Think of dementia and you’ll probably think about the most common form: Alzheimer’s disease.
The second most common type – vascular dementia – can get overshadowed. Caused by disease of the brain’s blood vessels, it is usually said to be responsible for 20 to 30 per cent of dementia cases.
However, we may also be underestimating its impact. The latest research suggests it is more common than is thought, often occurring alongside an Alzheimer’s diagnosis but going unrecognised.
The good news is that there are several drugs already in use for other conditions that cut the odds of vascular dementia, including the humble blood pressure pill.
And there are further treatments around the corner that could be more potent still.
The two reasons Man Utd have given Carrick shock second chance
Michael Carrick will remain in charge of Manchester United for their weekend trip to Chelsea, despite overseeing the club’s worst start to a top-flight season in 40 years.
Carrick is ‘preparing team to face Chelsea’
The i Paper has been told that despite several alternatives being explored, Carrick was at United’s Carrington base taking training on Tuesday and is “preparing the team to face Chelsea on Saturday”.
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A closer look at the detail
Club sources insisted that “Michael and the players will have the opportunity to turn the situation around”, with everyone focused on “showing our response on the pitch”.
Carrick was expected to be relieved of his duties on Monday, with Eddie Howe the frontrunner to take charge. However, after senior executives held a crisis meeting on Monday, Carrick will get a surprise reprieve.
What happened on Monday?
- With the squad on a day off, Carrick was not expected to be at Carrington, as senior figures were sharpening their axe. Instead, there was no white smoke from the boardroom.
- Rumours circled that United were waiting for the afternoon and the New York Stock Exchange to open before making an announcement, but club sources insisted no news would be coming out of the club.
Why has Carrick got another chance?
- Insiders told The i Paper that chief executive Omar Berrada and director of football Jason Wilcox could not make a call on sacking Carrick yet until they believe a suitable successor is lined up.
- Dismissing Carrick will cost the club a considerable amount, so they must be certain the next coach is fully interested.
- One source has claimed that there is a feeling the club needs to stop the cycle of sacking managers.
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Why Neil Young is suing Trump campaign for the second time
The Canadian-American singer has filed a $10m (£7.5m) lawsuit against a fundraising committee that supports Donald Trump, citing “unauthorised” use of his music.
What does Young claim?
Young, 80, alleges that the Trump 47 Committee infringed on his copyright when it used his hit song Rockin’ in the Free World before Trump took to the stage at a rally in Ohio on 12 October.
The lawsuit claims the use of the song amounts to an “unauthorised public performance”, and that Young “has not, and would not, grant the required licence”.
A closer look at the lawsuit
The lawsuit said Rockin’ the Free World is “a blistering anthem that contrasts the hollow promises of American political rhetoric with the harsh realities faced by the poor, homeless and forgotten”.
- Young says that the song is “the opposite of everything that Donald J Trump stands for”.
“We have all been here before,” to quote by Young’s former supergroup Crosby, Stills, Nash and Young.
This is the second time Young has sued Trump over use of the song. The singer filed a lawsuit in 2020, which was later settled.
Young’s lawsuit says Trump’s use of the song again breaks the terms of the prior settlement. The new $10m lawsuit also asks for an injunction against further public performance for political purposes.
The Trump administration has not yet responded to the suit.
The Rolling Stones, REM, Rihanna, Adele, and the estate of Prince have all previously criticised the president for using their music at his campaign events.
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Why Bolsonaro has fled to the US after Brazilian election
Brazilian senator and opposition candidate Flávio Bolsonaro has left the country for the United States after losing Sunday’s presidential election.
The US State Department is expected to grant him and his family entry visas.
What you need to know
Bolsonaro is yet to concede to the current President and leftist candidate Luiz Inácio Lula da Silva.
The losing right-wing candidate left Brazil amid a probe into alleged money laundering, wrongdoing he has denied. He refused to comply with a supreme court order to surrender his passports.
Bolsonaro is the eldest son of former President Jair Bolsonaro, who is currently under house arrest as part of his 27-year sentence for attempting a coup after losing the 2022 election to Lula.
US via Argentina and Ecuador
Argentina’s migration department said on Wednesday that Bolsonaro and his family had briefly entered the country’s Misiones province on Tuesday night through a road crossing, with valid travel documents
They then boarded a private plane bound for Guayaquil, Ecuador. The current location of Bolsonaro, his wife and two daughters was not immediately clear.
Donald Trump and Argentina’s President Javier Milei have been vocal allies of the Bolsonaro family.
Tense relations
- Bolsonaro’s departure threatens to deepen a rift between Brazil and the US – the two most populous nations in the Americas.
- Lula has accused Washington of colluding with the Bolsonaros to put them back in power.
- Trump told reporters on Wednesday that he would approve of Bolsonaro coming to the US.
- The US President on Monday said the Brazilian vote “looked like another rigged election”.
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Like father, like son?
Trump has previously alleged that Jair was a victim of judicial persecution in Brazil.
- The elder Bolsonaro also went to the US after refusing to concede to Lula in 2022, when then US president Joe Biden was in office.
- Lula, speaking in Brasilia, said he had just heard that Flavio had left the country, and called it shameful, saying he should have stayed in Brazil and proved his innocence.
- Bolsonaro had been favored to win Sunday’s presidential election but ended up losing in a shock result.
- Eduardo Bolsonaro, Flavio’s younger brother who lives in the US, said ahead of the vote that an election loss would require a move out of the country.
The election in pictures
Everything we know so far about fatal train crash in Spain
At least 39 people have been killed after two trains collided in Spain this morning, it has been reported.
The trains collided between the towns of Los Yebenes and Urda, in the Toledo province in central Spain. Rail operator, Adif, said the entire line from Madrid to the southern Andalusia region has now been suspended.
What do we know so far?
- The crash involved a high-speed AVE train that had left Madrid bound for Seville and an Iryo train travelling in the opposite direction.
- The Iryo train was reportedly carrying 147 people, while the AVE train was carrying 397.
- The crash comes nine months after Spain’s worst rail disaster in more than a decade.
- In January, two high-speed trains collided near Adamuz in Córdoba, killing more than 40 people.
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[I am] shocked by the serious train accident in Toledo…I remain in constant contact with the Minister of Transport, and with the president of Castilla-La Mancha. My affection, solidarity, and support to all the victims and their families.
Pedro Sánchez
The story in pictures
When will the UK rejoin the Erasmus plus scheme?
The Government has confirmed the UK will rejoin the Erasmus plus student exchange scheme from the start of January.
Foreign Office minister Hamish Falconer said applications would open next month for young people who will be able to study, train or get work experience in the EU.
What you need to know
- Falconer emphasised to MPs that the opportunities would be open to “educational institutions of all kinds”.
- Work on the UK joining the Erasmus programme was announced as part of former prime minister Sir Keir Starmer’s post-Brexit reset deal with Brussels in 2025.
- The UK left the scheme under Boris Johnson’s Brexit deal in 2020, with the then-prime minister arguing it did not offer value for money.
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What was it replaced by?
- It was replaced by the Turing Scheme, which was ended when the Government announced the new deal over Erasmus plus.
- The Government has previously said it expects more than 100,000 people to be able to benefit.
As well as university-based study exchanges, Erasmus plus allows further education students and apprentices to take up work placements in European firms.
Applications open this November. They are not simply for undergraduate university students. They are for educational institutions of all kinds.
Hamish Falconer
All cost of living help that could come in the Budget
From energy bills support to a minimum wage hike, here are all of the measures John Healey could announce in the Budget to offer Brits some relief.
Chancellor under pressure
The Chancellor will come under intense pressure to ease cost of living pressures on households up and down the UK in his maiden Budget on 28 October.
Labour has already unveiled a number of everyday fixes but households struggling will no doubt be looking for further support.
So, what help could be on the way and how much could it save you? Here, we look at the options.
What help might be coming?
- Energy bills help: A typical dual-fuel household would save £27 a year if gas standing charges were abolished and the costs were shifted into the gas unit price.
- Fuel duty tax hike delay: Delaying the hike could save around £2.75 compared with the full duty rate on a 55-litre tank.
- Minimum wage increase: The adult rate could rise by around 3.9 per cent to £13.20 from April 2027.
- Food tariffs: Recent cuts to these tariff cuts will save consumers up to £21 a year – around 40p a week.
- Carer’s allowance changes: The Government is changing the rules so unpaid carers no longer lose their allowance for earning over weekly limit.
- Paternity pay: The Government has said it will extend parental pay to over 150,000 additional parents per year.
Three-quarters of pilots have fallen asleep in the cockpit
Three in four European pilots have admitted to falling asleep in the cockpit.
A new study
Research commissioned by the European Cockpit Association, asked 7,200 captains and first officers about their tiredness levels while on shift.
A total of 77 per cent of respondents reported having at least one “microsleep” – a brief, unintentional sleep – while operating an aircraft in the four weeks prior to the survey.
The findings
- One in four pilots admitted to five or more microsleeps during the same four-week period, while 7 per cent admitted to having 10 or more.
- Of the pilots working for British airlines, 54 per cent said they had slept between one and four times.
- A further 13 per cent said they had fallen asleep more than five times and 6 per cent admitted to falling asleep more than 10 times.
If we are serious about managing the safety risks related to pilot fatigue, the numbers we see in this report – and the lack of any meaningful improvement over the past three years – are a clear wake-up call for airlines, authorities and the European Union Aviation Safety Agency that something must change in the way Europe deals with pilot fatigue
Captain Tanja Harter, president of the European Cockpit Association
The lesser-known dementia
Scientists have thought since the 1980s that Alzheimer’s is caused by build-up of two toxic proteins in the brain. First, a protein called amyloid was implicated, then one called tau.
The neat theory with the tempting solution of clearing away the proteins meant that for decades, studies of amyloid and tau soaked up most of the research funding for dementia.
Today, there are about 200 clinical trials under way in Alzheimer’s disease, compared with about 50 for all other forms combined, which includes vascular dementia, says Dr Richard Oakley, associate director of research and innovation at the Alzheimer’s Society.
Despite its name, the charity supports families affected by all forms of dementia.
The recent development of drugs that can clear amyloid from the brain, although not yet approved for NHS use, has meant families of people with vascular dementia can feel left out, Oakley says.
“People see the excitement about Alzheimer’s and say what about vascular dementia?” he adds.
Vascular dementia has always seemed a more knotty problem. In about a third of those affected the cause is a stroke, a localised area of brain damage caused by a sudden blood clot or bleed.
In the rest of vascular dementia cases, the brain damage is spread out and has happened over many years. It is caused by problems with the walls of small blood vessels in the brain.
With ageing, blood vessels can become leaky, stiff and unable to widen when necessary to supply enough nutrients to the brain’s nerve cells and take away their waste.
What this means for Alzheimer’s
Over time, this damages nerve cells and eventually kills them – which leads to the dementia symptoms of memory loss and confusion.
People with memory problems who get brain scans and other tests may eventually be told they have either Alzheimer’s or vascular dementia or one of the other rarer types. A small proportion may be told they have a mix of both Alzheimer’s and vascular dementia.
But the distinction between vascular dementia and Alzheimer’s may be less clear than is usually thought, says Professor Adam Greenstein, a clinician scientist at the University of Manchester.
That’s because latest research shows that when blood vessels cannot clear nerve cell waste, this worsens build-up of toxic proteins such as amyloid. And in a vicious circle, when there is excess amyloid, it also builds up within blood vessel walls, further restricting blood flow.
“So, this condition we call Alzheimer’s, which everybody has always talked about as being a neurodegenerative condition, is also to a large degree, a [blood vessel] illness,” says Greenstein.
The drugs that can already help prevent dementia
Those diagnosed with vascular dementia are usually told there are no treatments. But this ignores the fact that, if caught at the earliest stages of memory loss, known strategies for keeping blood vessels healthy can cut the number of people who progress to dementia.
The most obvious step is to keep blood pressure under control, as high blood pressure further damages the brain’s small blood vessels. Blood pressure drugs were shown last year to cut dementia diagnoses.
An authoritative review of dementia prevention measures drawn up by the identified 14 risk factors that people could avoid, and many involved blood vessel health.
They include standard lifestyle measures like stopping smoking, cutting alcohol, keeping fit and controlling cholesterol.
“We’ve long known that what’s good for your heart is good for your head,” says Oakley.
As our understanding of vascular dementia has grown it has opened the way for more specific treatments that can target the underlying blood vessel disease, says Professor Joanna Wardlaw, head of neuroimaging at the University of Edinburgh.
The promising new, cheap drugs
Two drugs already used to open up blood vessels to treat chest or leg pain, are currently being tested in three UK trials for vascular dementia, having shown promising results in a smaller study.
If they work, they are likely to be available in the next few years because they are relatively cheap – unlike the two amyloid-clearing treatments that have been banned for NHS use partly because of their cost.
“It may be that in 10 years’ time, people receive several different drugs,” says Wardlaw. “Something to help the blood vessels, something to get rid of the proteins and maybe something to damp down inflammation.”
In the meantime, though, at least some dementia specialists are starting to tell patients with mild memory problems that simple measures such as blood pressure control can cut their risk of progressing to full dementia.
Greenstein’s hospital has just opened the Manchester Brain Health Centre, a clinic designed to give earlier dementia diagnosis. They advise people at the stage of mild memory loss how to keep their brain’s blood vessels as healthy as possible.
“Nobody would tell you if you presented with chest pain to go away and come back after you’ve had your first heart attack,” says Greenstein. “We know that in vascular conditions, you have to pick things up early and treat them aggressively. This is what we are trying to do.”