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Cambridge Neuroscience would like to welcome Professor John O’Brien to Cambridge

Professor John O'Brien has recently been appointed Cambridge’s first Chair in Old Age Psychiatry at the Department of Psychiatry having spent much of his career investigating the biological basis of dementia and aging. Professor O’Brien is no stranger to Cambridge, having completed his undergraduate degree in Medical Sciences, carrying out his Part 2 in Experimental Psychology alongside Prof Trevor Robbins. John moved to Oxford for his clinical training, and continued his training in Psychiatry at the Maudsley Hospital in London. After another stint in Cambridge, John went on to lecture psychiatry in Melbourne for two years before moving to Newcastle as a Senior Lecturer. John was appointed Professor in Newcastle before he moved back to Cambridge this month to take up the new Chair in Old Age Psychiatry.

Professor O’Brien, How is it to be back in Cambridge?

It is great, it is very exciting. There is a lot that has changed, obviously, and for the better I think. Neurosciences was always strong in Cambridge and it is even stronger now. There are lots of research facilities and opportunities that were not here before, and there are excellent clinical services. It feels really good to be back!

 When did you first become interested in dementia and Alzheimer’s disease?

I think it started when I was student here actually, because I became interested in neuroscience. Modules I did at the time included those relating to mental illness but also to cognitive impairment and dementia. During my clinical training I got very interested in the extent of memory problems and dementia in older people and in fact very little was actually known about the underlying scientific basis of it. There were however, beginning to be some treatments trials and it was a very exciting, emerging area and so I decided to specialise in that both from a clinical point of view and from a research point of view as well.

Your previous work includes a wide range of projects from looking at Lewy bodies and white matter intensities to effects on specific regions of interest in individuals with dementia. How will you expand on this during your time here?

Well, I suppose my research here is largely in two areas.  I am interested in methodology, namely brain imaging, which I have been interested in using both to understand the neurobiology of lots of different disorders in late life, but also as a marker for diagnosis. In parallel, I have an interest in specific disorders including Lewy body dementia, vascular dementia, and also late life depression.  The work here will really be extending those fields and moving that work forward. There are a great opportunities for different imaging here in Cambridge, particularly PET imaging with novel ligands, as well as excellent MR facilities. There are also great facilities for the basic biologies, genetics and there are cognitive strengths as well.

Are you planning to do any treatment trials?

Yes, we are planning some treatment trials. We are looking at studies involving disease modification, particularly in dementia. We have had symptomatic treatments for about fifteen years now and there have been a lot of attempts to develop treatments to modify disease, which unfortunately have not been successful to date. But there are some new avenues that can be tried so I think that represents exciting opportunities. We are also planning multidisciplinary approaches. We are planning a study in Lewy body dementia in which we are bringing together drug treatment and non-drug treatments to try and improve patient care.

Do you then focus on the early stages or mostly on late stages?

I think all stages are important in dementia, but I think increasingly, the focus is on early identification because that is going to be key to maximizing future benefit of treatments. Certainly a lot of the imaging work I have been involved with has been around trying to get very early biomarkers for diagnosis and even before that, predicting who will later develop dementia.

Can you tell us a little bit about those early markers?

One that we have worked on quite a lot is a marker of the dopaminergic system in Lewy body dementia, which is now in clinical practice as a diagnostic tool approved by NICE (National Institute for Clinical Excellence) for clinical use; that is the dopamine transporter ligand. We are now looking at how that could be used in the early stages rather than those with established disease. Further, we are looking to expand that to look at blood and CSF markers.

What do you think is the most important challenge to be addressed in Alzheimer’s research in the coming years?

Well undoubtedly, it is finding effective treatments, preferably in the early disease process and particularly treatments that can actually modify the disease itself. Treatments will be so important because of the huge scale of the problem that exists: there are 820,000 people with dementia in the UK now, and that will double over 30 years. The problem is global and is even greater in developing nations. Developing disease-modifying treatment really is the greatest challenge that we as researchers face.

And finally… Almost daily, there are media reports of ‘cures’ for Alzheimer’s disease. What would be your advice for someone with AD or their families in picking the ‘wheat from the chaff’ from these stories?

That is a very good question! There is a lot of interest in Alzheimer’s because it is very common, everybody knows somebody who is affected by it, and it is a devastating condition. There are a lot of scientific advances and immediately everybody wants a scientific advance to leap to a treatment.  A lot of these advances may lead to treatments but we are talking ten or fifteen years down the track and so its very important for people to sort, as you say, the ‘wheat from the chaff’. I think that people need to look for reputable sources of information.  There are some organisations who are very sensible in their reporting, for example the Alzheimer’s Society has a section on research and often there are comments about new research findings. Alzheimer’s Research UK, which is a charity based in Cambridge, is a large funder of dementia research and also it provides excellent information about the context of latest research advances so as to allow for the best information.

Interview by Kate McAllister and Amber Ruigrok.

Adapted from Department of Psychiatry News pages.

Posted on 21/09/2012

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