Alzheimer’s, the secrets of the disease that science must reveal

Alzheimer’s is the most prevalent form of dementia. Why prevention is essential and what to do from an early age

Like a puzzle. There are many pieces, which are composed together to reveal the complete design. But the mosaic of knowledge on cognitive impairment and Alzheimer’s disease still hides some pieces that research has to reveal. Much is being done, however.

This was confirmed by the experts of the Italian Society of Neurology (Sin) on the occasion of the World Brain Week, scheduled from 14 to 20 March. The awareness-raising initiative is dedicated this year to the “seasons of the brain”. Although neurological pathologies are usually associated with increasing age, at least as regards degenerative forms, today it is discovered that they can manifest themselves in the various ages of the brain. So prevention is essential, from an early age.

Not just the elderly

“Cognitive deterioration and dementia are pathological phenomena that certainly have an important correlation with aging, but are not caused by aging – confirms Amalia Cecilia Bruni, President of SINdem (Italian Society of Neurology for Dementias). There are in fact, albeit very rare, forms of juvenile dementia (Young Onset Dementia or YOD), the prevalence of which increases with age: between 30 and 34 years we are at 6 subjects out of 100,000, between 34 and 64 it rises to 119 out of 100,000 to reach 853 out of 100,000 between the ages of 60 and 64 ”.

Obviously, these forms can manifest themselves differently than the classic pathologies of the third age. “The clinical pictures in these forms are mainly atypical, often with psychiatric disorders with the consequent risk of being often misdiagnosed – confirms the expert.

A not insignificant share has an important metabolic component such as Niemann Pick’s disease type C, a typically infantile form which however also has Late Onset forms (late onset) that fall back into YOD. The situation is different in late-onset dementias, after the age of 65, although the lengthening of life has made it possible to understand that even in this group there is a strong heterogeneity and that there are particular forms in the oldest-old (> 80 years), identified only from neuropathological studies. Alzheimer’s disease is certainly the most prevalent form of dementia, but identifying treatments, despite recent advances, is extremely difficult.

“This failure derives from the fact that science is divided on the interpretation of the pathogenetic value of the beta amyloid cascade as the sole cause of Alzheimer’s disease – continues the expert, rattling off the points to be clarified. Alzheimer’s disease begins as a biological process in the brain even twenty or more years before the onset of the first symptoms. This is now known from studies conducted on pre-symptomatic carriers (ie carriers) of genetic mutations.

It follows that establishing a therapy at the onset is already a late measure since the onset of symptoms does not correspond to the true onset of the disease and is to be considered rather as the moment in which the brain is no longer able to compensate for the disease, a little. like the vase that overflows when it has long since filled up. Furthermore, we are not at all certain that the picture that manifests itself in genetic Alzheimer’s disease is the same as that seen in “sporadic” Alzheimer’s disease.

There is therefore no Alzheimer’s disease but Alzheimer’s disease (different for localization and type of aggregated proteins) “. In short: it is still uncertain what the real cause of the disease is triggered and much research is still needed on the pathogenesis and treatments. Recently, new biological drugs and antibodies have been presented that are able to bind to substances accumulated in the brain due to the alteration of the metabolism of beta amyloid and to eliminate them. However, the results have so far been unsatisfactory.

Attention to prevention

Even if we don’t think about it, good habits are essential to preserve the nervous system. The brain is a plastic structure in continuous evolution and modulation throughout the course of life and is therefore sensitive to interventions that can also be reflected from the outside on genetics, metabolism and neural connections.

“Prevention is more important than you think: many biological, genetic and epigenetic risk factors, and unsuitable lifestyles increase the risk of developing dementia – concludes Bruni. In the middle age, cardio-cerebro-vascular risk factors, obesity, alcohol abuse, depression and deafness must be fought. In the older age, loneliness, physical inactivity, social isolation, smoking and diabetes “.

“When dealing with the nervous system – underlines Alfredo Berardelli, President of the Italian Society of Neurology and Full Professor of Neurology at the Sapienza University of Rome – it is always necessary to consider its extraordinary capacity for neurogenesis and neuroplasticity which is also maintained in old age and which, if accompanied above all by correct lifestyles, can help the brain to counteract and slow down even some neurodegenerative diseases “.

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