Dr. Camí, you who have spent so many years in the field of research, as general director of the Barcelona Biomedical Research Park and the Pasqual Maragall Foundation, can you tell us why this disease appears in some people? We do not know the origin or the primary causes. What is indisputable is that it is a neurodegenerative disease in which there is an anomalous accumulation of proteins that selectively destroy neuronal tissue.
How can we distinguish the first clinical symptoms from the forgetfulness that we all may experience? For example, people who begin to have clinical symptoms ask the same thing repeatedly during the same conversation. And they do so with the vehemence of asking it for the first time, because they are not aware of their forgetfulness. That is why it is usually the family who alerts them, not themselves.
What happens, in 2018, when someone is diagnosed with Alzheimer's? Is any treatment prescribed? There are no curative treatments, only symptomatic ones. It's like with a cold: you can lower a fever and decongest your nose, but there's nothing that can stop a cold in a day. With Alzheimer's it's the same: we can relieve depression and modulate behavior, among other symptoms, but not stop the development of the disease. As for non-pharmacological care, we can apply cognitive stimulation guidelines, but their effectiveness is relative. The most important thing is that there is someone willing to care for and accompany you.
And what about music? In the Life Soundtrack project carried out with adolescents and about which a documentary was made, the elderly seemed to revive when listening to "the soundtrack of their life." Yes, it is very emotional. The long-term memory of what has been the music of your life does not disappear like other memories. And the report shows that they are happier with the music "of their life." Well, that's a lot! If we can give them that happiness, we have an ethical obligation to provide it to them.
You argue that the sooner a person is diagnosed with Alzheimer's, the better. For me, it is an ethical issue to give the greatest number of opportunities to the person who begins to get sick, so that they can own many decisions that concern them and that do not have to be made by third parties: how to use their assets, how they want to be cared for... To take advantage of their autonomy while they still have it.
This year, the foundation celebrates 10 years. What help have you been able to provide to patients and their families during this time? We do science. There is no other shortcut to help them. But science needs time. And the almost 3,000 people who participate altruistically in the Alfa Study, promoted by "la Caixa" Social Project, are aware that they are contributing to future generations more than to themselves.
In addition, also together with "la Caixa" Social Project, we support caregivers, who are usually the spouse or, if there are children, it is generally the daughter, with groups led by psychotherapists to strengthen their emotional resources and training, and so they can share their experiences. There is data that if these people do not take care of themselves and get informed, they end up with physical and psychological sequelae. And if they are not well, neither is the patient.
And in terms of scientific advances? Basically there are two: one, we can now affirm that the disease begins decades before the first symptoms, silently. And two, we are the first to conduct clinical trials with new drugs in asymptomatic people at risk. The results will take time, but we have gotten down to business!
Why have we advanced so little in 100 years?
Until now, research has not been adequately supported. And we know that there is a very close relationship between economic effort and results. Look at what happened with AIDS. It is much more recent, but so many resources were poured into it that it went from being a fatal disease to a chronic one. That is why our signature campaign for a future without Alzheimer's makes sense, where we are heading towards 100,000 to get governments to change their priorities.
What is your next goal now? To do research in primary prevention, focused on people who have not yet started the characteristic biological process of Alzheimer's, to discover what we can do to reduce the probability of it appearing. I believe that we will achieve reducing the number of people who get sick before curing those who are already in the clinical phase. We must bet on prevention. In addition, there are starting to be very attractive and suggestive data that say that everything that is good for the heart is also good for the brain. Having that knowledge would allow us to give guidelines and advice.
And are you optimistic? Yes, we are close. Although the trials we have started will not yield results for another 5 or 10 years, science can surprise you, and we may find discoveries that allow us to make a qualitative leap. Furthermore, there have already been successes in other fields such as cardiovascular diseases: the fact that people stop smoking, control hypertension and diabetes, and there are medications to regulate cholesterol has radically decreased cardiovascular mortality. And it gives us confidence that working from prevention is a winning approach.
Interview: Ana Portolés
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