An article by Rosa E. Estalrich Ferrer, psychologist at
Experience in the social and healthcare sector shows us that it is necessary to bet on a rehabilitation coupled with a program of activities with meaning for each of the people we serve, practicing a therapeutic intervention while the person develops activities of their daily life or according to their tastes and preferences.
According to today’s demographic projections, it is estimated that the proportion of people over the age of 65 will reach 20-25% in 2021(1). At present, the segment of the population pyramid that is expanding the most is that corresponding to those over 75 years of age, while the base is drastically reduced due to the sharp drop in the birth rate. This growth trend will constitute one of the most important challenges that Western societies will have to face in the near future (2). It must also be borne in mind that the memory problems affect just 50% of people over the age of 65while dementias are suffered by 5 to 10% of this population (3).
Age is the main risk factor for developing neurodegenerative diseases, although some appear in young people
Age-related cognitive decline and intellectual decline
Currently the cognitive decline persists as a poorly defined concept with little consensus, which reflects a decrease in the performance of at least one of the following cognitive capacities: memory, orientation, abstract thinking, language, judgment and reasoning capacity, capacity for calculation and the ability to constructive, learning capacity and visuospatial ability. It presupposes a cognitive level higher than the current one, a decline or decline compared to the previous level of functioning, a partial or global loss of previously acquired capacities, which is not always demonstrable (4).
He age-related intellectual decline It usually presents as an apparently mild memory disorder for recent events, whose clinical manifestations vary over a wide range, from merely subjective daily and transient forgetfulness, to a serious memory impairment in the border area of dementia.
When cognitive impairment significantly affects the functional activities of daily life, we are probably facing a dementing syndrome (organic or pathological cognitive impairment, or with established dementia). Only a correct clinical evaluation will indicate where in the cognitive-functional continuum: normality – cognitive deterioration – dementia, the person is located. Often, only clinical follow-up will confirm if we are facing a stable situation or, on the contrary, it progresses to dementia (5).
Neurodegenerative diseases: diverse clinical manifestations
We call neurodegenerative diseases to those caused by a process that accelerates cell death, causing the degeneration of nervous tissue (central and/or peripheral). Their clinical manifestations are diverse, being able to affect movement, language, memory and reasoning, among others; resulting in a progressive loss of autonomy. The complexity of this type of disease is related to the , which governs our lives.
What distinguishes them from each other are the different neuronal groups or brain areas affected in each one, producing different symptoms and evolutions. However, some share features, both in clinical symptoms and in neuropathological alterations, which make it difficult to accurately identify the diagnosis. Therefore, it is not uncommon for a person to receive a first diagnosis and, as the disease progresses, it is redefined.
The causes and evolution of neurodegenerative diseases
In most cases, the causes that trigger the neurodegenerative process are unknown. In some diseases, those who are directly attributed the cause of the disease are known. In others, genetics may have an influence, such as , but it is not decisive. The research seeks to advance the knowledge of how genetic susceptibility interacts with environmental and lifestyle factors to modulate the risk of developing these diseases.
Another common feature is the existence of a long period before the manifestation of the first symptoms (preclinical phase), silent, in which brain changes are produced that go unnoticed until the symptoms begin, which will develop in a cascade for years. The time of evolution and life expectancy after the onset of symptoms is highly variable, both between them and within the same, and can be up to 20 years or more.
All these diseases, regardless of their particular characteristics, involve a progressive disability and consequent dependence on third parties, which leads to the need for someone to take care of the needs of the sick person, that is, a caregiver or several who will also require help and guidance to minimize the frequent feeling of overload, or an institution that provides care quality. Furthermore, currently these They are irreversible and have no cure.. Existing treatments are symptomatic, help alleviate symptoms and allow a better quality of life.
The age is the main risk factor to develop this type of disease, although some appear in young people. We are before a growing population aging worldwide and action must be taken to make it sustainable.
Most frequent neurodegenerative diseases
It is estimated that there are a few hundred neurodegenerative diseases, with frequent overlapping of clinical and neuropathological characteristics among many of them, which entails, as we have commented, significant difficulties in classifying and accurately diagnosing them in many cases. The two most frequent are, in this order, Alzheimer’s and Parkinson’s diseases; Of them and of three others, much less frequent, but well known, we offer here their main characteristics:
- Alzheimer disease
Alzheimer’s is the most frequent and the main cause of dementia. The different types of dementia depend on the cause that originates it and, for this reason, dementia due to Alzheimer’s disease is the best known. Alzheimer’s disease involves a set of cognitive and behavioral symptoms with a clear functional impact, progressively diminishing the autonomy of the person who suffers from it.
- Parkinson’s disease
Parkinson’s disease is the paradigm of those related to movement disorders, whose three main symptoms are tremor, slowing of movements and muscle rigidity. These are accompanied by various changes in mood or behavior, impaired speech, sleep disturbances and some cognitive difficulties, leading to progressive disability.
- Huntington’s disease
Huntington’s disease is rare compared to the above. Unlike most, in this case its cause is genetic, and therefore it is a hereditary disease. In addition, the onset of symptoms, although it can occur at any age, usually occurs between 30 and 40 years. Its symptoms are motor, cognitive and psychiatric, with great variability from one person to another. One of the most characteristic motor symptoms of this disease are the movements called “choreic”which are involuntary, sudden, rapid movements that the person cannot control.
- Amyotrophic Lateral Sclerosis (ALS)
Amyotrophic Lateral Sclerosis is a rare disease (due to its low frequency) that affects the neurons of the brain and spinal cord. It belongs to a larger group of diseases called “motor neuron diseases”, caused by a progressive degeneration and death of motor neurons, which establish communication between the brain, spinal cord and muscles throughout the body, to order movement. Gradually, all the voluntary control muscles will be affected, causing a progressive loss of strength and motor skills, affecting movement, speech and, ultimately, breathing. The symptoms can appear at any age, being the most frequent between 55 and 75 years. Most cases are “sporadic”that is to say, not attributable to genetic causes but, as in the case of Alzheimer’s and Parkinson’s, to the combination of different risk factors.
- Frontotemporal dementia
Frontotemporal dementia is less frequent than Alzheimer’s disease and it usually debuts at earlier ages (under 65 years of age), affecting mainly brain regions located in the frontal and temporal lobes, involved in the regulation of personality, behavior and language.
These changes in the brain can lead to different combinations of symptoms, including impulsive or socially inappropriate behavior, loss of empathy, or language disorders characterized by progressive difficulty expressing oneself or understanding the meaning of words.
Strategic lines of action
Throughout this article we have seen the vulnerability of the elderly to these diseases that, more than a cause of mortality, have an ivery high impact on years lived with disability (7). Due to the above and everything exposed throughout the article, it is essential that increase the efforts of the whole society in the following lines social action strategies:
- Prevention and early detection
- Health and social care for neurodegenerative diseases
- Comprehensive care for the person and their families
- Social and rehabilitation support
- Advanced stage care
- Attention to the caregiver(s)
- Support for caregivers
- Health and social coordination (intra and interdepartmental cooperation)
- Autonomy of the person
- Principles and rights of people suffering from these pathologies
- Citizen participation and agents involved
- Continuous training and professional training
- promotion of research
From the socio-sanitary sector dedicated to the service and care of the elderly (in which I have worked for many years, with elderly people, without or with different degrees of dependency) we believe it is necessary to bet on an approach based on these strategic lines, through rehabilitative activities through programs such as “Activities with meaning” in which we combine rehabilitative actions with meaningful activities for each of the people who participate in it, integrating a therapeutic intervention in the same activity while the person develops an activity typical of their daily life or an activity according to their tastes, hobbies and preferences.
Bibliography:
(1) López-Pousa S, Vilalta J, Llinás J. Manual of dementias. Barcelona: Prous Science; nineteen ninety six
(2) Selmes J, Antonie M. Living with Alzheimer’s disease. Madrid: Meditor; nineteen ninety six
(3)…