Thursday , July 29 2021

Senile dementia: these risk factors are largely ignored

Atlantico: A study conducted by the United Kingdom of the Alzheimer's Research Fund on 2361 UK citizens shows that only 50% of these people can recognize a risk factor that can lead to dementia. Only 1% of respondents can recognize 7 risk factors and how to prevent them. What are they?

André Nieoullon: If there is a common denominator of many neurological pathologies, the lack of knowledge of the general public about what is found – if not presumed – is a special risk factor (most commonly of a behavioral nature). ) diseases whose appointments are widely known and recognized by most of our fellow citizens because of their visibility through the media. As an illustration, as a specialist in Parkinson's disease, I always have a "mixture" between Parkinson's disease and Alzheimer's disease, for example, when we ask a question that indicates one or other of these diseases. So, with regard to their 'risk factors', it would undoubtedly be a survey that would be carried out in our country under the same conditions as the one you quoted in the United Kingdom gave similar results in terms of, and that is, people who are not facing more or less directly with the disease.

So there is a need to re-inform and inform, and this is our shared responsibility to you, the media and us, the researchers. The road is still long, but if popularization is noble, it must condemn the exploitation by force, which may be a trade that is developing on the basis of this misunderstanding and the enormous distress of the general public in relation to these diseases. In fact, at this stage of our knowledge, the claim that we can avoid Alzheimer's disease and more general dementia are such scams.

Despite the great recent work, especially in molecular medicine and genetics, our misunderstandings continue to be the enormous pathological processes on which Alzheimer's disease is based, the clinical entities of which show a great heterogeneity, which makes us seem not to be concerned with "a" disease, but rather with groups of closely related diseases, where the substance is quite differentiated, which makes experts more likely to speak of "Alzheimer-type dementias". To illustrate, while the most well-known and common forms usually affect people over 60-65 years old, there are many older forms, for example about 45, and clearly related forms. for vascular disorders of the brain, called "vascular dementia". And the notion of "risk factor" itself is not immediately accessible to all …

To put it simply, let's take an example of what is considered a "leading risk factor for Alzheimer's disease", that is, a progressive age. When you write this, you need to know that the risk of developing Alzheimer's dementia will increase when you are older. In fact, this is statistical data that can be verified on a particular population and can be extrapolated to the individual's scale. Epidemiological evidence suggests that if we are older, the likelihood of getting this disease is greater; it can even be argued that the probability (that is, the statistical term) of the development of the disease will reach values ​​ranging from one to four people to 85 (that is, almost in France today for women) or even three years after 90 years. Everyone will agree that this kind of risk can not be avoided, and in a state that we can do, it is more death.

On the other hand, the data are more vague and everyone can take full control of all the claims that are found here and there in this field with endless caution. It is scientifically that the causality of the disease is found only with very rare genetic mutations, leading to the so-called "family" form of exceptional Alzheimer's disease. One of the main features is that we start early, that is before the age of 45, unlike the most common forms (referred to herein), which is called "idiopathic", meaning "no known cause", later. Having a family history can therefore be an objective risk factor for the disease only if it is one of the few forms with an established genetic component. In any case, it is well recognized that, in all cases, if the disease is actually characterized by Alzheimer's disease (which is only part of the dementia countries that are still considered to be such …), the risk of developing Alzheimer's disease is multiplied by 2 or 3 in comparison with the whole population. So much about the most serious elements that are scientifically supported.

As for other risk factors that are thought to facilitate the onset of Alzheimer's disease, their most potential characterization is only the result of correlations reported more frequently than usual in the patient's experience. Pell-mêle, for the most commonly advanced: low level of education, the appearance of head injuries, such as light, and to the concept that has long been used to use in the kitchen of aluminum accessories! Of course, this does not mean that these events or behaviors are not involved in the onset of dementia, but in any case these are not important factors … and the use of baking trays or Bac + 5 can not mean "protection" against the disease … Excluding other types of possible Risks such as alcohol consumption, smoking, high blood pressure or suffering. Diabetes, the main effect of which is certainly not primarily the triggering of Alzheimer's disease.

However, given that at this stage we can not objectively perform a clear differential diagnosis of Alzheimer's disease among a multitude of dementia syndromes, as we are completely incapable of curing these diseases, there is nevertheless a genuine hope that the number of cases of Alzheimer's type of dementia, if not it reduces, at least, does not change anymore, despite the increasing life expectancy of populations. In this regard, the fact that, in most cases, Alzheimer type dementia is associated with vascular disorders of the brain. Thus, better control of high blood pressure and metabolic disorders such as diabetes can reduce the risk of developing dementia by reducing vascular risk. At this stage, nothing is definitive, but according to some recent epidemiological data, it seems clear that there is a policy of supply and prevention of vascular and metabolic risks anywhere, the number of cases of dementia no longer increases. In the absence of any other form of possible intervention to reduce the occurrence of the disease, it is possible to consider the disease as a true hope of final action, albeit very indirectly. In this context, certain cholesterol medicinal products, such as statins, or certain anti-inflammatory treatments, or even certain anti-diabetes treatments, including a prohibition of permanent physical activity, may be useful strategies to combat certain forms of illness, much more than a recommendation for the adoption of such or such a potential antioxidant, as it has progressed so often … These hypotheses are the subject of investigations.

How to explain the lack of knowledge about this disease and what is the extent of the wrong information about it? What are the ideas about dementia?

This was mentioned above: in the state of our knowledge, we do not know anything about the causes and physiopathological mechanisms of Alzheimer's disease. Of course, this does not mean that we are in complete ignorance, but here I would like to emphasize that all the valuable information that we have collected so far is only a correlate of the disease and nothing. second. We thus established with certainty the involvement of this brain region, which participates in memory mechanisms, such as, for example, Hypokampus, or intervention of abnormal proteins at the molecular level; such as the well-known beta-amyloid protein and tau protein, which unite in certain areas of the brain where neurons die. These fundamental discoveries have, for the time being, remained sterile in the implementation of drug treatment despite hundreds of clinical trials. It's a reality. Dementias are not inevitable, and surely a healthy lifestyle will prevent some of their forms. But in order to make an inventory with Prévert of these risk factors, there remains an exercise that can not be accessible to everyone. This is also the reason why the media play a role in educating the population, and above all, speculation and accusations, which are more or less well-intentioned, are burdened with so much confidence, most often with ignorance. And at this point I wonder about the motives of the English Alzheimer's Trust Fund, whose investigation could only result in the result that he accused of, for the reasons listed above!

What are the consequences of this incorrect information?

If, as I pointed out, the direct influence of the individual's behavior on the occurrence of the disease is insignificant or even zero, we can only conclude that the education of the population will have little effect on the number of new cases of dementia, with a notable exception to a healthy lifestyle that leads to a reduction in cardiovascular factors . It is only for this reason that a preventive policy in this area should be continued, which can therefore be useful for the indirect reduction of dementia. In my case, it should be concluded that public authorities will commit themselves to continue this policy "readable" for the population, with emphasis on cardiovascular and metabolic aspects (proven reduction in cardiovascular events, stroke Stroke and metabolic disorders of diabetes) , without necessarily placing potentially more ambitious goals than a reduction in the amount of insanity, which is much more hypothetical … But of course this does not exclude that the day will unequivocally identify the causal factors of Alzheimer's disease that go beyond very rare genetic mutations, provided they are "evading", so it is of course the time for an information campaign. this time she focused on the disease. But, from my point of view, this time has not come yet.

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