Research and development

Dementia:

Dementia is a syndrome characterised by progressive impairment of cognitive functions, such as memory, learning ability, orientation, language, etc., and is associated with increasing loss of autonomy in everyday life. A distinction can be made between primary and secondary forms of dementia. Secondary dementias represent only a small proportion (approx. 10%) of all dementias and are caused by other underlying diseases (e.g. intoxication by alcohol or medication, tumours, metabolic diseases, etc.). Primary dementias are chronic pathological changes in the brain. The most common form of dementia is Alzheimer’s disease (approx. 60-65%). Other forms (vascular dementia, Lewy body dementia, frontotemporal dementia, etc.) and mixed forms also occur. It is estimated that around 55 million people worldwide are affected by dementia. Around 10 million new cases of the disease are added every year. According to estimates by the World Health Organisation (WHO), around 140 million people will be affected by 2050. There is currently no cure for dementia. Treatment is focussed on alleviating the symptoms and improving the quality of life, and can slow down the progression of the disease somewhat.

Preclinical phase of Alzheimer’s disease

Dementias such as Alzheimer’s disease progress in phases, with many sufferers reporting subjective cognitive impairment (SCD) in the first “preclinical” phase. Although this cognitive impairment is perceived subjectively by the person, it cannot yet be detected using standard psychological test procedures. However, studies show that people with SCD are more likely to develop Alzheimer’s disease in the future. This phase is therefore described as a possible precursor to Alzheimer’s disease. The next phase is mild cognitive impairment (MCI), whereby cognitive deficits can already be measured using psychological tests.

Early detection and prevention

Scientific studies show that degenerative changes in the brain can be detected several years before the first clinical symptoms appear. This is why early detection and prevention are of enormous importance. Early therapeutic measures can be introduced in the first phases of the disease, when the changes are still in the early stages, and preventive measures can slow down or even prevent the progression of the disease. Monitoring and early detection allow individualised prognoses and timely interventions. Twelve modifiable factors have been identified that increase the risk of dementia, such as hypertension, diabetes, obesity, hearing loss, depression, etc. Preventive strategies primarily include measures that specifically influence these risk factors. The initial results of the Finnish Intervention Study (FINGER) show that multidimensional early intervention through lifestyle changes with a healthy diet, physical and cognitive training and the treatment of vascular risk factors makes a decisive contribution to improving cognitive functions and slowing down the process of mental decline. Over a period of two years, more than 1,200 people aged between 60 and 77 with an increased risk of dementia were examined. Overall, the participants’ cognitive abilities improved by 25 per cent, with an even greater increase in performance in individual domains(www.wwfingers.com).

Active Mental Ageing Initiative (AMA-I)

As the progression of dementia is usually gradual, the first symptoms are often ignored or overlooked. Although not every cognitive impairment is caused by the presence of dementia, any suspicion should be clarified and monitored over time. The aim of AMA-I is to determine the presence of a risk of developing Alzheimer’s disease through regular cognitive testing. However, it is just as important to identify people who are not at risk. The International Neurocognitive Test Profile (INCP) is a neuropsychological test procedure that is used to detect even minor cognitive changes. Its use can facilitate or enable the early detection of dementia. This tool gives cognitively healthy people the opportunity to regularly check their cognitive abilities independently on their own tablet. The first step is a detailed diagnosis during an appointment with a specialist (e.g. psychologist, neuropsychologist, psychiatrist, etc.) at the practice or clinic. This appointment serves to examine the cognitive abilities and determine the initial level. The follow-up examination is ideally carried out one year later. As it is very time-consuming and often not possible to carry out more frequent tests in a clinical setting, patients can carry out shorter tests from home in the meantime, independently and ideally on a monthly basis, until their next follow-up appointment with the specialist. Regular testing allows even the smallest changes in cognitive abilities (e.g. memory) to be detected at an early stage. An integrated traffic light system informs users immediately about the results of their tests. If changes occur during these regular tests, the test system recommends a consultation with the supervising clinical specialist so that a detailed diagnosis can be carried out again.

Specialists participating in the AMA-I:

Assoc. Prof. PD. Dr Johann Lehrner, psychologist, 1140 Vienna, johann.lehrner@meduniwien.ac.at