Alzheimer's disease (AD)

What is it?

The term “dementia” refers to a number of conditions that cause cognitive decline of such magnitude as to cause a loss of independence in activities of daily living. In Italy today, dementia affects more than 1 million people and this figure is expected to double by 2030 and triple by 2050. The most common form is Alzheimer's disease which comprises about 60% of cases. Dementias are divided into two major groups: reversible dementias and neurodegenerative-based dementias, which are the largest group. Reversible dementias are conditions caused by a correctable disorder, if detected, such as impaired thyroid function, vitamin deficiencies, or psychiatric disorders such as depression. Neurodegenerative-based dementias include Alzheimer's disease, frontotemporal dementia, Lewy body dementia, and vascular dementia (usually caused by repeated brain infarcts). These conditions most commonly arise after age 65, with the exception of some early forms of Alzheimer's disease and frontotemporal dementia.

Which are the symptoms?

Symptoms typically present include short-term memory disorders (difficulty in remembering appointments, conversations and activities performed during the day), spatial and/or temporal disorientation (possibility of getting lost even in places once known, difficulty in correctly articulating the days), language disorders (difficulty in naming objects or people or in understanding the content of conversations), behavior (changes in character, with the appearance of aggression or apathy) or sleep-wake rhythm (insomnia, agitation and / or daytime sleepiness).

  • short-term memory disorder
  • spatial disorientation
  • temporal disorientation
  • language disorders
  • behavior disorders
  • sleep-wake rhythm disorders
  • loss of autonomy in activities of daily living

How is it diagnosed?

A correct diagnosis is based on the use of several tests that provide complementary information. The key role is played by the neurological examination, during which the patient's history is reviewed in detail, symptoms are analyzed, and a neurological physical examination is performed. Then, a neuropsychological evaluation is performed, which involves tests to assess in detail the extent and characteristics of deficits in memory and other cognitive domains. These assessments are then followed by instrumental examinations such as: magnetic resonance imaging (MRI) or computed tomography (CT) to study the presence of areas of brain atrophy; PET allowing the metabolism of brain cells to be studied; electroencephalogram (EEG) to study patterns of brain activity; spinal tap allowing for the analysis of the CSF, a fluid that is in direct contact with the brain and contains molecules that may be altered in case of disease; blood test allowing to exclude the presence of reversible causes of dementia (vitamin or hormone deficiencies).

Suggested exams

How is it treated?

Dementia is an extremely debilitating condition for both the patient and family members. It has a progressive course leading to an increasing loss of autonomy of the patient, with the need therefore of a person in the house who takes care full time of the patient. Unfortunately, to date, there is no cure for degenerative forms of dementia.

There are, however, resolving therapies for reversible forms, as well as valid options that help slow down degenerative forms and improve the condition of the patient. Drugs that slow the progression of Alzheimer's disease include acetylcholinesterase inhibitors and memantine.

Other drugs often prescribed are antipsychotics and antidepressants, since they can improve behavior and sleep-wake rhythm disorders, thus helping family members in the management of the patient. In addition to pharmacological treatment, it is important to undertake a targeted program both at the physical level, through physiotherapy, and cognitive level, with training consisting of exercises that help reduce the extent or impact of the memory disorder.

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