— Vladimir Anatolyevich, is Alzheimer’s disease considered a hereditary disease?
Alzheimer’s disease presents in several forms. When it begins before age 65, hereditary factors are more often involved than in the common late-onset form. A genetic predisposition also influences late development, tied to apolipoprotein E4, a protein involved in fat metabolism. Yet much remains unknown about the heredity of this condition.
What is the main hypothesis for the origin of this disease?
The beta-amyloid hypothesis is currently the leading theory. It suggests that in the brain of someone with Alzheimer’s, beta-amyloid, a short protein fragment, accumulates into amyloid plaques between neurons and becomes toxic. A second major mechanism involves tau protein, which starts to misfold and form neurofibrillary tangles inside nerve cells. Additional factors include disturbances in calcium handling and links to vascular disease and diabetes, which has led some experts to describe Alzheimer’s as a form of diabetes of the brain, sometimes called type III diabetes.
Contemporary scientific articles occasionally challenge the beta-amyloid idea. What should be made of that?
Such challenges do not fully explain the disease. Nevertheless, the first anti-amyloid therapies have shown activity. For instance, in mid-2023 the FDA approved aducanumab for early-stage Alzheimer’s, though it carries notable side effects. In early 2024, data on the efficacy of lecanemab were released as part of ongoing clinical trials. A growing slate of treatments remains under investigation. Clinics specializing in Alzheimer’s care participate in multiple studies.
“A patient with memory impairment visits the clinic. Could it be just a distraction? What are the initial steps and what research is underway?
– The first step is to understand how the disease progresses. A full clinical evaluation is essential to establish a diagnosis. This includes reviewing medical history, current symptoms, and any other illnesses. It is also important to determine medications the patient is taking—some drugs may mimic or worsen memory problems. Neuropsychological testing, behavioral assessment, and the patient’s daily social activities are evaluated. Family members are interviewed, and laboratory tests are conducted, including blood tests, liver and kidney function, and vitamin B12 levels. An MRI of the head may be performed to look for structural changes. When the diagnosis remains uncertain, specific biomarker tests for Alzheimer’s can help clarify the situation.
— What signs are these biomarkers and where are they found?
– There is a cerebrospinal fluid (CSF) test that measures beta-amyloid and tau protein. In Alzheimer’s, CSF beta-amyloid tends to be lower, while tau protein rises, reflecting neuron loss; the pattern shifts as beta-amyloid accumulates in the brain. Other methods exist that are not yet widely used in some regions, including certain imaging techniques.
– What technologies are involved?
– Positron emission tomography (PET) with specific tracers can detect excessive beta-amyloid deposition in the living brain. This makes it possible to visualize amyloid burden directly in vivo.
— Can beta-amyloid be seen in the human brain with PET?
Yes, though PET can be costly. Analyzing CSF beta-amyloid is cheaper and, in many cases, provides comparable accuracy to PET.
— Why is this work not common in some countries?
It depends on available resources. In many places, Alzheimer’s is diagnosed far too infrequently. For example, regional health statistics show relatively low reported incidence in some areas, while population estimates suggest a much higher prevalence that may be underdiagnosed due to limited awareness and diagnostic access. In contrast, other regions report higher recognition and documentation of the disease.
– How does one distinguish Alzheimer’s from vascular dementia in practice?
– Clinicians rely on a combination of clinical evaluation and imaging. While vascular factors like hypertension and vascular disease influence cognitive decline, the distribution and pattern of symptoms help separate vascular dementia from Alzheimer’s in most cases. MRI is used to assess vascular changes as part of the diagnostic workup.
Is it difficult to distinguish extrinsic vascular dementia from Alzheimer’s disease?
– With careful clinical assessment and MRI findings, most physicians can differentiate the two, though overlap exists. In some settings, misdiagnosis may occur when expertise or imaging access is limited.
– Do neuropsychological tests include memory assessment?
– Yes. A standard memory test may involve recalling a sequence of words. If a patient forgets a word, investigators probe whether cues help or fail to trigger recall. In Alzheimer’s, semantic cues often fail to restore memory, unlike milder forgetfulness or distraction.
– What about the progression of dementia and its staging?
– If memory and other cognitive abilities decline only mildly, the condition may be termed mild cognitive impairment. More severe impairment with substantial functional loss is diagnosed as dementia. Early subjective concerns can still be treated with lifestyle changes and medical management to slow progression.
– Should subjective and mild cognitive impairment be treated differently?
– Both medicated and non-drug approaches are used, with attention to coexisting conditions. Controlling hypertension and diabetes is essential, and atrial fibrillation is a contributing factor. Regular physical and mental activity helps. If depression is present, psychotherapy and antidepressants can be beneficial. Vitamin B12 status is checked, particularly in populations at risk for deficiency.
– How quickly can vitamin B12 deficiency be corrected?
– In cases of deficiency, replacement can restore function over weeks to months. Deficiency is more common among vegetarians, individuals on certain medications, or conditions affecting B12 absorption.
What about physical activity? How important is it?
– Aiming for at least 30 minutes of activity three times a week is recommended. Even simple walks contribute to overall well-being. Greater activity often yields greater benefits.
– In the context of confirmed Alzheimer’s, what therapies are commonly used?
– Treatment typically includes acetylcholinesterase inhibitors (such as donepezil, rivastigmine, and galantamine) and, in some cases, memantine. These medications can improve memory, mood, and daily functioning, easing caregiver responsibilities across stages of dementia.
– Looking ahead to 2050, what seems most promising for Alzheimer’s care?
– Lifestyle remains foundational. Maintaining activity, a healthy weight, managing chronic diseases, and reducing stress can slow progression. On the pharmacological front, research continues, but practical, sustained lifestyle changes are already a powerful ally.