Challenges Confronted In Diagnosing Degenerative Diseases at the Initial Stage
Panjwani H, Eshvar SB and Abhishek BP
Published on: 2024-10-15
Abstract
Degenerative diseases are characterised by gradual idiopathic decline in the neuronal function, where in some cases there is atrophy of neurons and in other cases it could be more specific like as in neurofibrillary tangles in Alzheimer's disease. In some cases it can be associated with an atrophy. In general, neurological disorders are genetically determined biochemical disorder that have similar pathophysiology towards neuronal death. The site of lesion, the order and pace of degeneration are the clinical differences seen in between them.
Keywords
Degenerative diseases; Alzheimer's disease; Cognitive; ALSBrief Communication
Degenerative diseases are characterised by gradual idiopathic decline in the neuronal function, where in some cases there is atrophy of neurons and in other cases it could be more specific like as in neurofibrillary tangles in Alzheimer's disease. In some cases it can be associated with an atrophy. In general, neurological disorders are genetically determined biochemical disorder that have similar pathophysiology towards neuronal death. The site of lesion, the order and pace of degeneration are the clinical differences seen in between them [1]. They occasionally have a focal origin but are in general diffused, chronic and progressive, identifying this would help is in the categorization of the disorder. Diseases such as Alzheimer's, Parkinson's disease, ALS, etc. are the commonly seen disorders associated with increasing age, this can associated with the chronic inflammation in such cases this factor is considered as a pre-disposing condition and not as a direct causative factor, in either case it influence the pathogenesis [2].
The term ‘age related cognitive decline’ is generally interchangeably used with ‘normal ageing’ by the practitioners. Reisberg (1982) [3] introduced the term ‘mild cognitive impairment’ to describe the course of action of neurodegenerative disease where the cognitive functioning is not on par with the age even though there are no significant impairment in the daily functioning to categorise it in dementia [4]. Slight impairment in the episodic memory is one of the robust characteristics of MCI as it can be considered as the precursor of Alzheimer's disease thus it becomes important to carry out a genetic analysis to confirm the diagnosis.
The identification of risk factors among individual who were diagnosed with MCI to dementia is very important. The predictive factor of incidental dementia includes baseline memory performance and other cognitive impairments. MRI studies shows that atrophy in hippocampus and white mater impairments are greatly involved in this transition. Studies shows that individuals with MCI have impairment if daily functioning but still is not proven and is an area of controversy, in the initial stages of MCI the activities of daily living may not be compromised and these skills may show a rapid decline subsequently before changing its manifestation to dementia [5].
Lack of experience in general practitioners is a major concern related to the quality of treatment and the outcome. All these challenges interfere in the implementation of assessment and management of MCI, which is noted by lack of awareness and among patients, basically because the activities of daily living may not be compromised in the initial stages in addition to this loners and people staying at homes are also vulnerable to develop this condition. This creates a concern that should be addressed through a system’s approach targeting all the above-mentioned aspects [6].
References
- Schneider JA. Neuropathology of Dementia Disorders. Continuum (Minneapolis, Minn.). 2022; 28: 834-851.
- McGeer PL, McGeer EG. Inflammation and the degenerative diseases of aging. Annals of the New York Academy of Sciences. 2004; 1035: 104-116.
- Reisberg B, Ferris SH, De Leon MJ, Crook T. The Global Deterioration Scale for assessment of primary degenerative dementia. The American J psychiatry. 1982; 139: 1136-1139.
- Mild cognitive impairment (MCI). Rochester (MN): Mayo Foundation for Medical Education and Research. 2012.
- Farias ST, Mungas D, Reed BR, Harvey D, DeCarli C. Progression of mild cognitive impairment to dementia in clinic- vs community-based cohorts. Archives of Neurology. 2009; 66: 1151-1157.
- Lu Y, Liu C, Wells Y, Yu D. Challenges in detecting and managing mild cognitive impairment in primary care: a focus group study in Shanghai, China. BMJ Open. 2022; 12: e062240.