LivingRamón Cacabelos:

Ramón Cacabelos:

Five out of 100 people in their 60s have Alzheimer’s. The prevalence of the disease increases to 10 percent at age 65 and between 10 and 15 percent at age 75. By age 90, nearly half the population has some type of dementia. Dr. Ramón Cacabelos, director of the EuroEspes biomedical research center, knows what these data mean.

-Sincerely, I believe that we are facing an issue of international priority. Today it is more important to investigate Alzheimer’s than AIDS . The three great causes of mortality in the world are the “head”, cancer and the heart. And within the diseases that we could classify as “of the head”, the most important are cerebrovascular disease and dementia . But it is that, to top it all, senile dementia is the leading disease in the section of social and health costs. In the US, the 6 million people affected represent direct costs of $ 9.2 billion. In indirect costs (lost work hours, premature death, dedication of families …), the figure rises to 94,000 million dollars. In Spain, 400,000 patients cost more than a million and a half euros that in ten years will go to 4 or 5 million. According to the Spanish Antidementia Plan that we launched in 1995 from the Spanish Association of Neurogerontology and Neurogeriatrics, the average cost per patient per year ranges from 6,000 to 18,000 euros.

What other disease is there that costs society so much? In addition, from generation to generation the appearance of the first symptoms is anticipating, right?
-Almost allnervous system diseaseshispoligénicas, that is, they depend on many genes, because nature is not stupid enough to leave ourmemoryand our intelligence at the will of a single gene. The downside is that these complex diseases that have to do with the higher activities of the central nervous system tend to be anticipated generation after generation. While in the great-grandfather the disease had manifested itself at age 80, in the great-grandchild it appears at 65 or 70. We calculate that in each generation there is a time lag of between 3 and 5 years. That is why it is a fundamental factor to create sufficient prevention policies. Above all, if we take into account that the disease can manifest itself at 60, but it has been destroying us for 30 or 40 years.

It seems from his words that we are running out of time …
-You have to be optimistic. Look, medicine has been fighting cancer intensively for 50 years. Now is the first time in history that there is a genetic predictor for the risk of breast and ovarian cancer. Neurologists, in just a decade, have come to understand the molecular principles of Alzheimer’s and today we know that this degeneration of the nervous system that manifests itself inold ageit has started to occur much earlier. That is encouraging: what oncologists did in 30 years, we are achieving in 15 and with a much more complex pathology. A cancer is an anomaly of a cell but dementia supposes the death of the most specialized cell of the human organism, on which the happiness, dignity, thought, memory, humor, intelligence and capacity to exist of man depend.

It is a disease where the human factor is more evident than in any other …
-Sure. For this reason, in addition to pharmacological treatment, somatosensory and psychosensory stimulation techniques must be used. This task corresponds to psychotherapists and families, either at home or in the medical care center.

And, of course, social support …
-That is our great challenge: to get effective social and health support. But beware! This is not to say to start building nursing homes without rhyme or reason. The best strategy should start with home help. If this is not enough, the patient should attend a day center, which should not only be a custodial center but also a therapeutic one, so that it does not become a nursery for the elderly. Only as a last resort should one resort to nursing homes.

I thought you weren’t very fond of the residences …
-It is that the centers for the treatment of Alzheimer’s should not be understood as residences to use. They have to be super-specialized institutions in the management of a disease as complex as this. Unfortunately, today, residences are nothing more than old people’s warehouses. Behind this issue lies a serious cultural, institutional and professional problem. Alzheimer’s cannot be addressed unequivocally, dementia is the paradigm of multidisciplinary medicine. But there are still many who do not embrace this idea.

What does it mean?
-Sometimes I see monopolistic attitudes within the medical sector that I don’t like. When I came to Spain after working in Japan 10 years ago, nobody was talking about Alzheimer’s. Today this country is abuzz with dementia experts. Where were the programs with which these experts were educated, the casuistry they saw and their scientific publications?

Are the doctors not well prepared?
-That’s not what I mean. I just remember that doctors depend on what researchers give them and cannot turn their back on them. However, some are too lighthearted on the subject of dementia, and their views leave many families and patients disoriented.

What would be the solution?
-That when there is scientific progress, the politician, the manager, the lawyer, the technical advisor, the businessman, the trade unionist, the doctor and the researcher sit at the same table to find a socio-sanitary, industrial or technological utility for the finding. That should be done every day with Alzheimer’s.

What does a jurist and a politician paint in the fight against dementia?
-They must help us to design the society of the next decade. It is necessary to put legal solutions for the issue of disabilities, and economic solutions so that the elderly have a dignified old age. We have to stop the birds of prey that, taking advantage of the fact that there are old people, start to set up residences that end up being human garbage dumps; and to banish the opportunistic doctors who jump on the bandwagon without having proven any competence for the comprehensive treatment of the disease.

In other words, it is almost a matter of state.
-The State has a lot to say. I’ll give you an example: in the latest study of the Spanish Antidementia Plan it is said that 98% of the patients who stay at home do not have a legal disability. How can it be understood that one of these patients is not disabled! Reason borders on immorality. A retiree who suffers from dementia receives a pension of between 36,000 and 60,000 pesetas. But if you declare the sick person incapacitated before retiring, the State must pay him 160,000 to 187,000 pesetas. Dementia is an iceberg peak. It is the disease that attacks the most developed structure of the human being, its intelligence, its memory, its learning … But behind it lies an even more serious problem: its immense social burden.

Are we all equally vulnerable to Alzheimer’s?
-Despite what has been said, no one has ever been able to demonstrate that in rural areas there is more Alzheimer’s than in urban areas, or that in Burundi or South Africa the disease is more prevalent than in Scandinavia. Nor can it be said that women or men suffer it more. Logically, there are many more women with dementia, because they are longer-lived. Now we are discovering that women are much stronger than men in almost all aspects of life until they reach a certain age. But, when men are over 80 years old, they are superior to women in physical and intellectual capacity and resistance to disease.

We tend to identify aging with disease …
-The two concepts should never be mixed. Although it is very difficult to differentiate what is descriptive fromagingand the phenomenology of aging. With age, the skin becomes parchment, the eyelids fall, fat appears … but is this a consequence or cause of aging? Normally, when talking about aging, a description is made of the phenomena that accompany aging but not of those that cause it.

That’s what scientists are for …
-Science only has to dedicate itself to understanding why things happen and correcting the deviations of nature.

Isn’t it, then, the goal of scientists to end old age, to find the magic pill of youth?
-That’s monumental nonsense. Only typical of science fiction. Experts in aging know that the only thing we can do is understand the principles that govern it and mitigate the effects of some diseases associated with it, which is not small.

Jorge Mayor

This interview was published in May 1998, in number 204 of VERY Interesting.

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