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For many seniors with Alzheimer's disease, not everything is as it seems. A distinct form of late-onset dementia called LATE may be the real cause of their illness. The problem is far from easy.
The recently published guidelines could help clinicians distinguish between the two diseases, offering people with one of these conditions a better prognosis for their future mental health, while promoting awareness of various forms of dementia.
With so much attention paid to Alzheimer 's disease in recent years, it is easy to forget that there are other neurodegenerative conditions to watch out for.
Some are relatively easy to identify based on the patient's history, various biomarkers, or distinctive symptoms.
A particular form of dementia called aging-related TDP-43-related encephalopathy, predominantly limbic – or LATE – means unusually, like Alzheimer's disease, offering many possibilities for misdiagnosis.
"Recent research and clinical trials on Alzheimer's disease have taught us two things," said Nina Silverberg, director of the Alzheimer's Disease Treatment Centers Program at the National Institute. American aging.
"First, all the people we thought had Alzheimer's disease were affected, and secondly, it's very important to understand the other factors of dementia."
Although the name of the condition is new, LATE has been on the radar for a long time.
The researchers first noticed a strange tissue stiffening in the hippocampal regions of dementia patients in the mid-1990s. Alzheimer's disease is usually associated with a mess of protein in the form of entangled chains. of tau and cluster of beta amyloid inside neurons. However, the autopsied brains of these patients showed no sign of such accumulations.
More than a decade later, a culprit in the form of a protein called TDP-43 has been discovered.
Far from its usual place in the nucleus and charged with phosphorus, the pathological form of the protein seems to cause many problems in specific areas of the brain associated with memory and emotions.
This is not a rare event either. Autopsies suggest that 20 to 50% of all people over 80 could accumulate enough errant TDP-43 protein to be affected cognitively.
As common as it may seem in older demographic groups, the consequences are similar to Alzheimer's disease, characterized by a decline in memories and a deterioration of thought and social skills.
It is not easy to separate the two without autopsy, especially without a set of agreed criteria. In addition, having one form of dementia does not exclude the other. People with both Alzheimer's and TARD could experience a double dose of symptoms.
Noting the trend in research involving the TDP-43 as a possible imitator of Alzheimer's, a group of experts organized a workshop to provide a starting point for further research that will better understand a topic. another factor contributing to brain changes at the end of life, "said Silverberg.
As a result of this workshop, clinicians have now proposed a set of criteria that could be used to differentiate LATE from Alzheimer's disease, as well as a set of recommendations on the next step to which researchers should to turn.
The differences are still quite subtle, including contrasting patterns of various neurocognitive test scores and differences in rates of decline.
Unfortunately, none of these criteria include something as simple as a blood test. As beautiful as it is, finding a practical biomarker for one or the other of these conditions is always on the to-do list.
But researchers have identified some genes to watch for, some of which seem to coincide with the genetics that play a role in both diseases.
Having a way to separate the conditions could be a major win for researchers who are studying promising treatments for Alzheimer's disease, who have been baffled by a series of failures in recent years.
Not only could we be mistaken about many of our basic assumptions about the disease, but we could also conduct clinical trials of patients with misdiagnosis.
Dementia should become a growing problem in an aging world. a disease that is much more complex than it seems. Unraveling this complexity is a necessary step to find the best course of action to help people.
This research was published in Brain.
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