Alzheimer’s disease, what the future of memory will be like

This article is published in issue 39 of Vanity Fair on newsstands until 26 September 2023

Its earliest cases were those of two women aged 32 and 33. Giovanni Frisonifull professor of Clinical Neurosciences and director of Memory clinic of the University Hospitals of Geneva, cites them while explaining that there is not just one type of Alzheimer’s, but three. «The patients were at an already advanced stage of a very rare form, which strikes before the age of 40-50 and runs in families for several generations, regardless of sex». He also adds that this rare form, determined by three specific genes (App, Ps1 and Ps2), “has a few hundred cases in the world and is the only one that can be diagnosed through DNA testing”.

Alzheimer’s disease, of which World Day is on September 21stis the most widespread cause of dementia: six out of 10 patients suffer from it, approximately 60 percent of the 55 million cases currently registered in the world. Two-thirds become ill due to a mutation in the Apolipoprotein E (ApoE) gene. “This type of Alzheimer’s occurs at an advanced age, between 65 and 75 years of age, and affects the regions of the brain that regulate learning, with very strong memory disorders,” he explains.
Frisians. “The difference compared to the first type is that the presence of the gene does not mathematically determine the development of the disease, but indicates a risk factor.” ApoE is the gene that Australian actor Chris Hemsworth, 40, also discovered he has. In an interview given last year to Vanity Fairthe star of Thor he said the risk of getting sick pushed him to change his life and focus on physical and mental health.
Finally, a third of patients become ill even without the presence of a specific gene. «It is the last form, the one that includes memory and cognitive disorders, concerning the ability to carry out complex actions», adds the expert.

Pierrette left France for love. She married a Calabrian and followed him to her homeland. Quiet life, two children. Then, 15 years ago, the disease. Today, at 86 years old, she no longer remembers a word of Italian. She lives in Cicala (in the province of Catanzaro), within the HomeCountry, a small village of over 900 m2 where people with dementia can feel free to live at their own pace. “Pierrette speaks her own language, but we understand her perfectly,” he says Elena Sodano, founder of this special community. «Pierrette is a calm person, thanks to the time that expands here and to an awareness: the ailments of the 14 guests are necessities not understood; we must learn to satisfy them.”

In such a vast picture, is it possible to understand why the disease manifests itself in some cases rather than in others? “Today we know that it develops due to a convergence of genetic and environmental factors» replies Frisoni. «In the first form, genetics are sufficient to determine its appearance. In the second, environmental factors are also necessary, which become priorities in the case of the third.”

One 2020 study released by Lancet Commission has increased the risk factors that can contribute to the development of Alzheimer’s from nine to 12. It’s about hypertension, obesity, hearing problems, smokedepression, poor physical activity, diabetes, lack of social contacts, low level of education, excessive alcohol consumption, brain trauma And air pollution. «There are probably others that we know less about, but we have understood that prevention has a fundamental role: it is the most important frontier in the treatment of the disease», underlines Frisoni.

Although it is still incompletely known, over the last 30 years many aspects of the pathophysiology of Alzheimer’s have been clarified which they also made it possible to develop new drugs active on one of the primary causes. «This is a phenomenal advance if you consider that, when I began my journey in 1992, inside the first Italian center specifically for Alzheimer’s in Brescia, it wasn’t even clear whether it was truly a disease or simply a somewhat particular aging process”, highlights Frisoni.

2023 marks important milestones on the research front. «New studies have confirmed the effectiveness of three monoclonal antibodiesdemonstrating that, if we act on a certain neurobiological pathway – namely the amyloid cascade (a substance whose appearance is connected to the process of breakdown of cellular proteinsed.) -, the disease can be significantly slowed down”, he explains.

The three new drugs – Aducanumab, Lecanemab and Donanemab – today they are only approved in the United States. They act as “slowers” of cognitive decline, but can be used exclusively in the prodromal phase (which heralds the appearance of symptomsed.) and in cases of mild dementia. It is not yet known when they will be available in Europe, but it is known that they are only useful for a very small percentage of people (between 5 and 17 percent, according to a Mayo Clinic study) and that, since they are administered by infusion, it is possible to use it only in structures equipped with adequate machinery. In short, we are still far from a real “cure”, but research is progressing, as the neuroscientist confirms: “We are currently focusing on the study of the intestinal microbiota since, among the environmental risk factors, there is probably the ecosystem bacterial that each of us carries in our bellies. We also do research on blood markers given that, in recent years, technological advances have made it possible to measure certain molecules that are toxic to the brain in the blood. At the same time, we work on the development of prevention protocols, pilot projects that focus on lifestyles, the use of nutritional supplements and probiotics.”

Elena and Paolo are mother and son, both with Alzheimer’s. They also live in the HomeCountry, always with the support of a team of psychologists, doctors, health workers and social workers. Paolo was the first to fall ill and, although he is over 60 years old and has gray hair, the disease transformed him into a teenager. He hides behind doors, runs along the avenues, is greedy for snacks: his mind lives in a constant playful phase. Elena, his mother, is 93 years old but she still takes care of him. She looks after him during the day, she watches over him at night, she cooks his favorite dishes, only to then forget she did it.

Estimates say that, in 2030, there will be 78 million people with a form of dementia in the world, 139 million in 2050. It is inevitable to ask with what state of mind we should look to the future. Frisoni replies: «The risk of developing a form of dementia is lower than decades ago, but the number of elderly people is growing and cases will continue to increase. However, it is important to look to the future with optimism. The latest discoveries demonstrate that prevention is fundamental and the new drugs tell us that, if we also add preventative treatments to better lifestyles, making a difference in the management of the disease will really be possible.”

We nurture solidarity

In Italy, there are more than one million people with Alzheimer’s. They still suffer strong social prejudice from those who do not understand well and are unable to accept this pathology. «We are trying to fight stigma by increasing information about the disease and promoting projects like the Communities friendly to people with dementiaplaces where patients and their families can feel included and at ease”, he explains Mario Possentigeneral secretary of Alzheimer’s Federation Italy. At an institutional level, however, the prospects still remain uncertain, with a fund of the National Dementia Plan established in 2021 which, in three years, has allocated 15 million euros for the development of regional initiatives, but which is now nearing completion.

«The projects are almost completely finished, the funds are running out and no one is talking about renewal. There are regions where, even today, after a diagnosis people are at the mercy of nothingness”, underlines Possenti. In fact, «dementia does not only involve the health part, but also the social welfare part. This is the case of day centers, very important structures for both patients and their families.” However, there is some good news: «By January 2024, the government will issue new legislative decrees for non-self-sufficiency. The accompanying allowance will be modified, there will be more attention to the type of pathology and, for the first time, the cognitive aspect will also be examined in addition to the functional aspect.” A fundamental step in supporting those who today, in Italy, fall ill with a form of dementia.

What does it feel like to be a person with dementia? To answer this question the Alzheimer Federation Italy, on the occasion of World Alzheimer’s Day, he made a social experiment. In a city market, with the complicity of the traders, unaware customers experienced situations that surprised and confused them but which, once the intention was revealed, made them understand the daily life of over 1,400,000 people That in our country they live with dementia.
Through this initiative the Federation promotes the campaign #don’tforgettoloveme which aims to raise awareness among more and more people about the importance of become “Friends of People with Dementia” and help create an increasingly inclusive society.

To subscribe to Vanity Fair, click here.