Alzheimer's is equated with forgetfulness among the people. In fact, Alzheimer's can manifest itself with symptoms such as introversion, irritability, and indifference long before forgetfulness. The approval of the drug, which stops the progression of Alzheimer's disease, by the American Food and Drug Administration (FDA) in 2021 is seen as a ray of hope in treatment. Professor from Memorial Şişli and Ataşehir Hospitals Neurology Department. Dr. Türker Şahiner gave information about Alzheimer's disease and new developments in its treatment before the "21 September World Alzheimer's Day".
Alzheimer's may not be preventable, but it can be delayed
Alzheimer's disease is thought to be caused by the accumulation of a protein called Amyloid Beta in the brain. Amyloid Beta is not a harmful protein molecule. It is a molecule that brain cells called neurons synthesize many times every day, and it is estimated to have a role in the transmission of electrical signals in the brain. For an unknown reason, this protein accumulates in the intercellular environment instead of disintegrating after doing its job. In fact, the existence of a similar mechanism has been shown in Parkinson's and many other diseases that destroy the brain. Only the accumulated protein and the regions it destroys change. Today, the genetic addresses of the accumulated proteins are known and people who are genetically predisposed to these diseases can be identified. However, subsequent accumulation is quite common in individuals born genetically normal. In this case, factors such as environment, nutrition and lifestyle are effective. Although it is not possible to prevent Alzheimer's disease, it is possible to delay the disease.
- Cardiovascular health, especially keeping blood pressure under control
- Regulation of blood sugar
- Prevention of obesity
- Doing physical body exercises regularly and every day
- Regular performance of cognitive brain exercises
- Preventing depression can delay Alzheimer's disease.
When should forgetfulness worry you?
Not every forgetfulness is Alzheimer's, and even the forgetfulness seen in this disease is very different from the forgetfulness that most people complain about today. Alzheimer's patients are often unaware of their forgetfulness and they deny their forgetfulness. Patients may even blame their relatives for believing that they are not forgetful. The forgetfulness experienced by the patients leads to the gradual loss of the skills that the person has achieved very well, and the social relations of the patient, who almost takes on a completely different personality, are deteriorated. However, forgetfulness, which almost everyone complains about, is a defense mechanism of the brain and in the face of information bombardment due to very intense communication, the brain closes itself to new information recording with the "pause" button. Unrecorded information cannot be remembered, that is, it cannot be forgotten.
Alzheimer's can give symptoms before forgetfulness
Alzheimer's drags the person towards a different personality long before forgetfulness, and in the early stages, patients often prefer to be introverted and narrow their own circles. Depression symptoms dominate the clinical picture. Indecisions easily turn into anger. The intolerance of criticism due to lost skills is striking. Responsiveness sometimes tires its immediate surroundings. There is often excessive selfishness and recklessness along with depression. Sometimes, they may even be unconcerned about the death of a close friend. During this period, they can still run their individual businesses and maintain their hygiene, but the quality of the work is deteriorating.
Early diagnosis can shape treatment
Today, genetic analyzes and measurement of amyloid beta protein and TAU protein in cerebrospinal fluid are very valuable in early diagnosis. In 2012, the diagnostic criteria in the world changed and chemical analyzes were included in the early diagnosis criteria. Amyloid PET, which is only available for commercial use in the USA today, has been in use in Turkey since 2020. Brain MRI studies are very valuable in early diagnosis and studies are ongoing for widespread use.
New treatments could be a glimmer of hope for patients
Many promising studies for the treatment of Alzheimer's continue in the near future, using large resources. The vast majority of these studies are immune therapies. It is aimed to clear the "garbage proteins" introduced to the immune system by the human immune system. The drugs that succeeded in this work in 2012 were not approved for commercial use. Because these drugs were administered to advanced-stage patients, and even if the proteins that naturally destroy the brain were cleared, the clinical picture of the patients did not improve. In the same year, young members of families with a large number of genetically defined high-risk patients who contracted the disease at a very young age began to receive these treatments voluntarily. In 2021, the US Food and Drug Administration (FDA) granted sales approval for a drug that stops the progression of Alzheimer's disease for the first time in history. Aducanumab, which is used as the active ingredient of the drug, can clear the amyloid accumulated in the brain. This drug, which can be a turning point in terms of brain health, has not yet been offered for sale in countries other than the USA. However, it remains a beacon of hope for patients and their families.