Alzheimer: the primary form of dementia

Alzheimer's disease is a progressive neurodegenerative condition that primarily affects older individuals. There are early-onset forms in young adults, but they remain rare. Alzheimer's is the most common cause of dementia, leading to cognitive deterioration and loss of independence over several years. This article aims to provide an overview of the disease, its early symptoms, the diagnostic procedure, risk factors, and the available treatments to date.

Current scientific studies characterize Alzheimer's by the presence of two types of lesions in the brain: amyloid plaques around neurons and neurofibrillary degeneration inside neurons. These lesions caused by fibrous protein clumps are part of the aging process. However, in the case of Alzheimer's, they are present in much greater quantity than normal. These lesions disrupt communication between neurons and lead to their death. Over time, the disease results in a reduction in brain volume (atrophy), initially affecting memory and gradually extending to other cognitive functions.

Alzheimer's disease mainly affects individuals over the age of 65, with the risk increasing with age. However, about 5% of cases are considered "early-onset," beginning before the age of 65. Women are slightly more at risk than men, possibly due to their longer life expectancy.

The initial signs of Alzheimer's disease include:

- Frequent forgetfulness, particularly of recently learned information (short-term memory)

- Difficulty performing routine tasks

- Loss of awareness of time and place

- Difficulty following a conversation or finding the right word

- Impaired judgment

- Mood and behavioral changes without apparent reason

The diagnosis of Alzheimer's disease proceeds through elimination. It combines clinical examination, patient history, and various tests. A comprehensive neurological examination is essential to evaluate the patient's cognitive functions. Instruments such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA) are used to measure the severity of cognitive decline. Medical imaging examinations such as MRI or positron emission tomography reveal typical brain changes associated with the disease. Potential cerebrospinal fluid analyses can also be used to detect characteristic biomarkers of the disease (Park and al, 2023).

Several risk factors have been associated with Alzheimer's disease. While age and genetics play a major role, other elements can influence the onset or progression of the disease, such as cardiovascular diseases, diabetes, obesity, smoking, alcoholism, or a low level of education.

To date, there is no definitive cure for Alzheimer's disease, but medications can alleviate symptoms or slow their progression. Current treatments primarily focus on anticholinesterase medications (such as donepezil, rivastigmine, and galantamine) for mild to moderate stages and memantine for more advanced stages. These drugs work to regulate neurotransmitters in the brain to improve cognitive functions.

Apart from medications, non-pharmacological interventions are recommended to support patients and their caregivers. This may include:

- Regular cognitive stimulation through tailored activities

- Physical exercises to maintain motor function and autonomy

- Nutritional interventions and lifestyle adjustments

- Psychotherapeutic support to manage anxiety, depression, and behavioral disorders associated with the disease

- Education for families and caregivers to prepare them for the disease progression

Complete recovery is not yet a reality; current therapeutic strategies aim to improve patients' quality of life and delay progression to severe stages of the disease. Longitudinal studies have revealed that a combination of medical and non-medical treatments often leads to better overall outcomes, although individual responses to treatments can vary significantly.

Understanding and treating Alzheimer's disease are constantly evolving. While no cure has been found to date, early identification of symptoms, comprehensive patient management, and advancing research pave the way for increasingly effective management strategies for individuals affected by this disease.