DR PAPASAVVAS - ALZHEIMER'S, MARTYRDOM FOR MILLIONS OF PEOPLE

 Filenews 11 October 2020 - by Giannis Antoniou

"Silent killer" is the predominant characterization attributed to Alzheimer's disease, which afflicts millions of people around the world and afflicts their family and social environment. The disease is only cured symptomatically with existing medicinal preparations. "But there is light at the end of the tunnel because science continues the treatment effort incessantly," Professor Savvas Papakostas, Senior Neurologist, Director of the Neurobiology Department of the Cyprus Institute of Neurology and Genetics, tells "F", referring to the innovative drug which is expected in Cyprus and the rest of Europe by the end of 2021. In Cyprus, according to the results of the last bi-community survey of 2004, the proportion of Greek Cypriots suffering from the disease is estimated at around 7.2%.

-What exactly is Alzheimer's disease and what are the main symptoms?

-Alzheimer's disease is a progressive, neurodegenerative disease (where brain cells are gradually destroyed) whose initial and main symptom is an ever-worsening memory disorder. Subsequently, all mental functions such as critical thinking, orientation, recognition of familiar persons and spaces, communication, behaviour and the ability to self-preservation are gradually affected. Neuropsychiatric disorders such as depression, psychosis, motor problems also occur, while in the final stages patients become fully dependent on others.

- Where is the disease attributed? What's to blame?

-The exact cause of the disease is not known. But there are some pre-availability factors such as specific genes, which increase the risk of developing the disease. It is estimated that first-degree relatives of these patients have an increased risk of developing the disease during the senile period. The brain exhibits specific changes such as atrophy in the areas involved in memory and other cognitive functions and behavior. Under the microscope, the brains of these patients present characteristic findings of the so-called amyloid plaques and neurofibroid complexes that cause the above-mentioned lesions. By the way, these findings were identified and first described by the German neuropsychiater Alois Alzheimer, whose name bears the name of the disease.

- There's a confusion between dementia and Alzheimer's disease.

-Alzheimer's disease is responsible for about 50% of dementia cases. Dementia (or, as it was previously wrongly called, arteriosclerosis), is the condition that is characterized by disturbances in brain functions, behaviour and which results in patients not being able to carry out their daily activities in the family, work or society. The important thing is that dementia patients don't all have Alzheimer's disease. This means that some other causes that cause similar symptoms need to be identified because they may, with appropriate treatment, be reversible. However, various forms of dementia that may result from other pathological causes such as vitamin B12 deficiency, hypothyroidism, multiple medications, depression and others need to be diagnosed in a timely manner as they can be cured.

- It affects older people more, doesn't it?

-There are rare familial forms where the disease is strongly hereditary and the onset of symptoms occurs between 40-60 years. Fortunately, the number of these families is limited. The majority of people with the disease have the so-called sporadic form which occurs after the age of 65.

- Do we have numbers for Cyprus? How many people does this disease suffer? On a global scale, where do the numbers range?

-It is estimated that the disease affects about 5% of people over the age of 65 and 20% of people over the age of 80. In Cyprus, according to the results of a bi-community survey conducted in 2004, the proportion of Greek Cypriots suffering from the disease is estimated at around 7.2%. It is one of several neurological diseases that cause dementia and in the United States is the fourth leading cause of death for elderly people.

- There's no effective cure. But there's medication that can slow her down.

-Unfortunately Alzheimer's disease is only cured coincidentally with existing medicinal preparations which also slow down to some extent its deterioration. But there is light at the end of the tunnel because science continues to relentlessly try to cure it. In fact, the administration of an innovative drug that seems to dissolve the amyloid plaques that cause Alzheimer's disease has recently been approved in America. We estimate and hope that it will be released in Cyprus and the rest of Europe by the end of next year.

-How does the Cyprus Institute of Neurology & Genetics help these people and their families?

-21 September has been designated as World Alzheimer's Day in order to raise public awareness of the disease. The international scientific community conducts research activity to determine the pathophysiology of the disease with a view to creating effective treatment. The Cyprus Institute of Neurology & Genetics (ING) participates in this effort with its own research projects. The Institute has been operating for more than 25 years a dementia clinic where patients with memory disorders are referred for evaluation, diagnosis and treatment. In addition, it deals with specialized research on dementia and in particular Alzheimer's disease.

He conducted clinical studies with new therapeutic drugs, studied the epidemiology of the disease in Cyprus, and through his master's degree in Molecular Medicine Cyprus, studies are carried out on mouse models that develop the disease in relation to its pathophysiology at the cellular level of the brain. A doctoral thesis on the burden on caregivers of dementia patients has previously been carried out. In order to help both the patient and his family, support links have been established worldwide and in Cyprus. The Cyprus Association has been active for many years and provides important assistance to both patients and caregivers. Day centres have been set up where patients with early stages of the disease can spend a few hours and release their relatives to deal with important cases but also to subject the patients themselves to systematic psychosocial therapy, mental empowerment, physiotherapy and occupational therapy.

-Are there other ways, other methods to slow the worsening of the disease?

-If there is no effective treatment and once the symptoms appear, the disease unfortunately progresses unabat, it is a good thing to identify mechanisms for preventing and avoiding or shifting in the future of the onset of the disease. There is research evidence that by avoiding harmful substances such as excessive alcohol, smoking, the use of illegal addictive substances, and with a proper diet (such as the Mediterranean diet), we reduce the chances of developing the disease even when heredity is important. Also, frequent brain training in mental activities such as daily reading, crossword solutions, learning a new language and generally avoiding inactivity, help keep brain neurons alive for longer. The general health status of the patient also plays an important role in brain health especially the control of diabetes and hypertension.

Recent research, which also includes Cyprus, shows that the use of headphones and glasses helps to involve people more actively in society and to maintain mental health. It is also encouraged to reduce air pollution and avoid craniocerebres of factors that burden normal brain function. Finally, it has been shown that the higher a person's level of education, the lower the risk of developing the disease and, therefore, the more concerted effort is made to provide adequate schooling. Passive occupations such as watching TV for many hours do not seem to protect and can have harmful consequences, while the active lifestyle benefits.