Treating neurodegenerative diseases.

jections) or as an opportunity—a delay in the onset of these conditions by, say, 5-10 years would dramatically reduce their incidence and therefore costs. Individuals have realised that if they are lucky enough to side step or survive cancer and vascular disease the next threat is neurodegeneration in its various guises. But have governments realised this? Secondary postponement of disability is possible and it is impressive and fast moving in Parkinson’s disease and modest in Alzheimer’s and motor neurone disease. The key characteristics of these conditions are that progressive degeneration occurs as a primary event long before symptoms develop and that it is selective, at least initially, for a particular neuronal pool. Other groups of neurones could join—for example, sensory end organ failure—and there is overlap with what we arbitrarily accept as ageing. In the future these diseases will be increasingly defined by the proteins involved. Improved diagnostics will hopefully change terminology and reduce the need to second guess pathology, thus increasing the accuracy of classification from the start. Eventually the mechanisms through which particular proteins cause toxicity would be elucidated, as will genetic and environmental risk factors. Primary preventive strategies could then emerge and ultimately (as in the case of polio and vaccination) these diseases will be defined by their solutions.