Home » Alzheimer’s, faster diagnosis thanks to the first European guidelines

Alzheimer’s, faster diagnosis thanks to the first European guidelines

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Alzheimer’s, faster diagnosis thanks to the first European guidelines

A guide indicating the tests to undergo, based on the 11 ways of presenting symptoms, to recognize Alzheimer’s and other forms of dementia. These are the first recommendations approved and shared by experts from the major European Scientific Societies to identify a precise diagnostic path in four successive steps and untangle the many causes of dementia.

The first European guidelines

The first European inter-society recommendations made by experts from the major scientific societies in the sector and coordinated by specialists from the University of Genoa – IRCCS Ospedale Policlinico San Martino, the University of Geneva and the IRCCS Centro San Giovanni di Dio Fatebenefratelli of Brescia, will allow be able to give a name to the problem of those who show the first signs of cognitive deterioration sooner and better, recognizing whether it is Alzheimer’s, as happens in one case out of two, or another form of dementia.

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11 modes

The recommendations, just published in the magazine The Lancet Neurology, for the first time they are not centered on the disease, but on the patient and his symptoms. Starting from 11 different ways in which the signs of cognitive deterioration present themselves, in 4 successive steps and with different tests depending on the profile of the individual patient, it will now be possible to identify the responsible pathology more quickly and with less waste of resources.

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The diagnostic process, in addition to blood tests, cognitive tests, MRI or CT scan and in some cases electroencephalogram which are provided in the first step, changes depending on the patient and may or may not include the analysis of specific markers in the cerebrospinal fluid, PET or SPECT of different types, scintigraphies. In the near future, when it will probably be possible to associate these tests with the use of biomarkers detectable in the blood, the process envisaged by these new recommendations could reduce unnecessary instrumental tests by up to 70% for precise, reliable and timely diagnoses which at the same time at the same time they will reduce costs for the Health Service.

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“These recommendations arise from the need to have shared, international and well-documented indications but above all centered on the clinical presentation of the symptoms, on the patient rather than on the disease – he explains Flavio Nobili, co-coordinator of the study and Professor of Neurology at the University of Genoa – IRCCS Policlinico San Martino Hospital – The patient with an initial cognitive deficit has approximately a 50% chance of having Alzheimer’s or another of the various pathologies that cause disorders neurocognitive. To unravel the many causes and arrive at a diagnosis, in addition to cognitive tests, today there are many instrumental tests, from CT scans, to magnetic resonance imaging, to the examination of the cerebrospinal fluid: for each method there are guidelines and areas of application depending on the different diseases, but when the neurologist confronts the patient for the first time he does not yet know what pathology he is suffering from, therefore it is difficult to use guidelines designed to identify one pathology or the other. This is why it was necessary to build recommendations based mainly ‘on the symptom’ and not on the disease.”

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I study

The study published on The Lancet Neurology is the result of the work of 22 international experts belonging to the 11 major European scientific societies in the field of neurology, psychogeriatrics, radiology and nuclear medicine. Over the course of approximately three years, with the supervision of six additional internationally recognized experts on the topic and with the support of a representative of the Association of Alzheimer Europe patients and their families, recommendations on diagnostic pathways were shared and approved to be undertaken in people with signs of pre-dementia or early dementia, based on the scientific literature and the clinical experience of the professionals involved.

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After the initial clinical evaluation, which is the essential starting point, the process involves three further steps:

1) through the clinical analysis of symptoms, cognitive tests, the examination of some parameters in the blood (such as vitamin B12 and folate), an MRI or CT scan and, in some cases, the use of the electroencephalogram, each patient refers to one of 11 different ways of presenting symptoms (for example, prominent disturbance of memory, language, executive functions, with or without other neurological signs);

2) for each of the 11 profiles we proceed according to different procedures which include, depending on the case, tests such as PET, SPECT or the examination of the cerebrospinal fluid to evaluate the presence of markers such as the tau protein and the beta-amyloid protein;

3) based on the results of the second step, in cases where diagnostic doubt persists, further tests are identified such as scintigraphy or specific types of PET or CSF examination.

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“These recommendations help to generate a hypothesis of the probability of disease and therefore subject the patient to a logical flow of tests, choosing the most appropriate ones among the many available and then deciding, based on the results, whether to stop or continue with further tests. tests, until a diagnosis has been reached with reasonable certainty – he adds Federico Massa, co-author of the study and researcher at the University of Genoa – IRCCS Ospedale Policlinico San Martino -. Following a single diagnostic path that is the same for everyone can be ineffective, imprecise and expensive: carrying out all the tests available to all patients is not only unsustainable from an economic point of view for the Healthcare System, but also goes against the protection of the patient who would thus be exposed to excess radiation and all the risks associated with each procedure. There are dozens of diseases that present with cognitive deficits, although Alzheimer’s is the most frequent cause: having a path to move towards the right diagnosis quickly and economically is fundamental.”

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The search continues

The recommendations, which must be periodically updated based on scientific progress, are recommended for individuals under the age of 70 followed in the Centers for Cognitive Disorders and Dementia and to be evaluated on a case-by-case basis for patients over 70 years of age. In the near future it is hoped that they can be integrated with the use of the analysis of specific biomarkers in the blood, currently available only for scientific research and in the approval phase for clinical use. As he points out Giovanni Frisoni, coordinator of the study, Director of the Memory Center and Professor of Neurology at University Hospitals and the University of Geneva, “thanks to these recommendations, people with memory disorders will have a harmonized and high-quality diagnosis in every center in Europe. Furthermore, the recommendations that we have developed may soon be updated for the use of Alzheimer’s markers in the blood which will soon be able to be used clinically. All this will allow us to intercept patients with Alzheimer’s disease at the most suitable and, in the not too distant future, to direct them to therapy with monoclonal antibodies which we hope will soon arrive in Europe. These drugs, if administered to the right patients in an initial phase of the disease, will in fact be able to delay memory loss.”

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