Maria Eriksdotter.
The researchers also observed that other treatment, such as anti-depressants or anti-psychotic drugs could be postponed while cholinesterase inhibitors were used.
“But patients with dementia also risk being under-treated for other concomitant diseases,” Maria Eriksdotter adds. “It’s important not to miss symptoms that are due to other diseases.”
Also carried out covid-19 research
Another study based on SveDem showed that people became worse at visiting the dentist following a dementia diagnosis.
“Our studies have led to the National Board of Health and Welfare issuing new guidance so that dental health doesn’t fall by the wayside,” Maria Eriksdotter says.
During the pandemic, Maria Eriksdotter has been leading Karolinska Institutet’s resource group on health of the elderly and also carried out research into older people and COVID-19. The Stockholm Gero-Covid study gathered data on more than 4,600 people with COVID-19 in partnership with geriatric clinics in Stockholm.
The results show that the mortality rate for COVID-19 in geriatric clinics was five to ten times higher than for those receiving treatment for non-COVID illnesses during the pandemic. Advanced age, being male, poor kidney function and dementia lead to a poorer prognosis but the degree of fragility is most clearly linked to a poor prognosis. However, mortality has fallen over time, probably due to improved treatment and the impact of vaccination.
Many people have been critical of the way the coronavirus pandemic was handled, particularly in terms of the elderly, and Maria Eriksdotter is no exception.
“I think that measures to reduce transmission were brought in far too late, especially during the first wave. Also, a third dose of vaccine, both for the elderly and for staff, should have happened earlier and more forcefully,” she says.
Maria Eriksdotter believes that geriatric competence should be more highly demanded in society, for example by the Public Health Agency of Sweden.
“In many places people do not know how care of the elderly is organised and there is limited knowledge of the major needs – in terms of medical and social care – in homes for the elderly and sometimes for vulnerable elderly people in their own homes, which was especially demonstrated by the pandemic,” she points out.
Maria Eriksdotter also thinks that age discrimination has a part to play.
“Elderly people are afforded a low status in our society. Jobs in elderly care are also seen as stop-gap jobs. They are viewed as something to do if you aren’t qualified for anything else. I think this attitude affects the care elderly people receive. We have to improve the status of care of the elderly. It’s a very important job. The staff are often doing an amazing job but they need better training and conditions and improved medical skills,” she says.
She thinks that higher status can be achieved through improved leadership and more education on aging and elderly health for staff and for students of health professions. Proper investment in research into ageing and the diseases of old age is needed too.
But what do we mean by “elderly”?
“In the past, the word elderly was often used to refer to people over the age of 65,” says Maria Eriksdotter. “Today we use the concept of biological age. People who are biologically aged are people who often have more than one disease, with complex disease patterns and disabilities.”
But many people also feel healthy long into very old age. And Maria Eriksdotter finds that even those who do suffer from illness and setbacks often have a surprisingly strong zest for life.
“You need to remember that few people see themselves as being old. The body ages but inside you don’t feel very different. You learn more over the years and benefit from your experiences throughout your life but fundamentally, you are naturally the same person,” she says.
Facts about Maria Eriksdotter
Name: Maria Eriksdotter.
Title: Professor of Geriatrics at the Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Senior Consultant in the Themes Inflammation and Ageing, Karolinska University Hospital Huddinge. Dean of KI Syd (South).
Family: Two adult sons.
Motto: Work hard and have fun.
Relaxes: By reading, spending time with family, skiing and walking in the forest.
Role model: My mother is my role model. She supported me every way she could.
Best qualities as a researcher: Persistent, curious, systematic and hardworking.
Most unexpected research finding: That treatment with cholinesterase inhibitors is linked to such a large reduction in mortality.
Maria Eriksdotter on…
... screening for Alzheimer’s:
The disease can be identified long before the symptoms appear but as long as we don’t have any really good treatment to offer to slow its progress, I don’t think screening for it is a good idea. All we would be offering would be worry.
... the effects of the pandemic:
The number of people newly diagnosed with dementia has fallen by 30 percent because many people avoided seeking healthcare but also because many memory clinics closed when transmission was at its height.
... everyday technology:
Technology can be a help or a hindrance. Technological progress is a good thing but the technology needs to be adapted to the user. People with cognitive disabilities also need to be able to live and function in our increasingly digitised society.
... our obsession with youth:
70 is the new 50. Elderly people today generally feel healthy but their experience and expertise is under-used. At the same time, there are elderly people who need support from society but they too have experiences that we should be making better use of.