Alzheimer's Disease

"We have several clinical trials with investigational drugs that aim to modify the course of Alzheimer's disease in its early stages. In addition, we have research projects underway to identify new biomarkers that contribute to the early and accurate diagnosis of this entity".

DR. MARIO RIVEROL FERNÁNDEZ
SPECIALIST. NEUROLOGY DEPARTMENT

Alzheimer's disease is the most common neurodegenerative disease and the leading cause of dementia in the population.

Currently, there are around 600,000 people in Spain with this disease and, due to the progressive aging of the population, it is estimated that by 2050 there could be a million cases of this disease in our country.

It is a neurodegenerative disease, characterized by the abnormal deposit of amyloid protein and tau protein in the brain.

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What are the symptoms of Alzheimer's disease?

Currently, we know that the brain alterations typical of Alzheimer's disease begin years before the first symptoms appear.

Therefore, three phases can be distinguished: a preclinical phase, in which, although there are subjective cognitive complaints, the neuropsychological performance in the tests is normal; a prodromal phase, in which the patients present cognitive symptoms and objective failures in the exploration without repercussion on the activities of daily life; and a dementia phase, in which the cognitive deterioration already affects the patient's functionality.

Pre-clinical phase

The preclinical phase of Alzheimer's disease is of great interest from a research point of view, in order to establish risk groups that could be subsidiaries of early treatments with potential disease-modifying effect at the time they become available.

Within this phase there is a subgroup of subjects who observe a worsening in their own cognitive performance with respect to previous stages of life, but in which the instruments of cognitive evaluation do not show deterioration. These people receive the diagnosis of subjective cognitive impairment.

However, cognitive complaints (especially of memory) are very frequent in the general population and, of course, do not always indicate an onset of Alzheimer's disease; they can also be associated with normal aging, psychiatric disorders such as anxiety or depression, non-degenerative neurological diseases such as cerebrovascular pathology or brain trauma, or systemic diseases.

Prodromal phase

The prodromal phase of Alzheimer's disease is characterized by the appearance of cognitive symptoms, predominantly memory problems in remembering recent events, which are objective and measurable in neuropsychological tests but do not have an impact on the activities of daily life. This situation is called mild cognitive impairment. 

We know that some patients with mild cognitive impairment will develop Alzheimer's disease in the future. However, this is not always the case. There are people who will develop other dementias, others who will not progress or even revert to normal. Therefore, it is important to identify those patients with a high risk of progression, for which we have image biomarkers and analytical biomarkers in cerebrospinal fluid. 

Phase of dementia

The dementia phase of Alzheimer's disease implies that there has been a progressive cognitive deterioration that comes to affect the activities of daily life and the autonomy of the person. 

Most patients with dementia due to Alzheimer's disease (70%) present a typical form of presentation, which consists of an initial and predominant memory impairment for recent events. Patients are repetitive, forget details of conversations, lose commonly used objects, and forget appointments.

This memory affectation usually also associates problems of time orientation (e.g., they do not remember the date). Often, patients are not very aware of their mistakes. It is also frequent in the initial stages, the difficulty to evoke the name of objects. As the disease progresses, there is a further impoverishment of language, errors in dressing, or difficulty in recognizing objects or their relatives.

Approximately 30% of cases present initial symptoms where memory is not predominantly affected, called non-amnestic or atypical variants. In these cases, language, visuoperceptive or behavioral alterations may predominate.

It must be taken into account that dementia due to Alzheimer's disease not only produces cognitive symptoms, but can also manifest itself with behavioral alterations. Apathy and irritability are frequent, as well as anxiety and depression. The latter can even make it difficult to diagnose dementia. Later, delirious ideation (e.g., to think that one is being robbed) or hallucinations can appear.

The most common symptoms are:

  • Cognitive impairment.
  • Temporal-spatial disorientation.
  • Difficulty to express oneself.
  • Difficulty to perform daily life activities.

Do you have any of these symptoms?

You may need to have a neurological check-up

What are the causes of Alzheimer's?

The ultimate cause of Alzheimer's disease is unknown, except in those cases where there is a genetic component and there is a family history of Alzheimer's disease.

In Alzheimer's disease, two proteins (beta amyloid and hyperphosphorylated tau) are deposited in the brain early, even before the first symptoms appear.

These proteins form aggregates in the form of plaques and tangles that are deposited around the neurons, causing neuronal damage.

What are the risk factors for Alzheimer's?

The main risk factor for Alzheimer's disease is age. Some studies also show that it is somewhat more common in women.

Other risk factors are cardiovascular risk factors (hypertension, diabetes or obesity), sedentary lifestyle and lower level of education.

Genetic factors that increase the risk of the disease have also been identified. However, familial Alzheimer's disease (inherited from parents to children) is very rare.

How is Alzheimer's disease diagnosed?

The diagnosis of Alzheimer's disease is based on the clinical information provided by the patient and his or her companions, and the data obtained from the patient's physical and cognitive examination.

It is always necessary to rule out treatable causes of cognitive impairment, so an analysis and brain imaging study (such as a CT scan or MRI) is usually performed.

In people with mild cognitive impairment, biomarkers are used to establish the presence of Alzheimer's disease-related proteins, either by analysis of the cerebrospinal fluid or by imaging techniques (amyloid PET and brain metabolism PET).

These markers are also often used for the diagnosis of Alzheimer's disease in cases of early onset or atypical presentation

How is Alzheimer's disease treated?

At the present time we do not have any curative treatments or treatments that slow down the progression of this disease, but we do have symptomatic drugs.

In the mild-moderate phase of Alzheimer's disease, acetylcholinesterase inhibitors (donepezil, rivastigmine or galantamine) and certain food supplements for medical use are indicated. In moderate phases, the drug memantine can be added.

Likewise, it is relevant to influence the non-pharmacological treatment of patients. Thus, in people with cognitive impairment and dementia due to mild or moderate Alzheimer's disease, cognitive stimulation therapy is beneficial. In our center, we have a personalized cognitive rehabilitation program for each patient that aims to improve and enhance their cognitive abilities.

Likewise, we have several clinical trials with drugs under investigation that aim to modify the course of Alzheimer's disease in its initial stages, as well as drugs aimed at treating agitation. In addition, we have research projects underway to identify new biomarkers that contribute to the early and accurate diagnosis of this entity.

The assistance in the basic needs of daily life, the assistance to the family nucleus and the liberation of its overload, the social and medical legal advice and the facilitation of a support to the families, the truthful, continuous and intelligible information to the families and to the society in general, the suitable formation of the informal caregiver, the care of the caregiver are crucial points of a suitable assistance that has as main aim the maintenance of the sick person the major possible time in the family environment with the best quality.

The person suffering from Alzheimer's and his or her family members need a specific resource that serves as support, represents an alternative to permanent institutionalization and provides comprehensive care and attention including therapeutic aspects.

The care of these patients should be directed and coordinated by a team of professionals including physicians (neurologist, psychiatrist, geriatrician), clinical psychologists, geriatric assistants, neuropsychologists, nursing professionals, social workers and therapists integrated in diagnostic and treatment units.

These units are fundamental for the support of primary care teams and in the coordination and adequate use of the social and health resources available.

Where do we treat it?

IN NAVARRE AND MADRID

OUR MEDICAL TEAM

Specialists from the Neurology Department

The Neurology Department has extensive experience in the diagnosis and multidisciplinary treatment of neurological diseases.

We offer a diagnosis in less than 72 hours, along with a proposal for personalized treatment and post-consultation follow-up of the patient by our specialized nursing team.

We have the most advanced technology for an accurate diagnosis with cutting-edge equipment such as HIFU, deep brain stimulation devices, video EEG, PET and epilepsy surgery, among others.

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