Researcher at the Department of Social Psychiatry of the National Institute of Mental Health (NIMH) Pavla Čermáková, MD, Ph.D., focuses on topics related to cardiovascular diseases and dementia. We asked her questions about dementia, its diagnosis, and the role of modern technologies in research. Read the interview below.
What is dementia, and how does it differ from normal aging? How many different types exist, and which do you think the public understands or knows the least about?
Dementia is a brain syndrome affecting older people, leading to the death of neurons. It often begins with difficulty remembering recent events, progressing to challenges with complex tasks, spatial orientation, and recognizing familiar faces. Lack of understanding, speech difficulties, and behavioral or psychiatric symptoms may also occur. Alzheimer's disease is the most common type, followed by vascular dementia, but mixed dementia, combining both, is increasingly recognized. Less common types include Lewy body dementia, Parkinson's-related dementia, and frontotemporal dementia.
What do we know about the causes of dementia? Why do people suffer from it?
The most common form, a mix of Alzheimer's and vascular pathologies, results from a combination of factors, including genetic sensitivity, environmental influences, and the cumulative effect of various risk factors. Age is a significant risk factor, with other risks tied to high blood pressure, diabetes, obesity, physical inactivity, high cholesterol, smoking, and depression. Education, social integration, and an intellectually stimulating lifestyle are protective.
Some believe dementia occurs because every human brain has an "expiration date." What's your perspective on this?
Unlike cells in other organs, neurons cannot replicate, and the exact reason for their death in dementia is unclear. There's no singular cause, likely a cumulative effect of various factors. While aging affects all organs, our bodies often handle it better as it doesn't compromise independence, unlike dementia.
How is dementia diagnosed, and how challenging is it to distinguish between different types? How definitive is the diagnosis?
Diagnosis involves clinical exams, cognitive screening, ruling out other causes, and brain imaging. Distinguishing types isn't easy, and a specific diagnosis typically requires a postmortem autopsy by a neuropathologist.
Is it true that dementia is usually diagnosed several years after its onset? What can be done to improve early diagnosis, and are there symptoms to watch for?
Yes, dementia is often diagnosed late. Early detection benefits remain inconclusive, but individuals concerned about memory or behavioral changes should consult a doctor for cognitive assessments and further evaluation.
What is the prevalence of dementia in the EU? Is there any form of dementia prevention?
Dementia prevalence in Europe is approximately 2% at 65-70 years, doubling every five years, reaching 25-30% at 85 years or older. Strategies like exercise, weight loss, a diet rich in fruits and vegetables, non-smoking, and an intellectually stimulating lifestyle may contribute to prevention.
Are there treatment procedures for dementia, a drug, or at least methods for managing symptoms?
There's no cure for dementia, and symptoms are mainly managed with acetylcholinesterase inhibitors and memantine, providing temporary cognitive improvement.
What do you think is the primary goal of current dementia research? Is it early diagnosis, symptom treatment, or finding a cure? How close are we to any of these?
Understanding the causes of dementia is crucial for discovering a cure. However, we're far from a breakthrough, and no new drug is expected in the next 15 years.
What role do modern technologies play in dementia research and treatment?
Advanced imaging methods help understand brain processes, and technologies aid patients in tasks, preserving independence. Monitoring technologies can track symptoms, providing alerts before potential issues occur.
Is dementia research underfunded, or does it receive the attention it deserves?
Researchers often argue their field is underfunded. While dementia gains attention, increasing resources are essential due to the lack of a cure and the growing number of dementia patients.
How does the EU engage in this field, through research funding or awareness campaigns? Is the EU actively involved, and what more could it offer?
The European Joint Programme on Neurodegenerative Diseases (JPND) is an example of a European platform addressing dementia. Investing in the education of talented individuals is crucial for future research leadership. Initiatives like SyDAD aim to provide exceptional training, focusing on synaptic dysfunction in Alzheimer's. A "bottom-up" approach, supporting ideas from individuals rather than government-driven projects, proves effective, allocating resources to those with the highest potential and integrity. More funding and support for high-quality research are needed.
In conclusion, dementia remains a complex challenge, and addressing it requires a multifaceted approach, involving research, technology, and societal awareness.