One in two of those surveyed in the 2017 Anxiety Study said they feared becoming a care recipient in old age. Many think of neurodegenerative diseases such as Alzheimer's dementia. Prof. Dr. Stefan Teipel, professor of clinical-experimental psychiatry, has headed the dementia research unit at the Psychiatric Clinic of the University Medical Center Rostock since 2008. He provides information on dementia diseases, diagnostic procedures and possibilities for early detection as well as preventive approaches and treatment.
Prof. Dr. Teipel: While just a few years ago it was assumed that the number of dementia cases in Germany could triple by 2050, the latest studies &„only“ predict a doubling. The number of dementia patients is currently continuing to rise, albeit less sharply than previously feared. The risk of developing dementia at a certain age has probably decreased slightly in recent years. However, due to the ageing of the population, there will still be a sharp increase in cases of dementia. Presumed reasons for this - which cannot be scientifically proven - could include better preventative healthcare and care as well as a healthier lifestyle. The fact is, however, that around 75% of dementia cases are influenced by genetic risk factors and very rarely are entirely hereditary. Anyone who gets old enough is therefore very likely to develop dementia.
Are there preventive options for dementia?Prof. Dr. Teipel: Yes, even if only to a limited extent. As I said, genes are usually the drivers of Alzheimer's dementia. However, data from a recently published study suggests that around a quarter of dementia cases could be prevented or at least delayed with a conscious lifestyle. Many small components add up here. These include the timely treatment of high blood pressure, hearing loss, visual impairment and poor dental status. In addition, do not smoke, drink alcohol in moderation and eat a healthy and varied diet. Another important piece of the puzzle is exercise, especially endurance sports and dancing - as a combination of endurance and coordination. Also important: a socially integrated lifestyle, even in later life. Loneliness alone does not prevent dementia, but it can contribute to it. It is also important for older people with various illnesses to have their medication plan regularly reviewed by their GP. I see further potential here, because taking medication incorrectly and drug interactions can cause dementia.
Every now and then, everyone forgets something. When do you need help?
Prof. Dr. Teipel: Since a person with Alzheimer's disease usually doesn't admit to themselves what's going on, relatives are particularly challenged. Is it a case of forgetfulness that happens to everyone - or is it the same thing being forgotten again and again? Do items find themselves in places where they don't belong? Do you find it difficult to operate everyday appliances such as the coffee machine correctly? Or are familiar objects, such as keys or the remote control, giving up secrets? Then you should seek a diagnosis. Unfortunately, an estimated 50 percent of people who actually suffer from dementia live without a diagnosis. This means: no medication, no treatment, no support. This is why a diagnosis is generally beneficial for both the patient and their relatives. Poor progression can be prevented and the effects delayed or mitigated. The Second Care Act (PSG II) brings many improvements for the everyday lives of relatives of dementia patients in particular.
How and at what point can dementia be diagnosed?
Prof. Dr. Teipel: Using biological markers and imaging techniques such as MRI and PET, we are now able to detect the presence of Alzheimer's pathology long before it breaks out. However, this does not necessarily mean that Alzheimer's disease will actually break out later. This is why this early diagnosis is not yet used as a routine test, but is reserved for research in the context of studies. Alzheimer's disease can be detected in routine care using biological markers and memory tests if the first memory problems occur before the full-blown dementia has developed. Another option is the memory consultation, especially for very early or unclear cases. Following a referral from a general practitioner or specialist, we carry out an early diagnosis consisting of a medical history, consultation, physical examination and various neuropsychological tests. Around a third of the patients in our memory consultation remain without any noticeable findings. However, if there is a suspicion of a memory disorder, further individual examinations are carried out, preferably on an outpatient basis. In addition, social workers at the Rostock memory consultation also provide intensive support and advice to relatives.
What hope is there after a diagnosis of „dementia“?
Prof. Dr. Teipel: Like other chronic diseases, dementia is one of the incurable diseases. However, the consequences can often be mitigated. In addition, the older the patient at the time of diagnosis, the more benign the course of the disease. Alzheimer's dementia therefore usually progresses slowly in a person who is 80 years old at the time of diagnosis and has multiple illnesses. Those who are younger at diagnosis, for example under the age of 50, are likely to have more genetic risk factors - usually with a more severe course and faster progression. Studies are currently underway with the aim of developing a vaccine, particularly for the patient group without multiple diseases. Otherwise, we have drugs available for treatment that are good at slowing down the progression of the disease symptoms in the early stages.
You are conducting research to improve the early diagnosis and treatment of dementia. Are there any collaborations here?
Prof. Dr. Teipel: We work closely with the German Alzheimer Society, MV State Association, and the Dementia Competence Center on state-wide training courses for relatives and low-threshold care services for people with dementia. As a cooperation partner of the GERIO e.V. funding association and the Tessinum, we support each other in the assessment and care/continuing care of patients in outpatient structures and are available to provide scientific support for projects. The main focus is currently on optimizing the acute and rehabilitative care of geriatric patients by networking geriatric care services in the Rostock region.
