Alzheimer's, so the made-in-Italy card estimates at 3 years the risk of falling ill

The 'card' for calculating the three-year risk of developing Alzheimer's disease with a predictivity that can exceed 82% - developed as part of the independent and all-Italian 'Interceptor' research project - receives the 'chrism' with the publication of the study describing it in the journal 'Alzheimer's & Dementia: The Journal of the Alzheimer's Association".
Developed by hundreds of 'top' researchers in close collaboration with the Istituto Superiore di Sanità and the patient association Aima - the project has produced among others a kind of 'litmus test', easy to apply. "We are talking about one of the first tools in the world, if not the first, thanks to which by entering a person's data within a predictive model or algorithm, we obtain a risk percentage at 36 months in the population with mild cognitive disorder, which in Italia counts about one million individuals and from which every year the new 100 thousand cases of dementia in the country derive". The speaker is Paolo Maria Rossini, coordinator of Interceptor, Director of the Department of Neuroscience and Neurorehabilitation at Irccs San Raffaele Rome and Director of Neurology at Policlinico Gemelli in the year the project was launched, the now distant 2018.

The publication of the article in the journal of the Alzheimer's Association marks a fundamental step for experts. 'From this moment on,' says Rossini, 'anyone who wants can request the card free of charge, both in Italia and abroad: the very absence of 'royalties' makes it a widely applied, almost routine tool'. But who to turn to for testing? 'Our main interlocutors,' the professor replies, 'are currently the five hundred Dementia Centres for Disease Control (Cdcd) present in Italia: if all of them were to be equipped with it, it would be very useful'.

The tool is twofold: with the basic version - in which only neuropsychological, socio-demographic and clinical data are entered - a predictive accuracy of at least 72% is achieved; to obtain a percentage of 82% or more, biomarkers must instead be added - also to be entered in the algorithm - and involving tests such as MRI, PET and genetics. Tests, these, that only specialised centres are (or at least should be) already able to make available today, no longer collecting biomarkers in random order but entering them into the algorithm to estimate the risk level of the person undergoing the test. And who should not yet be defined as a 'patient': 'Subjects with mild cognitive impairment or Mild Cognitive Impairement,' stresses Rossini, 'are not ill but present a small cognitive deficit detectable with the tests, while remaining fully autonomous and efficient in daily life. At least half of them, followed over time, remain so: only a part becomes ill and so the problem that the National Health Service has is precisely to identify how many people are at high risk of Alzheimer's, compared to those who remain stable or perhaps a little forgetful'.

With the summary sheet a skimming - in technical jargon 'stratification by risk' - is done: this is also important from a public health perspective. If the National Health Service decides to implement prevention programmes in which it intervenes on risk factors - for example, with gymnastics, reducing obesity or controlling diabetes - it will be able to intervene with good reason on the basis of the results of the 'card' and thus not on the one million people in mild cognitive decline but - in a more appropriate and cost-effective manner - on the 10,000 or 20,000 individuals found to be really at high risk. 'Not to mention the administration of the incoming drugs,' stresses Rossini, 'which today are very expensive and have significant side effects: they certainly will not be able to go to everyone, both because of the cost and because the population with a very high risk will have to be selected'.  

Like any organ in our body, the brain also ages, losing certain capacities, particularly cognitive capacities, from the age of 50 to 60. Between normal (physiological) cerebral ageing and pathological ageing that instead causes a picture of full-blown dementia, there is a large 'grey area' defined by the Anglo-Saxons - as mentioned - as Mild Cognitive Impairment (MCI). Receiving a diagnosis of MCI therefore entails an increased risk of developing dementia. In fact, epidemiological studies show that, if followed over time, up to 50 per cent of people with Mci progress to dementia (about 30 per cent in the first three to five years, with the remainder converting in later years). The other half - as far as is known from the scientific literature - may develop a late form of mild dementia or remain stable while maintaining full autonomy in professional and social life.