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: Whereas just a few years ago it was assumed that the number of dementia patients in Germany could triple by 2050, the latest studies see "only" a doubling. Currently, the number of dementia patients continues to increase, but less strongly than previously feared. The risk of developing dementia at a certain age has probably declined slightly in recent years. Nevertheless, due to the high aging of the population, there will be a strong increase in dementia cases. Suspected - scientifically unprovable - reasons for this could include better preventive health care and health care as well as a healthier lifestyle. But the fact is that around 75% of dementia cases are influenced by genetic risk factors, and very rarely are completely hereditary. So anyone who gets old enough is very likely to develop dementia.
Are there any preventive options for dementia?
Prof. Dr. Teipel: Yes, although only to a limited extent. As I said, genes are mostly the drivers of Alzheimer's dementia. However, data from a recently published study suggest that about a quarter of dementia cases could be prevented or at least delayed with conscious lifestyle choices. Many small building blocks add up here. These include timely treatment of high blood pressure, hearing loss, poor vision and poor dental status. In addition, do not smoke, enjoy 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 cause dementia, but it can contribute to it. It is also important for older people with various illnesses to have their medication regimen regularly reviewed by their family doctor. I see further potential here, because taking medications incorrectly and drug interactions can promote dementia.
Everybody forgets something now and then. When do you need help?
Prof. Dr. Teipel: Since a person affected by Alzheimer's dementia usually does not admit to himself what is going on, the relatives are particularly challenged. Is it a case of forgetfulness, which happens to everyone from time to time - or is the same thing forgotten again and again? Do objects find themselves in places where they don't belong? Is it difficult to operate everyday devices such as the coffee machine correctly? Or do familiar objects pose a riddle when it comes to handling them, such as keys or the remote control? If so, you should seek a diagnosis. Unfortunately, an estimated 50 percent of those actually suffering from dementia live without a diagnosis. That means no medication, no treatment, no support. That's why a diagnosis is usually beneficial for both the patient and family members. Bad progressions could be prevented, effects delayed or mitigated. The Second Care Strengthening Act (PSG II) brings many improvements to everyday life, especially for relatives of dementia patients.
How and at what point can a dementia disease be detected?
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 dementia will actually break out later. Therefore, this early diagnosis is not yet used as a routine examination, but is reserved for research in the context of studies. Alzheimer's disease can be detected in routine care by means of biological markers and memory tests when the first memory disorders exist, even before the full-blown dementia has developed. Memory consultation is also an option, especially for very early cases or for cases that are unclear. After referral from a general practitioner or specialist, we perform an early diagnosis consisting of a medical history, a doctor's interview, a physical examination and various neuropsychological tests. About one third of the patients in our memory consultation then remain without any conspicuous findings. If, however, the suspicion of a memory disease is confirmed, further individual examinations follow, if possible on an outpatient basis. In addition, social workers at the Rostock memory consultation also provide intensive support and advice to family members.
What hope is there after the diagnosis of dementia?
Prof. Dr. Teipel: Like other chronic diseases, dementia is a disease that cannot be cured. However, the consequences can often be mitigated. In addition, the older the patient at diagnosis, the more benign the course. In other words, Alzheimer's dementia usually progresses slowly in someone who is 80 years old with multiple diseases at the time of diagnosis. Those who are younger at diagnosis, for example under 50 years of age, are likely to have more genetic risk factors - usually with a more severe course and faster progression. Especially for the patient group without multiple diseases, studies are underway with the aim of developing a vaccine. Otherwise, we have drugs available for treatment that are good at slowing the progression of disease symptoms in the early stages.
You are conducting research to improve the early diagnosis and treatment of dementia. Are there any collaborations in this area?
Prof. Dr. Teipel: We work closely with the German Alzheimer's Association, MV state association, and the Dementia Competence Center on statewide training for relatives and low-threshold care services for people with dementia. As cooperation partners of the Förderverein GERIO e.V. and the Tessinum, we support each other in the assessment and care/continuing care of patients in the 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 offers for geriatric care in the Rostock region.