alarm bells and risk factors, new hope with early diagnosis
Worldwide, the number of people at risk of developing dementia is vastly underestimated and today accounts for around 416 million cases. Furthermore, 22% of the world population over the age of 50 – women – could use prevention strategies that mainly include interventions and treatments capable of blocking or at least slowing the progression towards Alzheimer’s disease and other forms of dementia. This is what emerges from an article on the spread of cases of people with Alzheimer’s around the world, published as part of the ‘Alzheimer’s value Europe’ (Pave) project. The only Italian in the group of authors is the prof. Paolo Maria Rossini, Director of the Department of Neuroscience and Neurorehabilitation of the Irccs San Raffaele in Rome. Benedetta de Mattei interviewed him to understand what are the alarm bells to pay attention to and the risk factors on which it is possible to intervene.
How many people get Alzheimer’s in Italy?
The answer is different from the one I would have given you a few years ago, meanwhile let’s talk about dementia of which Alzheimer’s is only the best known. There are about 1.2 million people affected by dementia in Italy, half of them affected by Alzheimer’s. The problem is that we have just as many in which the symptoms are still mild and the diagnosis has not yet been made; every year we have about 100,000 new cases in our country. In fact, the study that we did signaled an alarm bell in those who do health planning since the dimensions of this problem are probably double what we see clinically. therefore either we begin to do a serious work of early diagnosis and therefore of a timely attack to the disease or the problem will become increasingly greater. Moreover in Italy 80% of cases are managed at home therefore the disease involves a very high number of people and this creates an important load from a social point of view of direct and indirect costs as you stop or severely reduce your work.
Who does it hit?
It’s a predominantly female disease (about 2 out of 3) and since the most important risk factor is age, the more the population ages, the more the disease manifests itself.
At what age does the disease begin?
It is considered a disease of the third and fourth therefore, let’s say that from 65 years upwards there are the highest risk peaks. However, this is a pathology that before clinically manifesting probably 15-20 years, therefore, works in the dark, silently depositing toxic substances and destroying the nervous circuits; the brain resists because it has its own reserve capacity that allows it to hold up to a certain point until the reserve runs out and the pains begin. Therefore, even if the disease manifests itself after the age of 65, in people who will be affected by Alzheimer’s probably not too advanced, around the age of 40-45, the disease will cause progressive damage.
What are the first alarm bells?
Meanwhile family history, so it is good to look at previous generations, perhaps affected by diseases once also called arteriosclerosis. If I know I have several cases in my family, it means that there is a genetically determined predisposition and therefore I have to pay some attention. And then clearly the small ones forgetfulness we have as we age can be significant if we pay attention to them since forgetting where I put my glasses is normal after a certain age but if it alternates with other things such as forgetting important commitments I care about, business or social life appointments, moments when I am disoriented or I do not remember where I have parked the car rather that the PIN of the mobile phone or the ATM are signs that together with the family history must lead us to contact an expert center to start taking the necessary tests.
What are the exams to do in these cases?
There is a kind of pyramidwe start with the first ones which are however very important, which are i neuropsychological tests that are done with paper and pencil and of which there are different types, from the simplest ones, which last 15 minutes and can also be done by the geriatrician or general practitioner and which are used to screen but do not diagnose, to the more complete ones which last about 2 hours and explore all cognitive functions: from language to calculation, to various types of memory, to orientation, to the ability to solve problems; these tests are instead carried out by expert neuropsychology centers that are able to raise a diagnostic doubt. Even the electroencephalogram which – with modern analysis methods – explores the brain connections, can provide important and early information. If the tests and the EEG are normal, we usually stop while – where they are altered – we go on with imaging tests such as MRI to see if there is a degeneration of the brain. Then you go up even more by doing a PET scan to measure the blood flow because if there are many dead neurons in an area of the brain, that area does not consume energy and therefore does not suck blood.
What is the cure?
Unfortunately today a cure does not exist, there are only symptomatic treatments which are only that we prescribe with drugs that support but do not change anything in the progression of the disease. The drugs must intervene early but we have seen that if when the drugs have to intervene the symptoms are now overt, the clinic does not change, which means that it is probably necessary to intervene earlier and in that case perhaps some of the drugs that we have so far excluded that were not effective it might work instead
He is a leader of two major projects that focus on prevention why is early diagnosis so important?
The two projects are INTERCEPTOR funded in Italy by AIFA and the Ministry of Health and AI-MIND funded by the European community. both aim to develop a tool for early diagnosis. Early diagnosis is very important, first of all because it is possible to reduce or eliminate known factors that accelerate the risk of disease or its course. It is evident that today we arrive too late to a diagnosis of dementia and that methods for the early identification of the early stages (prodromal of the disease) have not yet been developed, which are precisely those that are most suitable and will lend themselves to preventive interventions. therapeutic and rehabilitative. The most of the study are very relevant and will have an impact on the organization of care, on clinical research in Europe, on the activities of drug regulatory authorities and, importantly, on patients and their families, representing a basis and a starting point for future strategies to combat this terrible disease.
What are the risk factors on which action can be taken?
– The sedentary lifestyle – doing an hour of gymnastics every day has proven to be a protective factor for the disease.
– L’obesity
– The smoke
– A uncontrolled diabetes
– One uncontrolled heart disease
– High blood pressure
– Endocrine disorders, in particular of the thyroid gland
These are all risk factors demonstrated by modifying early, which reduces the risk of disease by about a third or significantly slows down the evolution. So today with an early diagnosis, and an intervention on a national scale, by modifying these factors in the subjects who are at risk, one could already intervene on the disease by waiting for the drug capable of modifying its course to arrive.
Benedetta de Mattei