Popular action actor Bruce Willis has been diagnosed with a rare form of dementia. It took years from the first signs to a definite diagnosis. In the meantime, the American had announced that he could no longer act because he could no longer remember the texts.
Dementia and especially Alzheimer’s, but also depression, not only stir up fans of the actor, but also citizens whose friends or relatives are affected. How can the diseases be recognized early and what can be done about them? At the health days of the Lions Club Winnenden on February 18th presented after the lecture by Chief Physician Dr. Andreas Raether from the Center for Psychiatry (Department of Geriatric Psychiatry and Psychotherapy) asked four guests anonymously and in writing.
Question 1: What are the latest methods for diagnosing dementia?
dr Raether: The basics for diagnosing dementia are presented in so-called diagnostic guidelines of an international working group. They have recently put more emphasis on examinations of the brain and cerebrospinal fluid. These include PET (positron emission tomography).
This is an X-ray examination for which a radioactive substance is injected into the bloodstream. It targets the pathological protein deposits in Alzheimer’s disease, called amyloid. Accordingly, the examination is also called “amyloid PET”. It is very complex and at the same time very expensive and the significance is still limited – the certainty for the correct diagnosis is therefore not very high. This means that amyloid PET is not a routine examination.
The investigations of the amyloid proteins and the protein tau in the cerebrospinal fluid have more weight in connection with the perception of degradation processes in the brain. The cerebrospinal fluid (liquor) is obtained with the liquor puncture. The brain bathes in the cerebrospinal fluid, so that changes in the brain can be detected indirectly by examining the cerebrospinal fluid. Degradation of the brain, on the other hand, can be detected with the help of computed tomography or magnetic resonance imaging.
Question 2: Are there suitable drugs to treat dementia?
Dementia is a syndrome of many diseases, most commonly Alzheimer’s disease. But dementia can also develop in the course of many other diseases, for example in Parkinson’s disease, but also in the case of very long-standing circulatory disorders as a result of arteriosclerosis of the blood vessels in the brain. Therefore, there is no “one” drug for dementia.
However, the treatability of Alzheimer’s disease is making slow progress: In recent years, several antibodies against the pathological deposits in Alzheimer’s disease have been developed. And now, a few months ago, it seems to have been possible to develop a substance with the antibody lecanemab that – actually used in the early phase – can noticeably slow down the disease process. Approval for Europe is expected in the first half of 2023. The costs of the treatment will certainly not be low – the availability will probably not be great immediately either.
Question 3: How do doctors differentiate between ADHD and dementia in old age?
ADHD (Attention Deficit Hyperactivity Disorder) is a disorder of impulsiveness control with increased distractibility, which usually occurs in adolescence.
Ten years ago, there were first indications of a connection between ADHD in older people and dementia in old age – through noticeable shrinkage of certain parts of the brain that have to do with memory (hippocampus formation) and feelings (tonsil nucleus).
Last year, researchers showed a connection between the occurrence of ADHD and an increased risk of later developing a specific dementia disease, namely Lewy body dementia – with a much lower probability this also applies to Alzheimer’s dementia.
From today’s perspective, the difference between ADHD (from the age of 60) and dementia is due to a different distribution of degradation symptoms in ADHD and dementia: In ADHD there seems to be a stronger connection with certain neurotransmitters (the transmitter substances dopamine and noradrenaline), in dementia, an altered three-dimensional structure of proteins, which clump together and cannot be broken down, is likely to be the cause.
It should not be forgotten that, in terms of numbers, it is also important not to neglect diseases of affluence such as obesity, high blood pressure, diabetes, hardening of the arteries as the cause of many diseases, but also later brain damage.
Question 4: What are the first signs of depression?
The first signs of depression can be very diverse, they are often not recognizable as such, especially in the case of a first-time depression.
This means that for quite a few people, the actual symptoms of depression, namely the lack of joy, the reduction in initiative and drive, do not have to be at the beginning. A diffuse reduction in strength (“fatigue”), inner restlessness, fear, panic, sleep disorders can be the starting point, as can sexual dysfunction and thought disorders (with the difficult distinction from dementia in old age). Withdrawal from club life or increased irritability, in men the increased consumption of alcohol, can also give clues.
It is not uncommon for many physical symptoms, for example on the skin with new changes that have occurred, but also intestinal dysfunction or even cardiac arrhythmia as psychosomatic symptoms to go hand in hand with depression. In any case, from a certain point in time the body reacts with a physical and mental stress reaction – via the vegetative nervous system, the hormone and the immune system – which then causes new symptoms and can lead to a self-reinforcing cycle, so that the depression, despite treatment may increase at an alarming rate at first.
On the other hand, people who have already overcome depression in the past know some of the first signs of imminent depressive symptoms.
If the suspicion of depression is confirmed, professional advice should be sought at an early stage. At the latest when thoughts of the meaninglessness of life appear, constant brooding over the present and future, with thoughts of one’s own death, one can no longer speak of a mild symptomatology, and professional help is absolutely necessary.