Given the alarming increase in the Alzheimer's Disease (AD) related costs
and the number of patients, significant importance of the research of dementia in
elderly people is represented by the early detection of dementia signs and identifying
ways to slow down the cognitive decline that should be done by the entire medical
community, not only by specialists in psychiatry, neurology and geriatrics. An
integrated, multidisciplinary approach can only be achieved by recognizing some
clinical-biological parameters that may represent an early signal for a potential onset of
AD, or that may speed up the cognitive impairment. Dysfunctional neurobiochemical
mechanisms in AD engaging in multimodal pathogenic processes of cognitive
impairment, are correlated with the presence of clinical, imaging or biological markers.
Identifying risk factors for the progression of cognitive impairment in AD will bring
significant improvement in primary and secondary prophylaxis in late-onset AD with
improved quality of patient life and a significant decrease in the cost of care associated
with this pathology. The patient's assessment should consider multiple somatic
comorbidities, associated with cognitive impairment: neurobiochemical vulnerabilities
(acetylcholine, dopamine, serotonin and noradrenaline deficiency), traumatic brain
injury, disruption of the blood brain barrier, insomnia, depression, cardiovascular
diseases, diabetes, hepatic steatosis, infectious pathology. The etiology of late-onset
AD and the rapid progression of cognitive decline are complex, multifactorial and
incomprehensible, the genetic component is less involved, and is a real challenge for research on the pathology of cognitive impairment. These considerations make it
difficult to diagnose early and develop effective therapeutic strategies.
Keywords: Alzheimer’s disease, Acetylcholine, Amyloid-β, Biomarkers, Blood
Brain Barrier, Cardiovascular Diseases, Cerebral Amyloid Angiopathy, Cognitive
Impairment, Cognitive Reserve, Depression, Glymphatic System, Inflammation,
Insomnia, Microbleeds, Mild Cognitive Impairment Syndrome, Neurobiochemical
Vulnerabilities, Small Vessel Cerebral Disease, Traumatic Brain Injury, Vascular
Risk Factors.
