A disease that has no cure and is hard to predict, but it can be controlled: the importance of early diagnosis and appropriate lifestyle
21st September 2023 marks World Alzheimer’s Day, a date established in 1994 by the World Health Organisation (WHO) and by Alzheimer’s disease international (ADI).
This day is aimed at focusing on one of the scourges that target mostly the elderly (even if it is not a direct consequence of old age), significantly reducing their quality of life and undermining the most essential aspects of their emotional and cognitive well-being: their connection with loved ones and their personality.
New findings in science and medicine have helped extending life expectancy, but this also entails a higher likelihood of living with chronic and degenerative conditions, such as dementia, with Alzheimer’s being the most common form.
Unfortunately, the data is alarming and the number of people affected keeps growing: according to Italian Alzheimer’s Association (AIMA) there are approximately 650,000 Alzheimer’s patient in Italy, the majority receive cures at home for almost the entire duration of the disease, which also places an economic burden on family members, accounting for 80% of the total.
The situation around the world is not any better: according to WHO, over 55 million people worldwide are affected by some form of dementia, with Alzheimer’s being the 7th leading cause of death.
What is Alzheimer’s Disease?
Alzheimer’s disease is characterised by a degenerative process that affects brain cells, targeting areas of memory, language, and perception. Slowly but inevitably, it leads to a total decline in cognitive function, as well as the deterioration of each patient’s personality and relationships.
Even if the disease is more common after the age of 65, there are cases of younger individuals developing Alzheimer’s.
The disease starts affecting the patient subtly with some memory problems, often attributed to aging, but then gradually takes over the life of the affected person. It is called “The four A’s disease” because of its main symptoms:
- Amnesia: memory loss, which is generally the initial phase
- Aphasia: a language disorder that makes it more difficult to understand and formulate verbal messages. It often comes with difficulty finding the right words and substituting them with inappropriate ones.
- Agnosia: a perception disorder that cause a difficulty in recognizing places, things and people. It is easy for an Alzheimer’s patient to get lost and be unable to orient themselves.
- Apraxia: the inability to perform certain voluntary and simple movements such as dressing and self-care.
All these symptoms also lead to a change in personality, with sudden mood swings for no apparent reason and a progressive loss of interest in activities that once brought pleasure, such as hobbies. Moreover, Alzheimer’s patients often experience depression, anxiety and fear because they don’t recognize their own family members and surroundings, feeling surrounded by strangers.
How to diagnose Alzheimer’s Disease
According to Doctor Alessandro Stefani, Neurology Professor at UniCamillus for the MSc in Medicine and Surgery and the BSc in Nursing and Physiotherapy “In recent years we have been witnessing a potential revolution. In addition to clinical diagnosis – which remains the cornerstone of the diagnostic process, including periodically repeating neuropsychological tests with specialised personnel – we now have reliable markers. We are capable of identifying some of the early signs of the disease, in particular the alteration of certain “evil” molecules, like amyloid”. In addition to this method for investigating the early signs of Alzheimer’s there are routine radiological check-ups “among these, MRI is particularly appropriate, especially when the differential diagnosis is uncertain”.
Causes: can Alzheimer’s be prevented?
Apparently, Alzheimer’s does not have a specific cause. Usually, factors such as family history (genetics are associated with 10% of cases), the external environment and organic elements are taken into account. Currently, there is no way to prevent the disease, although doctors recommend maintaining a healthy lifestyle, as much as possible. “There is a well established awareness that having a healthy lifestyle can help the aging process, by having frequent check-ups for vascular risk factors, focusing on physical activity, and maintaining/consolidating cultural inputs.” says Professor Stefani. “A significant number of dementia cases depends on social isolation and inadequate lifestyle”.
If we notice one or more symptoms related to Alzheimer’s it is necessary to seek a first consultation with a General Practitioner who then may consider it appropriate to conduct further tests with specialists such as geriatricians, neurologists or psychiatrists.
Therapies: Can Alzheimer’s be cured?
This disease currently does not have a cure, but it can be controlled, with the goal of delaying its progression as much as possible “The pharmacological therapies currently used mainly focus on molecules that increase the availability of acetylcholine, with either choline/citicoline from two generations ago or with the so-called cholinesterase inhibitors” explains Professor Stefani. “Does it work? Not much, but that is all we have. In addition to this approach, another therapy is the use of molecule memantine, which should curb glutamate excitotoxicity. Other schools are trying to facilitate aminergic transmission. There are many proposals for new therapies, including unconventional ones. It should be noted, however, that we are currently in a critical phase: In the United States, the so-called humanised antibodies (are supposed to prevent amyloid accumulations and thus slow the progression of the disease) are in the midst of a debate. Molecules like aducanumab, but especially lecanemab and donanemab have (almost) obtained approval and commercialisation.
What about Europe? “In Europe there are doubts regarding the immunological approach. The costs? Not insignificant, we are on the edge. I talk about this issue in the preface of the second edition of my book Cervelli da Buttare?, that will be published by Armando Editore next October.” replies Professor Stefani.
But it is not just about medications, as our Professor states, “there is an experimental line of work that involve magnetic stimulation. We will see if it works on a large scale and if it truly modulates synaptic plasticity.”
The role of family members and caregivers
The appropriate therapies can significantly improve the quality of life of Alzheimer’s patients by fixing important cognitive and behavioural symptoms. The support of family members and caregivers is crucial, as they play a key role in the patient’s relational and emotional life.
Being a highly painful and complex condition for both the affected patient and their loved ones, the patient’s family should not be left alone in managing this difficult situation. Important support can be found through local home care services, as well as from associations of Alzheimer’s patients’ families, which provide useful information as well as social support. Qualified professionals such as social workers and psychotherapists can also be of great assistance.
While Alzheimer’s is a disease that has no cure or predictability, awareness is crucial for several reasons. Firstly, it can help, prevent underestimating early symptoms by promptly initiating symptom control therapy. Secondly, it highlights that this is a condition that predominantly affects the patient’s family, so stimulating initiatives aimed at improving the challenging of those caring for a loved one affect by Alzheimer’s.