neurology in Marbella
neurology in Marbella

Alzheimer’s and other dementias

Alzheimer

In Spain, 1 out of 10 people over the age of 70 suffers from some form of dementia.

 

It is a degenerative disease which causes severe memory loss and loss of intellectual capacity with forgetfulness, disorientation in time and place and behaviour and language difficulties. These progressively interfere with the patient’s daily life until they become completely dependent on others.

 
 

 
 

 
 

Prevention plays a particularly significant role, eradicating preventable vascular risk factors such as smoking, hypertension, obesity, poor eating habits, or sedentary lifestyle can delay the onset of disease until much later. Because it is a degenerative disease, prevention of neurone loss for other reasons is important.

  • Memory loss
  • Difficulty performing a complex sequence of tasks
  • Speech problems
  • Disorientation in time and place
  • Changes in state of mind
  • Loss of initiative

Major advances have been made in the diagnosis of Alzheimer’s:

 

Biomarkers

There are an increasing number of blood and cerebrospinal fluid biomarkers which enable us to better understand the disease.

 
 

Neuroimaging tests
  • MRI is usually the first recommended neuroimaging technique. It can  confirm that the symptoms detected are not due to other causes such as a tumour, and evaluate the degree of cerebral atrophy.
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  • In dementia, PET is the most sensitive test for detection in the initial phases, hence its importance not only for diagnosis, but also for differentiating between the different causes of cognitive impairment.

 

Cranial PET is increasingly specific in the study of dementia:

 

  • Amyloid PET¸ shows the presence of amyloid protein that accumulates in the brain of patients with Alzheimer’s disease and other dementias. It enables early detection of the disease, since the onset of accumulation begins at up to 20 years prior to the onset of symptoms.
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  • Tau PET, using a specific tracer, this allows us to see accumulation of the Tau protein. In contrast to amyloid, which accumulates widely throughout the brain, tau protein is concentrated precisely where brain atrophy is most severe.
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  • FDG PET shows increases or decreases in brain metabolism in numerous neurological diseases and psychiatric disorders. It facilitates the early and differential diagnosis of dementia.

 
 

Genetic tests:

 

  • Some types of dementia have certain genetic traits, some hereditary and some not. 
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  • Two categories of gene may be involved in the development of Alzheimer’s disease: genes that are not determinant, but which increase the risk of developing it (involved in the most common variant, known as “sporadic” Alzheimer’s) and genes that are determinant (involved in a rare variant, known as “familial” Alzheimer’s).
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  • Testing is recommended in cases of early onset of the disease or when several cases have occurred in the same family. 
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  • These tests are appropriate when performed within the framework of a genetic counselling programme and with specialist professional assessment. Management of this type of information is quite delicate, with significant emotional consequences.
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  • “Familial” Alzheimer’s usually accounts for a minimal percentage of cases of the disease. Three gene mutations have been identified as  a cause: the amyloid precursor protein (APP) gene, the presenilin-1 gene (PSEN1), and the presenilin-2 gene (PSEN2). Children of carriers of one of these genetic mutations will have a 50% chance of inheriting it.
  • Unfortunately, today there is no treatment as such for Alzheimer’s disease. There is no drug that changes the course of the disease, but there are those which can improve symptoms.
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  • There are many lines of research, there are currently around 10,000 clinical trials on Alzheimer’s disease worldwide. Curative treatment will be found in the medium term.
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  • The greatest progress has been made in diagnosis. There is also better determination of the type of dementia and choice of the most appropriate treatment, as well as early detection, when disease control is easier.
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  • By controlling preventable risk factors we can make the disease manifest much later.

 

Neurologists

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