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    Alzheimer on the prowl

Forgetting something or leaving the keys inside the car are not always signs of Alzheimer’s Disease. Frequently these lapsus are just lack of concentration or a depressive status; in fact, the same occurs to young people… although we do not need to fall into “alzheirmerophobia”, we should not be over confident either.

Alzheimer’s is a disease of old age which can erase from our brain the most basic habits such as brushing your teeth or turning off the stove, and needs to be discovered on time before it’s too late, and especially when life expectancy is getting longer and the elderly population in Colombia keeps growing. This trend increases the risk of suffering from the disease, with a twist, its advance is progressive and up to now, there are no drugs to treat it.

The critical stage of the disease is a visuospatial disorientation (forgetting how to get home, for instance) and language alterations, making it difficult to use previously known language, a condition medically known anomia.

“There is a progressive loss of memory, language, attention and high-level reasoning, among other knowledge functions”, said UNal professor and member of the Neurosciences Work Group Rodrigo Pardo Turriago.

Therefore, prevention is crucial and practically the only way to effectively control the disease and this is the work carried out for two years ago by a UNal interdisciplinary group, headed by Professors Pardo and Humberto Arboleda, both Genetic Specialists.

Alzheimer’s disease, like Huntington and Parkinson´s disease are known as proteinopathies, caused by storage of metabolism protein products. In these diseases, proteins properties are altered causing the known previously explained effects

In the particular case of Alzheimer´s, neurodegeneration is caused by the accumulation of amyloids which are deposited in the brain, producing toxic and inflammatory effects which damage the brain and alter its normal functions, also impacting motor and intellectual functions, among others.

The deterioration process differs according to ethnicity and scholarity level. The Colombian population is Caucasian according to Genetic studies carried out by renown Colombian UNal geneticists Emilio Yunis.

High Incidence

Colombia needs to prevent Alzheimer`s, as research as far back as in 1995 already had an estimate of 13.5 cases for every 1000 inhabitants, which according to UNal researchers is considered high. This estimate can surely grow with time, particularly when life expectancy has grown to 73 years of age for men and 80 for women.

The Neurosciences Group has researched the genetic risk elements in people with late Alzheimer´s disease. There is a probabilistic risk phenomenon in certain gene allele forms which code for Apolipoprotein E (ApoE), which has been identified as responsible for producing amyloid deposits which increase the risk of suffering from the disease.

“Our researches have verified discoveries from other parts of the world and also show that some genetic ApoE determinants produce a risk four times greater when the marker is present”, says Professor Pardo. This marker is a segment of DNA which could help linking a hereditary disease with the responsible gene.

They have also identified that a variant of the TOMM40 gene not only increased the risk of suffering the disease but it anticipates it, in other words, making it appear at a younger age, as occurs in the inhabitants of the Province of Antioquia, where people begin to suffer from the disease since 35 years of age.

UNal research has identified risk genes, helping to build a genetic risk map for Colombia, and also determine the protection factors to prevent the disease.

Professor Pardo says the completed an exploration of non-genetic proteic factors which are easy to identify and access to estimate the risk for people over 65-years of age.

From complaints to reality

The research group identified two types of patients: those with memory subjective complaints without having the disease, i.e. people that think they forget things but perform well in all other cognitive environments. The other group has mild cognitive impairment, although their performance is still satisfactory. Most of the 400 cases studied by Neurologist Óscar Mancera Páez and neuropsychologists Francy Cruz and Kely Bonilla belong to the latter group.

“The first thing we explore in the reason for the consultation,” says Cruz. In case of subjective complaints we use a scale between 0 and 45 to measure the level of complaints, due to forgetfulness. Then we have a more in-depth session with mental tasks and exercises. Then they apply a learning exercise with series of 16 words and alternating numbers as well as strategy planning and problem-solving.

Bonilla applies tests to patients such as Elena*, a woman who is worried about her forgetfulness, which she thinks is not normal.

“I was made aware of these consultation by a friend who works at the university and thought my case needed to be checked”, say Elena, while waiting for her turn. She also speaks about some of her experiences that could have impacted her “condition”. She says that to prevent the appearance of the disease, she has now joined a choir, although she had never sung before, but to help her memory and maintain her memory active.

Assessments also include clinical vascular risk tests, as well as cholesterol, mood tests, sleep alterations and hypothyroidism, among others. Additionally, they perform DNA analysis.

Dr. Mancera also highlights the importance of measuring vitamin B12 deficits, as in 15% of the cases studied they identified that the lack of this vitamin could be a cause linked to neurodegenerative processes.

After analyzing the tests, and also discarding other possible mental pathologies, such as emotional disorders and other brain diseases, including depression and schizophrenia – they provide their prognosis.

Most cases studied are mild cognitive impairment (MCI), evidencing the need for urgent and opportune prevention.

Learning is key

“Forgetting is a privilege for adults”, said Professor Pardo, alluding to unfortunate events or painful memories. In fact, the brain has a filter in which it removes information. The issue lies in acquiring new information by learning. This topic is receiving especial research emphasis, exploring all the competencies which could facilitate new knowledge without losing focus on memory.

Advancement in the field has demanded developing strategies to measure intellectual competencies of populational groups part of the research, making the UNal research group develop new methods adapted to the particularities of the Colombian population.

This rigorous and extended research will produce a “Public policy for dementia in Colombia”, which will be submitted at the end of the year in coordination with the Colombian Ministry of Health and Social Protection, the National Planning Agency and the National Administrative Department of Statistics (DANE, for its Spanish acronym) partnering with the Saldarriaga y Concha Foundation.

 * Name was changed to protect the identity of the patient.