Alzheimer’s or other dementia : when and why should you know ?

“It is important to determine if disorders, neuro-cognitive, are related to Alzheimer’s disease or other pathology, neuro-degenerative, even if there is still no drug to treat it”, says the Pr Yannick Béjot, and head of the department of general neurology, vascular and degenerative CHU, Dijon, france

These disorders do not affect in not the same areas of the brain and the same neurological process: it is thus necessary to adapt the support to the specific deficits that patients encounter in each case.

Thus, Alzheimer’s disease is more often by disorders of the memory, whereas the frontotemporal dementia affects the behaviour first. In the medium term, establish an early diagnosis allows you to better understand these pathologies and, in the long term, it is indispensable to develop and administer effective drugs for each of them, specifically. “Patients with dementia are identified earlier and earlier now and, even without medication, it is possible to reassure them because it is a disease that progresses slowly,” says the Pr Béjot. In the best case, with an early diagnosis, it is also possible today to provide them with compensatory strategies are targeted and can reduce the time in which these cognitive impairments make them too dependent on others. Alzheimer’s disease affects 6 to 8 % of people over the age of 65 in France. Alzheimer’s disease is the most common of the dementias, a term less used because it describes only the phase of the late stage of the disease. This disease represents 60 to 80 % of cognitive impairment degenerative and affects, in France, more than one million patients since it concerns 6% to 8% of persons over 65 years of age. Recent studies indicate that the number of new cases would decrease for the following generations.

But this trend will have only a marginal effect on the number of patients to be expected given the current aging of the population. Epidemiologists expect a 75% increase in the number of patients in 2030, related to both the huge demographic of baby boomers but also to the fact that life expectancy has increased – including for people with cognitive impairment to severe. The WHO announces that it’s way close to 135 million patients in the world by 2050, with a major impact on the health system and more broadly on the whole of society, because these patients require a lot of attention on the part of their entourage. The Figaro infographics mechanisms better connusL’of research interest for this pathology is obvious, and its mechanisms are beginning to clarify. The neurological disorders that it causes are related to the accumulation in the brain of two types of molecules, proteins, beta amyloid and tau proteins, which block the functioning of the neurons that they invest in, and eventually “choke”. These proteins are normally present in small amounts in the brain, but because they change shape – as in the prion diseases – and that the vascular system is less effective, they are no longer evacuated. The support policies put in place by the various plans, and Alzheimer’s are aimed also to mobilize the neural connections remain intact to preserve the autonomy of patients This change occurs first in the hippocampus, essential for memory, and gradually spread to the whole brain. Many years can elapse between the first accumulations of proteins and the onset of symptoms, particularly for patients in which the brain can compensate for the “empty”. The support policies put in place by the various plans, and Alzheimer’s – for which France is a pioneer – aim also to mobilize the neural connections remain intact to preserve the autonomy of patients. The amyloid proteins are now the main therapeutic target of the laboratories and, if some molecules have managed to curb their accumulation, no one has yet been able to show any effect on the symptoms.

These proteins are also the target of the first diagnostic tools early: they can be observed by MRI of the brain to confirm the diagnosis of Alzheimer’s disease when the balance of psycho-pathology, which aims to identify the area of origin of cognitive disorders, is not enough. They can also be measured in the cerebrospinal fluid, an examination which is not necessary in the routine but which is practiced in the context of clinical trials to identify the best candidates for each type of test as well as to follow the evolution of the disease where appropriate.

In all cases, an early diagnosis allows to avoid prescribing treatments, deleterious, especially any medication that has an anticholinergic effect – in particular, many antidepressants too easily prescribed to the elderly.

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