We diagnose Alzheimer’s disease in Poland after 24 months. Experts: It’s too late

On average, as many as 24 months in our country pass from the patient visiting the clinic to the diagnosis of Alzheimer’s disease. In this respect, we occupy one of the last places in Europe – the specialists of the Polish Neurological Society are alarming.

They discuss the problems with diagnosis on the occasion of the World Alzheimer’s Disease Day on September 21.

1. 44 million people are affected by Alzheimer’s disease worldwide. Scientists predict that this number could triple by 2050
2. Defects in the brain begin to form long before the first symptoms of the disease appear, doctors warn
3. The earliest symptoms of the disease include difficulty finding words, difficulty remembering and changes in mood
4. On September 21, we celebrate World Alzheimer’s Disease Day

Every 3 seconds in the world someone knows the diagnosis: Alzheimer’s disease

Alzheimer’s disease affects 44 million people worldwide, and a new case is diagnosed every 3 seconds. By 2030, the number of patients with this condition could double and by 2050 it could even triple. Early diagnosis is of key importance, because only then is it possible to delay its development and maintain the efficiency of patients for longer. Because there is still no cure for this disease.

1. Early symptoms of Alzheimer’s disease. They can appear as early as forty

In order to accelerate the diagnosis of Alzheimer’s disease and other forms of dementia, the specialists of the Polish Neurological Society, in the information sent to PAP, postulate the creation of a screening program for cognitive disorders in people over 65 years of age. It would be carried out by primary care physicians (POZ) who would also perform the initial diagnosis of dementia, including Alzheimer’s disease.

Alzheimer’s: one of the most common brain diseases

“In aging societies, brain diseases pose a huge challenge: today the annual social costs of brain diseases in the EU reach EUR 800 billion, which is more than the costs of cancer, cardiovascular diseases and diabetes taken together and will increase” – warns the president of the Polish Neurological Society, Prof. . Jarosław Sławek.

One of the most common diseases of the brain is Alzheimer’s disease, which causes the impairment or complete loss of the so-called higher cortical functions such as memory, orientation, understanding, counting, speech and motor skills. It usually develops after the age of 65, more often in women than in men.

“Defects in the brain begin to form long before the first symptoms of the disease appear, which we define as the preclinical phase of the disease” – explains Prof. Konrad Rejdak, president-elect of the Polish Neurological Society.

Factors associated with the death of nerve cells are abnormal protein deposits: beta amyloid (which is deposited on nerve cells to form the characteristic amyloid plaques) and the tau protein. However, we still do not know whether this is the direct cause of the degeneration of the brain tissue or just the accompanying pathological process.

Alzheimer’s disease: genetics matter

This disease may also be associated with a genetic predisposition (e.g. ApoE4 gene carriers are four times more likely to suffer from dementia than the rest of the population), which, however, affects only a selected subgroup of patients.

The mechanism of neuronal damage is very complex and is also involved in oxidative stress and oxygen free radicals, as well as glucose metabolism disorders (hence some scientists consider Alzheimer’s disease as a form of diabetes). Smoking, vitamin D deficiency, hypertension, high cholesterol, lack of exercise, poor diet and air pollution contribute to its development. The strong link between air pollution and Alzheimer’s disease is also well documented.

1. Early symptoms of Alzheimer’s that you can see with the naked eye

Specialists of the Polish Neurological Society emphasize that in Alzheimer’s disease, as in other progressive diseases, prompt diagnosis and early treatment initiation give a chance to more effectively slow down the development of the disease.

A quick diagnosis is what counts

“Unfortunately, in Poland, an average of 24 months elapses from the patient reporting to the primary care physician for the diagnosis of Alzheimer’s disease. It is one of the longest times in Europe ”- emphasizes prof. Maria Barcikowska, head of the Clinical and Research Team of Degenerative Diseases of the CNS, the Institute of Experimental and Clinical Medicine of the Polish Academy of Sciences in Warsaw.

Prof. Tomasz Sobów, head of the Department of Old Age Psychiatry at the Central Teaching Hospital of the Medical University of Lodz, points out that one of the most important tasks is to recognize whether the underlying cause of dementia in a patient is depression or other mental disorders. “When dementia is secondary to a psychiatric disorder, treatment is different from that for Alzheimer’s,” she adds.

Causal treatment of Alzheimer’s disease is still not possible. There are several medications to choose from to relieve the symptoms of your disease and slow its progression. These are drugs from two groups: acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine) and the NMDA receptor antagonist, i.e. memantine. In the treatment of advanced Alzheimer’s disease, neuropletic drugs are used to counteract or alleviate psychotic disorders and aggression, and reduce psychomotor agitation.

There is still no cure for Alzheimer’s disease

“Currently, there are several dozen molecules potentially effective in the treatment of Alzheimer’s disease, especially in its early stages, in clinical trials. Among others, anti-inflammatory substances, antioxidants, and compounds with neuroprotective effects. Another direction of research is to stimulate the patient’s immune system to fight the brain-damaging beta amyloid or the tau protein “- explains Dr. n. med. Joanna Siuda from the Clinic and Department of Neurology, Medical University of Silesia in Katowice.

In the treatment of Alzheimer’s disease, the most important thing is a multidisciplinary approach, which is why multidisciplinary centers for comprehensive diagnostics and treatment are the best solution. Such proceedings are not only cheaper, but also much friendlier for patients for whom hospitalization and a hospital stay for several days, separated from their relatives and home, is a traumatic experience that worsens their psychophysical condition.

The burden of care falls on loved ones

There are no such centers in Poland, as pointed out by the Polish Neurological Society. It also points to staff shortages and too few residencies in neurology (the Society has been trying for years to include neurology on the list of priority specializations, but nothing has changed in this regard). There are no centers dealing with the physical rehabilitation of these special patients, and there is a significant shortage of places in care and treatment facilities (day-care homes, temporary stay homes and long-term care homes focused on the care of patients with dementia).

For this reason, the burden of caring for patients with Alzheimer’s disease rests mainly with their relatives. “According to the EX-ON study, 36 percent of patients with Alzheimer’s disease care for them in Poland. cases of a spouse, in 29 percent. daughter cases, and 10 percent. cases syn. Nearly one third of carers look after themselves, they can only count on themselves ”- emphasizes prof. Andrzej Potemkowski, vice-president of the Polish Neurological Society.

He adds that daily care takes an average of 7,2 hours a day, and in severe cases of dementia up to 14 hours a day. Therefore, the quality of care for the patient, and thus the success of the therapy, depends mainly on the caregiver’s commitment and efforts. “The doctor’s task is to establish good cooperation with the caregiver, including discussing his professional and financial situation, family condition and mutual family relations. The physician should not avoid such topics and be aware of whether the care effort is overwhelming the caregiver – and if so, to what extent and what support should be provided. Especially that in many cases the sick are also looked after by an elderly person: as much as 20 percent. caregivers are over 70 years old “- emphasizes the specialist.

1. Is this how Alzheimer’s disease begins?

Only less than half of Polish carers use any form of assistance. Following the example of other countries, the families of patients could be supported, for example, by social care workers or community nurses. The difficult situation of patients and their carers was additionally complicated by the COVID-19 pandemic.

Alzheimer’s disease in the COVID-19 era: “we are concerned that many patients have stopped treatment”

“The coronavirus pandemic has significantly changed the way medical care is provided for many groups of patients, in particular for many elderly people. Early clinical observations since the onset of the pandemic have shown that the virus is particularly dangerous in elderly patients with various comorbidities: diabetes mellitus, heart failure, obesity, and others. There has been high mortality among nursing home residents. Initially, the issue of the coexistence of chronic neurological diseases in this context was ignored. However, subsequent studies confirmed that people from these high-risk groups very often suffered from dementia and other neurological diseases “- emphasizes Prof. Konrad Rejdak.

The specialist points out that telepaths and e-visits, which replaced direct contact between the patient and the doctor during the COVID-19 pandemic, are not forms that fully work for patients with Alzheimer’s disease.

“We are concerned that many patients have stopped treatment or used their medications incorrectly. The suspension of visits to specialist clinics and hospitals also made it impossible to conduct diagnostics, and therefore there were delays in diagnosing the disease in new patients ”- warns Prof. Rejdak.