An ultrasensitive blood test could be the key to detecting brain damage, predicting clinical outcomes, and identifying those at risk of dementia after a head injury.
A new study used a state-of-the-art test to track damage to the brain in people who have sustained traumatic brain injury (TBI).
The findings mean blood tests could provide similar information to magnetic resonance imaging scans, but in a more cost-effective and accessible manner.
Researchers suggest measuring the protein biomarker in the blood will provide a simpler, more accurate way to predict clinical outcomes.
They said it may help to identify those at higher risk of developing dementia.
Professor David Sharp is the senior author of the paper and director of the UK Dementia Research Institute’s (UK DRI) care research and technology centre at Imperial College London.
“Outcomes after TBI are very difficult to predict," he said. “What we need are more accurate diagnostic tests that can be used in our major trauma units and clinics.
“Our work shows that measuring neurofilament light soon after head injury helps to predict who will develop long-term problems.
“We are applying this in various contexts, including for the investigation of sporting TBI, and will be investigating whether this blood test can be used to predict those at high risk of developing dementia.”
Across the world, around 50 million people each year suffer TBI as a result of head injury.
In their brains, the nerve cells encounter severe forces which cause damage to the axons – the part which transmits electrical signals.
This damage is the best predictor of clinical outcomes and recovery but has been difficult to measure, researchers said.
The team from the UK DRI care research and technology centre set out to identify a chemical that could be easily detected in the blood – a biomarker – that would accurately reflect this axonal damage.
To do this, they began by detecting proteins that are important to the structure of the nerve cell axons.
Scientists found that measuring blood levels of neurofilament light, a protein important for axonal structure, provided an accurate long-term prognosis for the patient.
To validate the blood tests, the researchers used advanced types of brain imaging.
Dr Neil Graham is joint first author and Alzheimer’s Research UK clinical research fellow at the UK DRI’s care research and technology centre.
“I’m extremely excited by the ultrasensitive blood test technology we used here, as it has opened up a whole new world of possibilities when it comes to precise injury diagnosis and prediction of outcomes after head injury," he said.
“This is particularly useful in the area of dementia risk assessment after TBI, which is very challenging at present.
“If we could roll the neurofilament light test out across the country, it would be hugely impactful.
“We’re gearing up to offer it to NHS patients at Imperial in the near future.”
Dr Rosa Sancho, head of research at Alzheimer’s Research UK, said: “This work gets us closer to a blood test able to predict how brain changes develop up to one year after injury.
“Dementia develops over many years and we need to build on these findings to help improve longer-term prognosis and to reliably determine an individual’s risk of dementia following a head injury.”
The study involved more than 200 patients who had experienced moderate to severe TBI, recruited from eight trauma centres across Europe.
The study is published in Science Translational Medicine.
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Mercer, the investment consulting arm of US services company Marsh & McLennan, expects its wealth division to at least double its assets under management (AUM) in the Middle East as wealth in the region continues to grow despite economic headwinds, a company official said.
Mercer Wealth, which globally has $160 billion in AUM, plans to boost its AUM in the region to $2-$3bn in the next 2-3 years from the present $1bn, said Yasir AbuShaban, a Dubai-based principal with Mercer Wealth.
“Within the next two to three years, we are looking at reaching $2 to $3 billion as a conservative estimate and we do see an opportunity to do so,” said Mr AbuShaban.
Mercer does not directly make investments, but allocates clients’ money they have discretion to, to professional asset managers. They also provide advice to clients.
“We have buying power. We can negotiate on their (client’s) behalf with asset managers to provide them lower fees than they otherwise would have to get on their own,” he added.
Mercer Wealth’s clients include sovereign wealth funds, family offices, and insurance companies among others.
From its office in Dubai, Mercer also looks after Africa, India and Turkey, where they also see opportunity for growth.
Wealth creation in Middle East and Africa (MEA) grew 8.5 per cent to $8.1 trillion last year from $7.5tn in 2015, higher than last year’s global average of 6 per cent and the second-highest growth in a region after Asia-Pacific which grew 9.9 per cent, according to consultancy Boston Consulting Group (BCG). In the region, where wealth grew just 1.9 per cent in 2015 compared with 2014, a pickup in oil prices has helped in wealth generation.
BCG is forecasting MEA wealth will rise to $12tn by 2021, growing at an annual average of 8 per cent.
Drivers of wealth generation in the region will be split evenly between new wealth creation and growth of performance of existing assets, according to BCG.
Another general trend in the region is clients’ looking for a comprehensive approach to investing, according to Mr AbuShaban.
“Institutional investors or some of the families are seeing a slowdown in the available capital they have to invest and in that sense they are looking at optimizing the way they manage their portfolios and making sure they are not investing haphazardly and different parts of their investment are working together,” said Mr AbuShaban.
Some clients also have a higher appetite for risk, given the low interest-rate environment that does not provide enough yield for some institutional investors. These clients are keen to invest in illiquid assets, such as private equity and infrastructure.
“What we have seen is a desire for higher returns in what has been a low-return environment specifically in various fixed income or bonds,” he said.
“In this environment, we have seen a de facto increase in the risk that clients are taking in things like illiquid investments, private equity investments, infrastructure and private debt, those kind of investments were higher illiquidity results in incrementally higher returns.”
The Abu Dhabi Investment Authority, one of the largest sovereign wealth funds, said in its 2016 report that has gradually increased its exposure in direct private equity and private credit transactions, mainly in Asian markets and especially in China and India. The authority’s private equity department focused on structured equities owing to “their defensive characteristics.”
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