Alzheimer’s: when to seek a neurological evaluation

To mark World Alzheimer’s Day, a neurology specialist calls on people to recognise the signs that go beyond simple forgetfulness, and to seek a specialised neurological evaluation when there are persistent changes in memory, orientation or behaviour.

Forgetting where you left your keys, taking a few seconds to recall a name or missing an appointment can happen as we grow older. However, when lapses stop being isolated, interfere with daily activities or come with changes in orientation, behaviour or decision-making, it is important to pay attention and consider a neurological evaluation to determine the possible causes.

When these changes are persistent and begin to affect everyday life, they may be related to some form of dementia, including Alzheimer’s disease. According to estimates by the 10/66 Dementia Research Group, more than 100,000 people in the Dominican Republic could be living with dementia, based on an estimated prevalence of 11.7% among people aged 65 and over. Projections suggest this figure could rise to around 125,000 people by 2030 and 240,000 by 2050, according to Alzheimer’s Disease International.

While Alzheimer’s is a progressive brain disease and the most common cause of dementia, it is not the only possible explanation for a cognitive change. Some medical conditions can produce symptoms that resemble cognitive decline. It is therefore advisable to seek a specialised neurological evaluation for Alzheimer’s, in order to pinpoint the possible causes of the symptoms more precisely, reach a timely diagnosis and define the most appropriate treatment approach.

The brain changes behind memory loss

But what exactly is Alzheimer’s disease? It is named after the German physician Alois Alzheimer, who in 1906 first described unusual changes in the brain of a patient who had experienced memory loss, disorientation and other cognitive changes. Examining her brain tissue after her death, he identified deposits and tangled fibres now known as amyloid plaques and neurofibrillary tangles, two of the main features associated with the disease.

“Plaques and tangles are still considered the hallmark lesions of Alzheimer’s disease,” explains Dr Teresa Gomez-Isla, the neurologist who heads the Memory Division at Massachusetts General Hospital. These changes progressively affect brain regions linked to memory, reasoning, language and behaviour, which helps explain why the symptoms can go well beyond memory problems.

The disease usually affects people over 65 and, although its exact cause is unknown, it is thought to develop from a combination of different factors such as age-related brain changes, family and genetic history, some environmental factors and lifestyle aspects, including levels of physical activity.

As these changes advance, they begin to show in different cognitive and behavioural abilities. At first they can be subtle and vary from one person to another, but they tend to become more evident as the disease progresses. The signs and symptoms of Alzheimer’s in its early and middle stages include:

• Memory loss
• Confusion
• Difficulty carrying out everyday tasks
• Changes in mood and personality
• Increased anxiety, depression or aggression
• Difficulty speaking or communicating
• Changes in sleep patterns

“As the disease progresses, memory loss and confusion become more evident. People may even have difficulty recognising family members or friends,” says Dr Gomez-Isla.

Research opens up new ways to detect and treat Alzheimer’s

Although there is no cure for Alzheimer’s, certain medicines can help control the symptoms. The Food and Drug Administration (FDA) has recently approved new medicines for patients in the early stages which reduce amyloid plaques in the brain and may slow the progression of the disease.

For the Mass General Brigham specialist, these advances open up new possibilities: “Thanks to the new medicines available and a growing understanding of the origins of Alzheimer’s, we can improve the quality of life of patients and their carers around the world.” She warns, however, that “we are all unique and respond differently to medicines. It can take some time to find the right medicine and dose for you or your loved one.”

Research, meanwhile, continues to move forward. As part of that effort, Gomez-Isla and her colleagues at Mass General Brigham — an institution committed to teaching and research aimed at developing new treatments and cures for a range of diseases — are studying new diagnostic tools and therapeutic strategies. “We hope to use this knowledge to predict who will develop the disease and to develop therapies that can delay or prevent it,” she explains.

One of those lines of research found that difficulty using a simple telephone menu could be associated with a higher risk of developing Alzheimer’s. “The data show that we might be able to identify and treat people long before they show significant symptoms,” the specialist notes.

Further evidence comes from the long-term follow-up of a large Colombian family with a history of early-onset Alzheimer’s caused by a genetic mutation. In carriers of that mutation, researchers detected amyloid plaques up to 15 years before the first symptoms appeared.

“These pioneering studies give us a deeper insight into the disease. They also offer possible key clues for developing future treatments that could protect people and stop them from going on to develop Alzheimer’s,” concludes Dr Gomez-Isla.

As research opens up new possibilities for early detection and for the development of advanced medical treatments for Alzheimer’s, access to a specialised neurological evaluation also becomes more important. Institutions such as Mass General Brigham, one of the largest healthcare systems in the United States, provide international patients with high-quality personalised care. In this way they bring their medical expertise and centres of excellence closer to patients in different parts of the world, making it easier to access specialised care tailored to each person’s needs.