When we think of Alzheimer’s disease, we often associate it directly with memory loss. Although this is the most common and well-known symptom, the reality is more complex. In fact, particularly in younger people, Alzheimer’s can begin with symptoms that are often not recognised as being associated with the disease, leading to a delay in diagnosis.
This disease is the most common cause of dementia, a group of disorders that affect cognitive functions such as memory, language, orientation and the ability to make decisions. In Catalonia, dementia affects approximately 64 people per 1,000 inhabitants, with 13.7 new cases diagnosed each year per 1,000 inhabitants. Furthermore, its prevalence increases with age and is higher among women.
Alzheimer’s does not always start with memory problems
For people who develop symptoms of Alzheimer’s after the age of 65, memory loss is the first symptom in the vast majority of cases. However, when the condition develops before this age, the initial symptoms may be different. Some of the early symptoms may include:
- Language difficulties, for example, trouble finding the right words or following a conversation.
- Problems with orientation or visual changes, which may make it difficult to interpret spaces or objects.
- Changes in behaviour or personality, which affect the way a person normally behaves or interacts with others.
As these symptoms are less well known, they are often not initially linked to a neurodegenerative disease, which can delay diagnosis.
Why is early diagnosis so important?
Not all types of dementia are the same. As well as Alzheimer’s, there are other types, such as Lewy body dementia, frontotemporal dementia and vascular dementia. Correctly identifying the cause of the symptoms is essential for providing the most appropriate treatment and for helping the person affected, as well as those around them, make informed plans for the future.
Currently, when cognitive decline is suspected, specialists carry out a comprehensive assessment which includes a clinical interview with the patient and their family members, a neurological examination, neuropsychological tests, blood tests and brain imaging scans. In recent years, disease-specific biomarkers have also become an increasingly important part of the diagnostic process.
A blood test to detect Alzheimer’s
One of the major breakthroughs in this field is the emergence of plasma biomarkers, that is, proteins that can be measured through a simple blood test.
Until recently, detecting the biological changes associated with Alzheimer’s disease required more complex tests, such as a lumbar puncture or advanced nuclear medicine neuroimaging techniques. The new blood tests offer significant benefits.
Advantages of a blood test for diagnosing Alzheimer’s:
- Greater availability in clinical practice.
- Less invasive than a lumbar puncture.
- Lower cost compared with other diagnostic techniques.
- It may be repeated from time to time.
- The aim is to achieve an early diagnosis, that is, to identify the protein responsible for cognitive decline whilst the symptoms are still mild.
A disease that goes undetected for many years
Current studies suggest that biological changes associated with Alzheimer’s disease may begin between 10 and 15 years before first symptoms become noticeable. During this period, the disease progresses silently in the brain.
This knowledge is transforming our understanding of the disease and opens the door to intervening at much earlier stages, when treatments are likely to be more effective. At present, however, these asymptomatic stages are studied mainly in a research context.
In this regard, Hospital Clínic Barcelona and IDIBAPS are promoting the CONNECTA project, a research initiative working to improve the early detection of Alzheimer’s and other forms of dementia through new biomarkers, screening tools and innovative treatments. The aim is to identify the disease at an early stage and improve care for those affected and their families.
New treatments and prevention: two paths to hope
Research into Alzheimer’s is advancing rapidly. Some of the new drugs developed in recent years have been shown to slow the progression of the disease in selected people with early-stage Alzheimer’s. Some clinical studies have shown an approximately 27% reduction in disease progression.
However, prevention remains a vital tool. Although age remains the main risk factor for developing dementia, there are several risk factors that are modifiable:
Preventable risk factors for dementia
- Controlling high blood pressure.
- Preventing and treating diabetes.
- Avoiding smoking.
- Maintaining a healthy weight and preventing obesity.
- Practising physical activity on a regular basis.
- Detecting and treating hearing loss.
- Promoting social interaction and avoiding isolation.
- Reducing alcohol consumption.
- Managing other cardiovascular risk factors, such as high cholesterol.
- Avoiding traumatic brain injuries.
According to current estimates, modifying these risk factors could help to prevent up to 45% of cases of dementia.
What does the future hold for Alzheimer’s disease?
Alzheimer’s is much more than just a memory disease. It is a major health and social problem that requires increasingly early diagnosis, more effective treatments and a strong commitment to prevention. Advances in blood biomarkers and new treatments offer real hope of altering the course of the disease.
INFORMATION DOCUMENTED BY:
Dr Albert Lladó, Head of the Alzheimer's and Other Cognitive Disorders Unit. Neurology Department, Hospital Clínic Barcelona.
