— Vladimir Anatolyevich, is Alzheimer’s disease considered a hereditary disease?
There are different forms of this disease. When the disease occurs at a relatively young age (before the age of 65), it is much more often inherited than the more common form that occurs in old age.
There is also a hereditary predisposition for the late development of the disease – it is associated with apolipoprotein E4 (a protein involved in the metabolism of fats in the body). However, we still don’t know everything about the heredity associated with this disease.
What is the main hypothesis for the origin of this disease?
“Currently, the beta-amyloid hypothesis prevails. According to him, in the brain of a patient suffering from Alzheimer’s disease, beta-amyloid (this is a peptide – a short piece of protein) accumulates in the form of so-called amyloid plaques.
Beta-amyloid accumulates between neurons and has a toxic effect on them. The second pathological mechanism in Alzheimer’s disease is the formation of the tau protein, a protein whose chains start to join together and form neurofibrillary tangles inside nerve cells. In addition, there are disturbances in calcium metabolism, an increase in the disease and the effect of diabetes mellitus, possibly due to vascular pathology of the brain. For this reason, Alzheimer’s disease is sometimes called type III diabetes.
— Scientific articles appear from time to time that the beta-amyloid hypothesis is not true. What do you think about that?
It doesn’t really explain much. However, the first anti-amyloid drugs have already appeared and they work. Last June, the FDA (Food and Drug Administration, an agency of the U.S. Department of Health and Human Services) registered adukanumab, the first drug for the treatment of early-stage Alzheimer’s disease. However, it has many side effects. In January of this year, clinical data on the efficacy of Lecanemab became available. Many drugs are still being tested. As a clinic specializing in the treatment of Alzheimer’s patients, we participate in various studies.
“A patient with memory impairment comes to your clinic. Maybe it’s just a distraction. What is the first thing he learned? What research is being done?
– First of all, we learn how this disease develops. A complete clinical examination of the patient is required to make the diagnosis. It includes clarification of the anamnesis, clinical features, concomitant diseases. It is important to determine what drugs the patient is currently taking – perhaps the situation will improve after stopping the drugs. Neuropsychological tests, assessment of behavior, home and social activity are also done. For example, if there is depression, then it may be the cause of memory impairment. Close relatives are interviewed, laboratory tests are done: blood tests, liver, kidney function, vitamin B12 levels. Then an MRI of the head is done in certain projections. And if the diagnosis is unclear, there are special methods that find biomarkers of Alzheimer’s disease.
— What are these signs and where are they found?
– There is a study on cerebrospinal fluid (CSF) for the content of beta-amyloid and tau protein in it. In Alzheimer’s disease, the content of beta-amyloid in the cerebral fluid decreases, and tau-protein, on the contrary, increases, reflecting the death of nerve cells. And it decreases as beta-amyloid accumulates in the brain. There are also methods that are not yet widely used in our country.
– What are these techniques?
– With a specific substance, positron emission tomography (PET) can detect excessive beta-amyloid deposition in the brain in vivo.
— So, can you directly see beta-amyloid in the human brain using PET?
Yes, but expensive. Studying beta-amyloid in CSF will be much cheaper and easier, and its accuracy is comparable to PET.
— Why is such work not common in Russia?
Well, let’s start with what we have. Alzheimer’s disease in Russia is diagnosed very rarely. Last year, neurologists recorded this in less than 10,000 cases.
-How is it that Alzheimer’s disease is declared an epidemic almost all over the world, but it is rare in our country?
– Only Russian doctors do not know this disease well, the correct diagnosis is rarely made. Usually psychiatrists make this diagnosis, but at the very last stage, when a person is weak-minded and we are talking about his legal capacity. But in general
According to various estimates, there are 1.5 million such patients instead of 10 thousand in our country.
— Currently, what is the most common diagnosis in new-onset dementia patients in our country?
— Vascular pathology of the brain. They think dementia is from blood vessels, atherosclerosis, hypertension. Yes, these are factors too, but not the main ones. About 15-20% of dementia cases are caused by “veins”. To diagnose “vascular dementia”, it is necessary to do an MRI of the head.
Is it really difficult to distinguish extrinsic vascular dementia from Alzheimer’s disease?
“Physicians diagnosing Alzheimer’s cannot be wrong nine times out of ten using clinical examination data and brain MRI.
Let’s go back to the first date of a person who feels his memory is starting to deteriorate. Do neuropsychological tests include memory assessment?
– Definitely. A 10-12 word memorization test is used.
— But remembering 12 words is difficult even for a young person. Isn’t that true?
– If you make a mistake, we start asking. Suppose we are asked to remember five words: “grasshopper” – “truck” – “plate” – “lemonade” – “cinema”. If the patient has forgotten the word “grasshopper”, the doctor asks: Did we have some kind of insect? If the tips help, this may be a variation of the norm. But for a patient with Alzheimer’s disease, a semantic clue doesn’t work. What is “grasshopper” for him, what is “ant”, what is “cockroach”. He usually does not remember the word after a few minutes.
– Does the degree of dementia become clear after such a test?
Or its absence. If the results do not fall outside the normal range, but the patient complains of memory impairment, the diagnosis is “subjective cognitive impairment”. If the results show a slight decrease in memory and other cognitive functions, then a diagnosis of “mild cognitive impairment” is made. Significant cognitive impairment (dementia) is determined by severe impairment in memory and other cognitive functions.
– Should subjective and moderate cognitive impairment be treated in some way?
– Yes. There are medicated and non-drug treatments. You also have to deal with comorbidities. For example, hypertension and diabetes must be well managed. Atrial fibrillation is also a factor. Physical and mental activity should be regular. If there is depression, psychotherapy and antidepressants can be used. Check vitamin B12 levels.
– And if a person has memory impairment due to B12 deficiency, how quickly can this be restored?
– Monthly. B12 deficiency can occur in vegetarians, diabetics taking Metformin, some kind of violation of vitamin B12 absorption, and many other reasons.
What about physical activity? How required?
– At least 30 minutes 3 times a week. And you can just walk. The more physical activity, the better.
– There is still a diagnosis: Alzheimer’s disease. What is prescribed in this case?
– To improve memory and other cognitive functions, a patient with Alzheimer’s disease is prescribed acetylcholinesterase inhibitors (Donepezil, Rivastigmine, Galantamine) and (or) Memantine. These drugs can improve cognitive and emotional state, daily activity, making life easier for caregivers. They are prescribed for all stages of dementia.
– It is estimated that by 2050 there will be 3 times more Alzheimer’s patients in the world. Which drug or treatment method do you think is the most promising for this disease?
– Life style. If you are doomed to get sick, the process can slow down significantly.
First of all, it is necessary to work and enjoy it. Have sufficient physical activity, normal weight, properly treat existing diseases (hypertension, diabetes and others), enjoy life, cope with stress. As for specific therapy, that is, drugs, this is the medicine of the future.