Alzheimer's disease: diagnosis and treatment, errors in patient management

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Diagnostic hypothesis of Alzheimer's disease (AD) is based on the typical clinical picture of the disease and the exclusion of other diseases manifesting by cognitive and behavioural disorders by MRI scans of the brain and laboratory tests. For an accurate diagnosis of AD and exclusion of other diseases, detection of biological markers (biomarkers) of AD in the cerebrospinal fluid (CSF) is of great importance: a decrease in the level of beta-amyloid (Ав^ -42) and an increase in the level of phosphorylated tau protein. The analysis of AD biomarkers in the CSF of 63 patients (16 men and 47 women, mean age 72±8.7 years) with a typical picture of AD [30 patients in the moderate cognitive impairment (MCI) stage and 33 in the mild dementia stage] allowed us to confirm the diagnosis in 54 cases (85.3%) and to exclude it in the remaining nine patients (14.7%). We present a case of a 59-year-old patient with MCI in whom biomarkers typical of AD were detected in the CSF, confirming the diagnosis of AD. We also present the observations of two patients with possible AD, in whom the results of the CSF examination made it possible to rule out AD and indicated hippocampal sclerosis and tauopathy. At present, an accurate diagnosis of AD based on the study of biomarkers of the disease is of great practical importance, since at the stage of MCI and mild dementia it is possible to prevent the progression of AD with anti-amyloid therapy. Currently, AD is rarely diagnosed in our country, so it is of great importance to inform physicians about modern methods of diagnosis and treatment of AD.

Biological markers of Alzheimer's disease in cerebrospinal fluid: clinical and laboratory comparisons

Shevtsova,

Rozhkov,

Grishina

et al. 2024

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Resolution of the Expert Council on the problem of early diagnosis of Alzheimer's disease

Bogolepova,

Vasenina,

Vakhnina

et al. 2024

Alzheimer's disease (AD) is the most common neurodegenerative disease and the most common cause of dementia. In daily practice, AD is often diagnosed late, while the early stages of the disease are overlooked or mistaken for cerebrovascular pathology. However, the efficacy of existing and newly developed (disease-modifying) AD therapies is the greatest in the early stages of the disease. An accurate diagnosis of AD is possible when biological markers of the main pathological process (cerebral amyloidosis, tauopathy) are detected using positron emission tomography or neurochemical examination of cerebrospinal fluid, which are gradually being introduced into practice in Russia. The experts discussed the clinical aspects of the use of biological markers, obtained in the leading specialized centers of our country for the diagnosis and treatment of cognitive impairment (CI). First and foremost, biomarker testing is indicated in patients with mild CI and mild dementia possibly associated with AD, so that disease-modifying (pathogenetic) therapy can be initiated as early as possible upon on its availability (currently, drugs for anti-amyloid disease-modifying therapy are not registered in the Russian Federation). Patients with a non-classical (non-amnestic) or atypical AD phenotype are another group of patients in whom it is also advisable to analyze biomarkers for differential diagnostic purposes.

Management of patients with cognitive impairment in old age

Grishina,

Lokshina,

Sokolov

2024

Cognitive impairment (CI) is one of the most common disorders in elderly. As the population ages, the prevalence of cognitive impairment CI is also increasing. The importance of early identification of individuals with mild CI (MCI) lies in the fact that timely diagnosis of these disorders increases the potential for secondary prevention and therapeutic intervention, which can delay or even prevent the onset of occupational and social maladaptation due to the development of dementia. The current principles of classification of the MCI and the criteria for its diagnosis are presented. Current approaches to the treatment of patients with CI are discussed. It is shown that treatment should start as early as possible and include both non-pharmacological and pharmacological approaches to improve cognitive abilities and prevent CI progression. The possibilities of modern neuroprotective and symptomatic therapy of MCI and the role of choline alfoscerate in the treatment of MCI and dementia are presented. The results of the multicenter placebo-controlled ASCOMALVA study are discussed, in which the addition of choline alfoscerate to donepezil therapy in patients with Alzheimer's disease and cerebrovascular disease helped to slow the progression of CI, reduce the severity of the disease, and had a positive effect on the behavioral functions and emotional status of both patients and their caregivers. In addition, a decrease in the progression of cerebral atrophy was observed. A new form of choline alfoscerate (Cerpechol) for oral administration is reported that may increase patients' compliance and can be used in patients with dysphagia.