Filenews 17 October 2021 - by Xenia Tyrki
Every 3 seconds, someone in the world experiences some form of dementia, which, according to data from the World Health Organization, is the seventh leading cause of death in the world. It is estimated that more than 50 million are the sufferers at the moment, a number that will exceed 100 million in the next twenty years.
This is an extremely difficult disease that brings patients to their limits, as it is not cured, as well as their caregivers, who undertake to bear a huge burden. About the disease, the research that is being done and how it should be treated, spoke to Phileleftheros, Konstantinos Lyketsos, a pioneer expert in research on Alzheimer's disease and professor at Johns Hopkins University in Baltimore.
Alzheimer's disease is not a single condition as most people think, explained the Greek expert, but it has more than ten different forms. The fact that we still do not have a cure is precisely that we treat it as one entity and we have the same treatment for everyone, while the needs of each person suffering are different. In the future, Konstantinos Lyketsos mentioned, when we have the appropriate means, perhaps methods of "medical precision" should be applied, where each patient will have personalized care and treatment. The basic idea is that we want to give the right treatment, to the right patient, at the right time, which will help him to cope more effectively with such a difficult and complicated disease.
As he mentioned treatment of the disease at the moment there is and neither does anything appear on the horizon, at least for the next fifteen years. As he argues dementia will be cured when we fully understand its causes. However, as he said now we have the possibility of a preventive treatment with indicative treatment options, which, in combination with the supportive family environment, can prolong the quality of life of patients. It is for this reason that the health of caregivers is just as important as that of patients and we must pay special attention to them as well. Considering that in the future dementia will affect more and more people, it becomes necessary that the role of the State must change and be more supportive.
-In recent years the words dementia and Alzheimer's have been heard more and more often, more and more intensely. Have cases really increased and if so, why is that? What are the predictions for the future?
-Indeed, cases have increased significantly and this is because the population is ageing. The incidence of dementia is directly intertwined with the number of elderly people and especially with the number of elderly people. As we have more people who reach the age of 90 and 100, we also have an increase in the number of people with dementia. Globally, there are around 50 million sufferers and this number will double every twenty years. Which means that around 2040 there will be over a hundred million patients and to them we must add their caregivers. If for every person who will live with dementia for a period of time there are two to three people who treat them, then we are talking about 300 million people who will be directly related to dementia. The problem, therefore, is very important.
-Is it true that at the same time as the increase in patients their age decreases?
-This is mainly because the 50-year-olds and 60-year-olds we see diagnosed with dementia visit their doctor earlier than they would have done a few years ago. In the old days there was stigma and people were hiding, today when we know what is happening they visit their doctor without fear of what those around them will say, knowing that early diagnosis is crucial.
-How far are we from having treatments against dementia? Why don't we have something tangible that fights it effectively?
If we talk about treatment to eliminate the disease we are a long way off yet. Let me remind you that in America the notorious "war on cancer" began in the 1960s. The "war on Alzheimer", on the other hand, began in the early 2000s. Alzheimer's disease is a much more complicated disease, because we do not have something tangible. When we are dealing with cancer we can study it molecularly, if the patient has a tumour it can be removed and then have treatment. Dementia is a brain condition. Perhaps if we could do a brain biopsy to study the disease more well, we would have better results.
Having said that, I must say that we are far from healing. But there is the care and we know the care we can offer is quite effective and as far as quality of life is concerned, the progression of the disease and the caregivers are concerned. We may not have reached the Promised Land yet, but we have very good care that makes a difference.
-Talk to us, please also for your own research. Where do they focus and what are they aiming for?
-I am currently a department chair and oversee several investigations. Briefly let me tell you that we are doing research to understand the different types of Alzheimer's disease. One of the reasons we don't have a cure is precisely that we treat the disease as one entity and have a cure for everyone. In the future, we must practice so-called "precision medicine" when we are trying to see what the forms of Alzheimer's disease are and how they can be treated with different medicines.
Other research focuses on the various biomarkers, either in the blood, to make an early diagnosis or with stem cells to test new drugs. Also, other studies concern the prevention, treatment, treatment of neuropsychiatric symptoms such as depression, anxiety, lack of sleep that affect almost all dementia patients.
-You have said that Alzheimer's disease is not a single condition. How many do you estimate are the different forms of the disease?
-We still don't know exactly. So far we know about five to six, I do not believe that in the end we will exceed ten to fifteen. And I say this on the basis that they will have a different treatment. However, we can say that each patient has his own form of illness. The main thing, however, is to have some large groupings, so that each form has its own treatment. It sounds like a large number of fifteen that I mentioned. But when you consider how complex the human brain is, it's no surprise that there are so many.
The world is limited temporally and spatially to a tunnel
-Do we know what is happening in the minds of those affected and especially those who are in the last stage and have no contact with reality? For example, they can make thoughts, do they have feelings?
-We know very little because it is difficult to detect what is happening in the mind of a person who cannot speak or express himself in any other way. I often hear stories from families and caregivers talking about patients who, while they were incapable of communication and for a long time had no contact, suddenly for a while seemed to be well, communicated with their loved ones, and then dementia came back again. It's not something I've seen happen, so I can't have an accurate opinion. I believe that unscathed patients do not have thoughts in the same sense that we have about thoughts, but this is something that cannot be proven due to the lack of communication.
-Are the memories, the feelings present in these patients or do they disappear?
-There may or may not be. For me it is something that remains unknown and I cannot give a sure answer. My view is that they are probably disappearing or at least that they are fading. It is as if the thoughts look like a video whose images are fading more and more. Perhaps the image for some reason can one day come back for a while and then return to the faded one again. Most of the time, I believe that there are no memories and feelings as they were previously in nonsense patients.
-What does a world with dementia mean? How do patients themselves experience the loss of their memory?
-Now the diagnosis is made much earlier so we have the opportunity to understand some things better. Patients who experience it and who can describe it say that it is a strange experience, as if reality is taking you to a tunnel. Instead of being truly aware of the open world around you, the world is limited in time and spatially to a tunnel. And so they don't remember what happened a few minutes ago or what they have to do next. Also, some are very anxious because they do not have the certainty they had of what is happening around them. For some patients the world becomes scarier for others but again it becomes simpler. Some people seem to enjoy taking care of their family and the attention they have.
-What determines whether someone will become ill? Is it inevitable under certain circumstances e.g. heredity or lifestyle or is it something that arises in the course of a person?
-Everything plays a role. There are forms of Alzheimer's about 5% which is purely genetic form. That is, someone inherits let's say a bad gene and will suffer dementia no matter what happens as long as he reaches the age that is set to fall ill. On the other hand, there are people who have no genetic burden, they have no other risk factors, i.e. they are healthy, they exercise, they take care of their minds and yet they get dementia. We know that there are 30 to 40 genes that have a lesser influence on dementia. That is, if someone has one of these genes in the wrong form, for example, he has a 2% risk. If he has one more, another risk is added. That is what we believe is the case. Many patients inherit a number of these genes in their poor form, and this affects the likelihood of getting sick with dementia.
-Is there then anything that someone can do so that since he cannot stop the onset of the disease to slow it down?
-Look, there are two trends around this issue. For people with less genetic risk, physical exercise, social exercise, good nutrition, control of risk factors such as sugar, stress contribute significantly to the prevention of dementia. On the other hand, people who have a greater genetic risk unfortunately cannot do much.
-In the U.S. in the summer, a drug was released, Aducanumab, which some saw as "messiah" and others with plenty of scepticism. Your point of view?
-I belong to the second group. It is one of the antibody drugs that we mentioned earlier. It enters the brain and purifies largely of amyloid plaques, but does not seem to act symptomatically, that is, it does not improve memory or the ability to communicate in the people who receive it. For me it is controversial and I believe that it should not be approved with the knowledge we have now. More research had to be done to prove its effectiveness. Research on Alzheimer's and dementia focuses precisely on the role played by amyloid proteins. Their removal from the brain should improve a patient's image, but we do not notice that this is the case.
-Should we expect another new drug in the coming years?
-Nope. If there is to be another drug will be in the form of Aducanumab, about which there are several doubts. That's why I think it's better to focus on good care that makes a difference and that adds years. At least we know how to do this and we know that patients who have good care have a better course in the development of their disease.
