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Alzheimer's and dementia: how they differ and what the treatments aim at, in 8 questions to an expert

2023-02-17T14:48:51.167Z


After learning that Bruce Willis suffers from frontotemporal dementia, the concern to recognize brain disorders grows.


Great commotion was generated yesterday by the news that revealed the diagnosis of actor Bruce Willis: frontotemporal dementia.

Not only because of the international recognition and fame that the actor enjoys, but also because cognitive disorders generate concern in a population that lives more and more and wants to do so with a good quality of life.

Therefore, dementia is one of the greatest fears

associated with old age.

And this is where many doubts appear, since in the collective imagination it is often confused with Alzheimer's disease.

In an interview with

Buena Vida

that we reproduce below, Ronald Petersen, neurologist and director of the Alzheimer's Disease Research Center of the Mayo Clinic, in the United States, listed as a leader in international efforts to address the disease, cleared the

main doubts

that usually appear when addressing these terms.

***

1- Is there a difference between dementia and Alzheimer's?


The first thing to clarify is that someone with Alzheimer's has dementia, but

not all dementias

are related to Alzheimer's disease:

“Dementia is not a disease, but rather a term that describes a

group of symptoms

that affect memory, thinking, and social skills.

Alzheimer's disease is the most common form of dementia.

Petersen emphasizes clearly differentiating the terms, since dementia can be caused by various factors, but Alzheimer's disease is associated with certain

very specific issues.

“Dementia is a syndrome, and it means that a person cannot think as well as they used to: they have forgetfulness, difficulty finding the words they want to pronounce, problems with spatial skills, attention, concentration;

all of which

affects his daily functioning, ”

he points out.

Apathy and isolation can be non-cognitive signs of dementia.

Photo Shutterstock.

Petersen points out that when looking at what causes dementia, Alzheimer's disease appears as an

abnormality of two proteins

in the brain:

tau and beta amyloid, which "destruct" the correct functioning of the brain.

"Alzheimer's dementia has a high incidence, but the dementia could be caused by other issues such as small strokes, tumors, hydrocephalus and a variety of other things that contribute to dementia," they difference.

When talking specifically about Alzheimer's, the doctor and researcher focuses on three issues: diagnosis, treatment and ways to reduce risk.

2- How to catalog the first forgetfulness?

Petersen was asked about the difference between normal memory loss, very common as people age, and the

signs

that the disease is in the early stages.

"

Slight impairment

can be described as starting to forget information that I remembered, and probably those around me will tell me 'you are not having the same memory as before, you are forgetting important information,'" he graphs.

They advise, to reduce the chances of deterioration, not to abandon habits such as reading.

Photo Shutterstock.

And he clarifies: “This does not mean that he has Alzheimer's, but it may be that the memory was not what it was.

And it could be mild cognitive impairment," she warns.

"In those cases, we don't remember things in the same way as before, but our daily lives function normally: we pay the bills, we drive, so a casual observer doesn't notice. However, you and your family know that your memory is not what it was, and

that should be investigated

, ”he suggests.

And he advises that, if that happens, it should be consulted. "It is a clinical call to do tests, to test your memory, so that the doctor can tell us how our memory is."

3- Are there symptoms that are not cognitive?

Petersen admits that although cognitive functions are often referred to to detect symptoms, there are other characteristics of the development of dementia and Alzheimer's disease that are

behavioral,

which are often the product of these cognitive conditions, and that also serve to be alert. .

“There may be, for example, depression, anxiety, apathy, other symptoms that people are changing their behavioral style, their personality.

People tend to withdraw, to participate less, to isolate themselves from the environment, because Alzheimer's disease is underlying, for fear that others will notice that they are no longer as cognitively capable of interacting with others as they used to be," he describes. he.

These "slight behavioral changes", as Petersen calls them, are what -in addition to the cognitive ones- could lead to the identification of the

early characteristics

of this type of degenerative disease.

4- Does Alzheimer's affect women more?

Yes. If the prevalence of Alzheimer's dementia is studied, it can be seen that it is more prevalent in women, says Petersen.

The question is why?

"Taking into account that age is the greatest risk factor, and that women

tend to live longer

than men, we thought that the higher prevalence in women was linked to this issue: that there are more women who are older," poses.

Alzheimer's is the most common type of dementia.

Photo Shutterstock.

"But the answer may be more complicated -he counters-, and perhaps there are

biological reasons

that predispose women to develop Alzheimer's disease at a higher rate than men," he adds.

The biological explanation would be linked to the

impact that a certain protein

has on men and women, affecting women differently than men.

“When people with the e4 protein transmit it, this affects women differently than men.

A study points out that hormones affect aging in women, and these factors can affect whether a person develops dementia or not, and how this impacts the probability of Alzheimer's ”, she explains.

5- Are there advances in treatments?

Petersen distinguishes the symptom-oriented treatment, and the one that aims to

improve the disease,

which is under development.

“Symptomatic treatments already take 10 to 15 years, we have cholinesterase inhibitors that are designed to increase the neurochemicals that maintain neural cells, so that they last longer.

They stabilize

, they don't generally improve the picture, and they last for a period of time, ”he exposes.

“We are working more on medicines or drugs that aim to

modify

the disease, and we have two targets: amyloid and tau.

There are several drugs to reduce amyloid that will reach the final phase of the evaluation, phase 3, in a few months”, he is enthusiastic.

6- Are we close to finding a cure?

Another question was about the real possibility of finding a cure for this disease.

We're very far away?

How much are we missing?

"It is a difficult but important question -recognizes Petersen-, when talking about a cure for Alzheimer's disease we have to go back to its definition, and if we define it by the presence of the protein

amyloid and tau, for a cure we have to really

stop the advance

of these two proteins in the brain”, he explains.

And he adds: “Some of the treatments that seek to

affect

the disease are currently being investigated and have that purpose: to stop this processing of the

amyloid in the brain, tau is more difficult," he admits.

The doctor indicates that although these investigations are less advanced,

three drugs

will be tested to try to stop the misprocessing of the tau protein and remove amyloid from the brain, as a first step to cure the disease.

"It's going to be a long process, we still have a lot to do, but I think it's the first step in terms of progress."

7- Is there a link between COVID-19 and the early development of Alzheimer's?

“The data suggests that there are forms of covid that can affect cognition, but

whether this is due to inflammation that occurs in the brain when covid enters neural cells

is not yet clear ,” he says.

It is evaluated whether the virus can

precipitate processes

, that is, that this type of syndromes develop prematurely.

Attending conferences, another way to keep the brain "in shape".

Photo Shutterstock.

“Most likely, the

inflammatory condition

that occurs has an impact on brain function and this can accelerate neurodegenerative conditions that were already present,” he points out.

However, he clarifies that there is more talk of

dementia

than of symptoms of Alzheimer's disease.

"I think we don't know the impact of covid on the underlying proteins of Alzheimer's, but with respect to aging, cognitive functions and dementia, it could play a role," he says.

In this direction, he alludes to the long covid

syndrome

: “There are people who were infected months or years ago and are showing cognitive changes that could be due to covid, and that is another factor that complicates things and can lead us to think of a slight deterioration cognition or dementia itself.

We are learning about the impact on the central nervous system, but we have to study more”, he points out.

"100 years ago, with the Spanish flu outbreak, there was a form of that infection called encephalitis that produced Parkinson's disease in the brain, so it is possible that these viruses could affect function directly or indirectly through inflammation," he

outlines

. .

8- How to reduce the risk of dementia?

Petersen encourages us to pay attention to the issues that are within our reach to prevent

cognitive decline.

“There are more than a dozen risk factors that people

can control

,” she enthuses.

”These include blood pressure, cigarette smoking, obesity and diabetes;

In addition, another important factor is sleep.

With age, and for different reasons, many people have difficulty sleeping », he points out.

Other risk factors he mentions are excessive alcohol consumption, hearing loss and environmental pollution.

"If one or more of these factors is attacked, the risk of developing an intellectual disability as we age

may decrease

," he encourages.

Diet

is another of the central factors to take into account: and he gives the Mediterranean diet as an example of a healthy option, with a large presence of vegetables, lean meat, chicken and fish

.

Finally, he points out the importance of staying active, both physically and socially and intellectually.

  • Do exercise.

  • Read books.

  • Attend talks.

  • See family and friends.

***

Do you want to read more about Alzheimer's, dementia and brain care?

These notes may interest you:

➪Silver generation: 12 strategies that help take care of the brain after 60

➪Alzheimer: what changes can help prevent it and add years with quality of life

➪Why memory is lost and how it changes over time: a neuroscientist answers the most frequently asked questions


➪How to keep the brain active and reduce the risk of dementia

➪What is cognitive impairment, why are consultations increasing and 10 warning signs

➪Dementia: three daily tasks that can help prevent it

***


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