17 October 2017

Alzheimer's disease

How to recognize and what to do

Vladimir Zakharov, XX2 century

Alzheimer's disease (AD) is a progressive disease of the nervous system. Neurofibrillary glomeruli and amyloid plaques are formed in the brain of patients, which is accompanied by memory impairment, loss of the ability to navigate in space, speech disorders and, ultimately, loss of the ability to self-serve. It is better to learn about this diagnosis as early as possible and as much as possible. In order – as far as possible – to delay the onset of the disease and reduce the rate of progression of symptoms.


Contrary to popular belief, Alzheimer's disease cannot be called a "disease of the elderly" – theoretically, it can develop at any age – at 20, 30, and 40 years. But, according to statistics, the older a person is, the higher the risk of developing Alzheimer's disease. In most cases, the BA really debuts after 60.

In addition to age, another risk factor for the development of AD, the role of which has been proven, is hereditary burden. According to some data, every third person has a genetic predisposition to AD. Another thing is that most of those who have a predisposition are "programmed" to get sick after a hundred years. Therefore, most potential patients simply do not live up to their illness. But if we increase life expectancy, there will be more patients suffering from Alzheimer's disease.

Both age and heredity belong to the so-called unmodifiable risk factors, that is, to what we (at least for now) cannot influence. There are also "modifiable" risk factors – something that, theoretically, we can influence. These are: diseases of the cardiovascular system, diabetes mellitus, obesity, high cholesterol, traumatic brain injuries, sedentary lifestyle and lack of proper intellectual activity.

Presumably, mental and physical activity can reduce the risk of Alzheimer's disease. Long–term (15 or more years) training, puzzle solving, reading, exercise and walking - all this helps to keep the brain "in shape", since special substances (neurotrophic factors, neuropeptides) that protect the brain are produced. A diet enriched with vitamins C and E is also useful, these are natural antioxidants.

In short, while the prevention of Alzheimer's disease is reduced to compliance with the principles of a healthy lifestyle. It is highly desirable to protect yourself from traumatic brain injuries, not to abuse alcohol, if necessary, take statins and antihypertensive drugs prescribed by your doctor - all this helps to maintain the health of the central nervous system to one degree or another.

We identify

High-precision methods of early diagnosis of Alzheimer's disease have already been developed. This is, first of all, positron emission tomography (PET) with the introduction of a special substance accumulating in senile plaques, accumulations of beta-amyloid formed in AD. The accuracy of this technique is close to 100%, its results almost always coincide with what is revealed during postmortem morphological examination of brain tissues. However, the expediency of widespread use of PET as a screening is still very doubtful.

When we have the means for pathogenetic therapy of AD at our disposal, it will be possible to conduct a medical examination of all people over 40, and if appropriate changes are detected, prescribe therapy. But so far, the treatment of AD is only symptomatic. We only affect the symptom, if there is no symptom, there is nothing to influence. This means that it is pointless to identify preclinical Alzheimer's disease, such an approach can only frighten and upset the patient.

But there is another problem. It lies in the fact that the clinics where Alzheimer's disease is diagnosed in Russia can be counted on the fingers. As a rule, patients who have clinical signs of AD are diagnosed with some kind of "encephalopathy of vascular genesis" or "chronic cerebral ischemia". The proportion of patients with the correct diagnosis is negligible. And this is a purely Russian problem. Western clinics are more likely to have problems with the diagnosis of vascular disorders, while our doctors believe that memory disorders in the elderly are most often associated with cerebral circulatory insufficiency. This point of view was popular at the beginning of the XX century, it has long been abandoned all over the world, but we continue to adhere to it.

In the early stages of AD, forgetfulness is most often manifested. There are so-called atypical forms that begin not with memory damage, but, for example, with speech, vision or behavior disorders. But these forms are very rare, 1-2% of cases. The remaining more than 90% begin with a decrease in memory. However, it should be understood that we are not talking about everyday forgetfulness, when we cannot remember where we put the keys or why we came to the room. With BA, everything is a little different.

The indicator symptom is the so-called Ribot's law, according to which "I don't remember what happened recently, I remember what happened a long time ago well."

For an ordinary person, it is easier to remember what happened yesterday than what happened a year ago. For a patient with incipient Alzheimer's disease – exactly the opposite. This is a very specific symptom. If it is detected, you need to visit a neurologist as soon as possible, because the treatment possibilities are maximum in the early stages.

We treat

What does the treatment do? It allows you to extend the stage of the disease at which the patient is for several years. Obviously, it is better to prolong the "stage of forgetfulness" rather than the "stage of dementia". Therefore, it is necessary to strive to apply at an early stage, when treatment can bring more benefits to both the patient and relatives.

In AD, cholinergic neural systems are primarily affected and, accordingly, there is a decrease in the activity of acetylcholine in brain cells. Therefore, cholinergic replacement drugs, cholinesterase inhibitors (IHE) are used as the main therapy of the early stages of AD. These include donepezil, galantamine and rivastigmine. An alternative therapy strategy is memantine, which reduces the damaging effect of glutamate. Both IHE and memantine improve memory and intelligence, contribute to the normalization of behavior and greater independence of patients. Neurometabolic drugs are also used as additional therapy in our country: actovegin, cerebrolysin, choline alfoscerate, citicoline, standard ginkgo biloba extract and some others.

(All the listed means of additional therapy do not have a clinically proven effect or their effectiveness has been refuted – see the "Firing list of drugs" – VM.)

However, drug therapy is only half of the treatment for Alzheimer's disease. To achieve maximum effect, it is necessary to combine it with non-drug methods: lifestyle correction, nutrition modification, increasing the level of mental and physical activity.

The so-called cognitive training is actively used. This is a simple training of functions disrupted by the disease. That is, poor memory – learn poetry, poor attention – look for differences in pictures, train in those areas where the deterioration is most noticeable.

Cognitive stimulation is considered an even more effective technique. For this intervention, patients with early-stage AD are brought together and invited to do something intellectual or creative together. It can be a game of chess, amateur art, dancing (the latter requires both motor and intellectual activity).

Non-drug treatment of AD must necessarily include physical activity. Such an integrated approach brings no less benefits than pills.

But the means for pathogenetic (or, as it is also called, disease-modifying) there is no therapy for AD yet. However, work is underway in this area, and very actively, so I believe that such a drug will appear, if not by 2020, then by 2025. Most likely, the "Alzheimer's drug" will be a vaccine by its mechanism of action.

Of course, this does not mean that we will completely defeat BA in 2025. But patients will be able to count on long-term remission and prolongation of the active period of life.

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