▲The disease course of limbic systemic aging disease (LATE for short) progresses slowly, and appropriate medication can help control the disease; the picture is a photo of the situation, and the people in the picture are not related to this article. (Photo credit: cccshutterstock)
Text / Luo Yanyu
The 85-year-old Mrs. Li has suffered from Alzheimer’s dementia for many years, and she is always accompanied by her eldest son to see the doctor. Year after year, although the test of cognitive function has not reached the level of the age or education level, it has not regressed. For almost 10 years, Mrs. Li always came to the clinic with a smile, but when asked She couldn’t always remember times or dates, or even what she had for breakfast, but other life functions seemed to go on as usual.
Her eldest son said emotionally: “Fortunately, my mother has been taking medicine as usual to control it, so it has been almost 10 years, and there has been no deterioration. I am really grateful!”
I reviewed the medical history and brain scan of Mrs. Li, and I was really surprised to see the results maintained for so many years. Her symptom is still short-term memory impairment, and other aspects are still normal, but the brain scan is limited to the hippocampus. atrophy, and there are no problems such as cerebrovascular disorders.
memory impairment disease
I said to her eldest son, “Actually, my diagnosis of Alzheimer’s disease in the past may be wrong. Your mother may be suffering from a memory impairment disease that has only been defined in recent years, called limbic system aging. Pathological changes, which are caused by a special protein TDP-43.”
Her eldest son was taken aback when I said “misdiagnosis”. I went on to say: “This kind of brain lesion is more common in the elderly over 80 years old. Only short-term memory impairment occurs, and the rate of degeneration is very slow. It accounts for 1/4 of our clinical diagnosis of Alzheimer’s disease. In other words, Nearly 1/4 of the Alzheimer’s disease we have diagnosed is not the kind of degeneration caused by amyloid accumulation, but aging lesions of the limbic system, but due to our limited pathological diagnostic tools, we cannot verify it in time.”
The rate of degeneration is slow in those over 80 years old
Occasionally, a family member of a patient took the report of “dementia has been cured” and asked me, “the treatment of dementia should be very promising, right?” I dare not pour cold water on their optimism, but I always think in my heart: ” Is the diagnosis of dementia correct?” In terms of the definition of disease, dementia is a gradual decline and irreversible neurodegenerative process. If you see “better” clinically, most of the factors that promote the deterioration have been removed, or the diagnosis itself is open to question, such as brain injury or stroke. Brain function will be affected by the injury, but it will also change over time. recovery.
Among the many dementia patients, there are indeed a small number of patients who can maintain the same cognitive level for many years, and it is not necessarily because of the use of cholinease inhibitors or so-called dementia drugs that the effect is obtained. The original course of the disease is quite benign, and there are even few mental symptoms, such as restlessness, hallucinations, anxiety, depression, and insomnia. I said to Mrs. Lee’s eldest son, “Although I said I misdiagnosed Alzheimer’s disease, I’m glad I was wrong in the past! The most important thing is that Grandma can continue to enjoy her life in peace!”
American scientists have deduced a new type of clinical dementia through large-scale neuropathological research since 2019, referred to as LATE. We have seen such patients in the past, but we don’t know why their prognosis is better. With the progress of science, the accuracy of diagnosis will also keep pace with the times.
(The author is the Director of Department of Neurology, Hualien Tzu Chi Hospital)
medical dictionary
Limbic-predominant age-related TDP-43 encephalopathy (LATE for short). It is currently known that it occurs more frequently in the elderly over 80 years old. Short-term memory impairment is obvious, and the location of objects is often forgotten or the direction is difficult to recognize, but the rate of degradation is quite slow.
Brain MRI can show atrophy of the limbic system or medial temporal lobe (pictured). Currently, no biomarkers other than pathological testing can establish the diagnosis.
According to the review of pathology and clinical diagnosis, it is estimated that 1/4 of the clinically diagnosed Alzheimer’s patients are actually aging lesions of the limbic system.
(Text/Luo Yanyu)
▲Atrophy of the hippocampal gyrus in the medial temporal lobe of the aging lesion of the limbic system appears, but it is difficult to distinguish it from typical Alzheimer’s disease. (Photo provided / Luo Yanyu)
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2023-07-03 21:30:00
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