Pre-clinical Alzheimer’s present up to 20 years before the diagnosis of cognitive impairment, even in those who do not yet have memory problems. The crucial stages of the disease are in its infancy
Can you predict who will get Alzheimer’s disease and how badly? The demographic changes underway expose us more and more to the risk of falling ill with a more frequent pathology in an aging population. A study just published in Neurology by researchers at the Albert Einstein College of Medicine in New York directed by Ellen Grober shows that by crossing the results of a neuropsychological testing called SOMI with i laboratory findings for Alzheimer’s markers
of the cerebrospinal fluid (tau-phosphorylated proteins) and with the neuroimaging data of the magnetic resonance and delta prositon tomography possible predict risk
in people who are still cognitively normal.
Twenty years earlier
More and more studies document memory problems and cognitive impairment in the so-called phase Alzheimer preclinico which is present up to 20 years before even the diagnosis of MCI, the mild cognitive cognitive impairment, i.e. mild cognitive impairment, commonly called pathological forgetfulness and considered by many to be the antechamber of Alzheimer’s disease even if it is not always an obligatory step. More and more data indicate that some cognitively normal subjects are carriers of a mild baseline cognitive impairment. Already 11 years ago Heiko Braak of the Goethe University of Frankfurt has developed a staging of the progression of dementia indicating that the injuries that occur in the early stages are closer to the real pathological core that will lead to the disease than those of the advanced stages and therefore at the beginning that it is necessary to investigate to grasp the true essence of this disease.
Less hippocampus and more Tau
Precisely for this reason the same authors of this study had already published another one on December 31, 2021 where, again with the SOMI test, they had seen that those with memory storage and memory recovery deficits have a hippocampusthe brain area of memory, smaller and a greater amount of protein value compared to those with no (SOMI 0) or mild (SOMI 1) memory impairment.
FINNISH
The test is based on the performance that can be evaluated with the previous FCSRT test (acronym for free and cued selective reminding, i.e. spontaneous or suggested recovery of memories), but it can also identify mild cognitive impairment.
0 : no impairment
1: mild impairment in memory retrieval
storage retained with normal recovery performance
2a: Moderate impairment in memory retrieval
doubles the decline rate of free recall
storage conserved
2b: moderate impairment in recovery
memory retrieval on request inadequate
Mistake 3: Significant storage impairment consistent with dementia If dementia is already diagnosed Intellectual decline impairs performance of daily activities
SOMI assessment is also useful for clinical trials because, given that the goal of treatment is at least to slow cognitive decline, the inclusion of individuals with a higher likelihood of disease may give a false impression about the effects of a treatment used when the cognitive destiny already sealed.
Double or triple risk
In this latest study published in Neurology, the American authors provide the first demonstration that those who are cognitively normal but fall within the highest levels of the SOMI test are at greater risk of cognitive deterioration. By following 969 subjects with an average age of 69 and a half years for over 6 years (more than half were women: 59.6%) they saw that SOMI 1 and SOMI 2 subjects run an almost double risk compared to those who do not have memory problems and in SOMI 2b and SOMI 3 the risk tripled. This is consistent with their previous findings that among SOMI-1 individuals about 7 years before the onset of clinical dementia there is an initial acceleration of the decline in memory retrieval. In another study, they demonstrated that SOMI-2 subjects with moderate impairment of memory retrieval and intact memory still have an increased risk of progressing to dementia over 5 years. For those who instead fall back into stages 2b and 3 with impairment of memory storage it happens earlier: 2 and a half years.
Also beta amyloid
The study published now concludes the line of research they had undertaken two years ago and in fact in the conclusions they venture that this test, making use above all of the number marker and neuroimaging data, able to predict well in advance the conversion from normal cognition to symptomatic cognitive impairment. The next development will also include in the evaluation beta-amyloid protein, another fundamental marker of Alzheimer’s disease against which the latest therapies based on monoclonal antibodies . Even if not everyone carries the seed of the process that leads to Alzheimer’s, even those who do not always develop the clinical symptoms of the final stages of the disease and there are significant differences between individuals in the speed with which individual phases of the pathological process – comments the President of the Italian Society of Neurology, Professor Alfredo Berardeli of the Sapienza University of Rome – Some develop the typical neurofibrillary tangles as early as adolescence, while others must be over 90 to show the same type of alterations. These large interindividual differences do not yet find a convincing explanation.
April 20, 2023 (change April 20, 2023 | 07:12)
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