Alzheimer’s: the early symptoms not to be underestimated

Alzheimer’s: the early symptoms not to be underestimated and the link with hypertension and kidney disease

Alzheimer’s is when forgetting is no longer a simple distraction. “Where did I put my keys?” “What was that person’s name?” “Why did I come into this room?” It happens to everyone, especially when we are stressed or have particularly busy days. Memory is not a perfect mechanism and, as the years go by, it is normal for it to become less quick. And yet there is a subtle difference between an occasional lapse and those small changes that may represent the first signs of a neurodegenerative disease.

Alzheimer’s is one of the diseases that people and their families fear the most. Not only because it progressively impairs memory, but because it changes the way a person thinks, communicates and, over time, even experiences relationships with the people around them.

In recent years, however, the way this disease is approached has changed profoundly. Whereas once the diagnosis came when the symptoms were already obvious, today neurologists and researchers increasingly focus on early diagnosis. Identifying the first warning signs means being able to start the treatment path promptly, plan the most appropriate interventions and, above all, correct the risk factors that can accelerate cognitive decline. The most recent Italian guidelines stress precisely the importance of early identification and of a structured diagnostic pathway, accompanied by comprehensive care for the patient and the family.

For the NefroCenter Group, talking about Alzheimer’s also means addressing a topic that is often little known: the strong link between brain health, cardiovascular health and kidney function. The brain, in fact, is an organ that is extremely sensitive to changes in blood circulation, blood pressure and metabolism. And it is precisely on this connection that the second part of this guide will focus.

Alzheimer’s is not only about memory

When we think of Alzheimer’s, the image that immediately comes to mind is that of a person who forgets names, appointments or familiar faces. In reality, memory is only one part of the problem.

The brain can be compared to a gigantic network made up of billions of neurons that communicate constantly with one another through electrical impulses and chemical substances. Every memory, every word spoken, every decision made comes from this incessant dialogue.

In Alzheimer’s disease, this system slowly begins to lose efficiency.

The nerve cells progressively stop working, the connections break down and some areas of the brain begin to undergo a degenerative process. It does not happen overnight. It is a silent change that can begin many years before symptoms appear.

For this reason, specialists today increasingly speak of a “preclinical” disease, a phase in which the brain already shows biological changes but the person continues to lead an entirely normal life.

When the first memory problems appear, it means, in most cases, that the disease process began some time ago.

What is Alzheimer’s disease, really?

From a medical point of view, Alzheimer’s disease is a progressive neurodegenerative disease.

Two abnormal proteins build up in the brain, beta-amyloid and tau protein, which alter the functioning of neurons until they die.

The consequence is a progressive reduction in cognitive abilities.

At first the patient remains independent. As the years pass, however, increasing difficulties can appear in remembering, speaking, finding one’s way, making decisions and carrying out even the simplest activities of daily life.

In Italy it is estimated that about 600,000 people are living with Alzheimer’s disease, which is the most common form of dementia, accounting for about 50-75% of cases. The aging of the population makes this disease one of the main health challenges of the coming decades.

The early symptoms of Alzheimer’s: the signs that deserve attention

One of the most frequent mistakes is to consider all changes in memory that appear with age to be normal.

In reality, there are certain characteristics that distinguish normal forgetfulness from the first symptoms of Alzheimer’s.

The fundamental difference is that small lapses do not interfere with daily life. A person may forget the name of an actor and remember it a few minutes later. Or they may lose their glasses and find them again without particular difficulty.

Those who develop cognitive decline, on the other hand, progressively begin to have problems that affect their normal independence.

It is not simply a matter of “forgetting.”

One forgets that one has forgotten.

Recent memory is the first to change

The most typical feature concerns the memory of recent events.

The person may remember perfectly episodes that happened thirty years ago, but cannot remember a conversation that took place a few minutes earlier.

They may ask for the same information several times.

They may tell the same story repeatedly without realizing they have already done so.

They may forget an appointment made the day before, or not remember having taken their medication.

These changes are not always obvious at first.

Very often it is the family members who notice them before the person concerned.

Words seem to disappear

One of the lesser-known symptoms concerns language.

Many people report a particular feeling.

“I knew perfectly well what I wanted to say, but I couldn’t find the word.”

It can happen to anyone.

In the patient with Alzheimer’s, however, this phenomenon becomes progressively more frequent.

Sentences break off.

Words are replaced with generic terms.

Objects are referred to simply as “that thing.”

Even following a complex conversation can become more difficult.

When daily habits change

There is also an aspect that often goes unnoticed.

It is not only memory that changes.

Organizational abilities change.

A person who has always managed the family budget perfectly may begin to make mistakes with payments.

Preparing a familiar dish may take much longer.

Following a recipe known for years may suddenly become complicated.

These are apparently trivial activities, but they require memory, attention, planning and decision-making skills to work together at the same time.

It is precisely this combination of difficulties that raises suspicion of an initial cognitive decline.

Orientation: a warning sign that is often underestimated

One of the signs that most concern neurologists is orientation.

People with Alzheimer’s may begin to have difficulty finding their way even in perfectly familiar places.

They may forget the way home.

They may confuse the days of the week.

They may lose track of the month or the season.

Of course, this does not mean that every episode of disorientation is a sign of Alzheimer’s.

But when these events become frequent, they always deserve a specialist evaluation.

Character can change too

Many family members describe a common experience.

“He’s not the person he used to be.”

Even before memory, changes in mood and personality can appear.

Someone who was very sociable can suddenly become withdrawn.

A patient person can become irritable.

Anxiety, suspicion or a loss of interest in hobbies and activities that until recently were a source of pleasure can appear.

These changes should not simply be interpreted as consequences of age.

In some cases they are one of the first manifestations of the disease.

Why is recognizing the early symptoms so important?

The question many people ask is simple.

“If there is still no definitive cure, why is it so important to make an early diagnosis?”

The answer is that today early diagnosis profoundly changes how the disease is managed.

First of all, it makes it possible to distinguish Alzheimer’s from other conditions that can cause memory problems but are potentially reversible, such as thyroid disorders, vitamin deficiencies, depression, sleep disorders or side effects of certain medications.

It also makes it possible to plan a treatment path, involve family members early and act on the modifiable risk factors that can accelerate cognitive decline.

And this is precisely where an increasingly important aspect of modern prevention comes into play: brain health does not depend on the brain alone.

A growing number of studies show that blood pressure, diabetes, chronic kidney disease and cardiovascular health directly influence the risk of developing cognitive decline. Controlling these factors is now one of the pillars of prevention recommended by health institutions and by the main international guidelines.

The causes of Alzheimer’s: the link with hypertension, kidneys and heart

For many years Alzheimer’s disease was considered exclusively a disease of the brain. Researchers’ attention focused almost entirely on changes in neurons, on the buildup of beta-amyloid plaques and tau tangles, considered the main features of the disease.

Over the last twenty years, however, research has completely changed perspective.

Today we know that the brain is not an isolated organ. It lives thanks to an extraordinarily complex network of blood vessels that guarantee it a continuous supply of oxygen and nutrients. Even the slightest change in circulation can impair the functioning of neurons long before symptoms appear.

It is precisely for this reason that neurologists, cardiologists and nephrologists increasingly talk about the heart-kidney-brain connection. Three apparently different organs, but united by the same risk factors and the same mechanisms of damage.

Does Alzheimer’s have a single cause?

One of the most frequent questions concerns the origin of the disease.

The answer, unfortunately, is less simple than one might imagine.

Alzheimer’s does not have a single cause, but arises from the interaction of numerous biological, genetic and environmental factors that, over many years, contribute to the progressive deterioration of nerve cells.

The typical changes of the disease begin long before symptoms appear. Some studies suggest that the neurodegenerative process may develop even 15 or 20 years before the patient begins to have memory problems.

This means that the brain may already be affected by the disease while the person is still leading a perfectly normal life.

And it is precisely in this long silent phase that prevention can make the difference.

Age remains the main risk factor

The most important risk factor is age.

After the age of 65, the likelihood of developing the disease increases progressively and continues to rise with aging.

This does not mean that Alzheimer’s is an inevitable consequence of age.

Very many people pass the age of eighty while maintaining excellent cognitive abilities.

Age is rather the ground on which other risk factors can act, which, added together, increase the likelihood of developing the disease.

Genetics matters, but it does not decide our fate

Many people worry when a parent or grandparent has had Alzheimer’s.

Family history is certainly an element to consider, but it is not a sentence.

In most cases Alzheimer’s is not a hereditary disease.

There are very rare genetic forms, which appear even before the age of 60, but they account for a very small percentage of cases.

Much more frequently, what is inherited is a predisposition, not the disease.

In other words, genetic makeup can increase the risk, but lifestyle, control of cardiovascular factors and prevention continue to play a decisive role.

Why hypertension increases the risk of Alzheimer’s

One of the most interesting findings of recent years concerns the role of blood pressure.

Uncontrolled hypertension does not only damage the heart or the kidneys.

It also affects the brain.

Every day the brain receives about 20% of the blood pumped by the heart.

To function properly, it needs continuous and perfectly regulated circulation.

When blood pressure stays high for years, the walls of the arteries slowly begin to thicken.

The small blood vessels of the brain become less elastic.

Their capacity to carry blood decreases.

Tiny lesions develop in the white matter, often invisible in daily life but clearly recognizable on magnetic resonance imaging.

This small damage, added up year after year, can impair communication between different areas of the brain and increase the risk of cognitive decline.

For this reason, specialists now consider hypertension one of the main modifiable factors in the prevention of dementia.

When the brain suffers in silence

One of the most insidious aspects of hypertension is its silent nature.

Most people notice no symptoms.

There is no pain.

There are no obvious signs.

And yet the damage proceeds slowly.

In the brain, the following can occur:

• small silent infarcts;
• microhemorrhages;
• chronic reduction in the oxygen supply;
• changes in the microcirculation.

Many of these events do not cause immediate problems.

Over the years, however, they can contribute to the appearance of memory and concentration problems.

This is also why controlling blood pressure is now considered a true strategy of neurological prevention.

➡ Recommended further reading: High blood pressure and the kidneys: the risks of hypertension
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Alzheimer’s is not the only one: what vascular dementia is

When we talk about memory loss, we tend to automatically use the term Alzheimer’s.

In reality, there are many forms of dementia.

One of the most frequent is vascular dementia.

Unlike Alzheimer’s, it does not arise mainly from the buildup of the proteins beta-amyloid and tau, but from progressive damage to the circulation of the brain.

The two diseases, however, can coexist.

Many older adults in fact show both the changes typical of Alzheimer’s and vascular damage caused by hypertension, diabetes and atherosclerosis.

For this reason, specialists today increasingly speak of mixed forms, in which the vascular component accelerates cognitive decline.

The role of diabetes

Diabetes is also an important risk factor.

High blood glucose levels promote chronic inflammation, damage to small vessels and atherosclerosis.

Over time, all of this can impair both the circulation of the brain and the health of neurons.

People with diabetes in fact have a higher risk of developing cognitive impairment compared with the general population.

Once again a fundamental concept emerges: protecting metabolism also means protecting the brain.

The surprising link between kidneys and brain

This is probably the least well-known aspect, but also one of the most fascinating.

At first glance, the kidneys and the brain seem to be completely different organs.

In reality they share very similar characteristics.

Both are crossed by an extremely rich network of small blood vessels.

Both depend on perfect regulation of blood pressure.

Both quickly feel the effects of changes in circulation.

When chronic kidney disease appears, the entire body enters a condition of greater vulnerability.

The buildup of toxic substances normally eliminated by the kidneys, chronic inflammation, anemia and changes in metabolism can also affect the functioning of the brain.

Several studies have shown that people with reduced kidney function have a higher likelihood of developing cognitive impairment and dementia compared with people with normal kidney function.

This does not mean that the kidney directly causes Alzheimer’s.

Rather, it indicates that kidney health is one of the fundamental pieces of brain health.

Chronic inflammation: the invisible thread that connects many organs

In recent years research has identified another protagonist.

Chronic low-grade inflammation.

When our body lives for years in a state of persistent inflammation — promoted by obesity, diabetes, a sedentary lifestyle, kidney disease or hypertension — the brain can be affected as well.

The immune cells present in the central nervous system can become overactive, helping to accelerate the neurodegenerative process.

It is one of the reasons why prevention today concerns not only the brain, but the entire body.

Heart, kidneys and brain: a single network to protect

Modern medicine is gradually moving past the view that treats each organ as separate from the others.

The heart, the kidneys and the brain communicate continuously.

When one of these organs becomes ill, the others too often become more vulnerable.

For this reason, controlling blood pressure, kidney function, blood sugar and cholesterol is much more than simple cardiovascular prevention.

It is a global strategy for protecting the whole body.

And this is precisely the approach that characterizes the NefroCenter Group, where specialists from different disciplines work together to identify risk factors early and build personalized prevention pathways.

Alzheimer’s: can it be prevented? Early diagnosis, new drugs and the role of the heart and kidneys

For a long time the word Alzheimer’s was associated with a sense of inevitability. A diagnosis that seemed to leave little room for prevention and even less for the possibility of intervening. Today the situation has changed profoundly.

Scientific research in recent years has shown that, although there is still no definitive cure, an important part of the risk can be modified. The goal is not only to slow the progression of the disease when it appears, but above all to delay its onset through a healthy lifestyle and control of the main cardiovascular and metabolic risk factors.

According to the Lancet Commission on Dementia, up to 45% of dementia cases could be linked to modifiable risk factors across the life course. This is a figure that radically changes how we look at Alzheimer’s: prevention becomes a true public health strategy.

Alzheimer’s prevention begins many years earlier

One of the most common mistakes is to think that prevention should begin after the age of seventy.

In reality, the brain begins to age much earlier.

The habits we adopt between the ages of forty and sixty profoundly influence neurological health in the following decades.

It is precisely in this phase of life that the following often begin to appear:

• high blood pressure;
• diabetes;
• high cholesterol;
• overweight;
• a sedentary lifestyle.

These are conditions that, if neglected, slowly damage the network of small blood vessels in the brain.

The good news is that acting on these factors means protecting the heart, the kidneys and the nervous system at the same time.

Blood pressure: one of the brain’s best allies

Among all the risk factors, blood pressure plays a central role.

Many people live for years with high values without realizing it.

Hypertension rarely causes symptoms, but it continues to slowly damage large and small arteries.

In the brain, this process promotes:

• reduced blood flow;
• changes in the microcirculation;
• small silent cerebral infarcts;
• greater vulnerability of neurons.

Numerous studies show that keeping blood pressure well controlled during middle age significantly reduces the risk of developing dementia in later years.

For this reason, regular blood pressure monitoring is one of the most effective preventive strategies available today.

The kidney: an organ that can tell a lot about brain health

When we talk about Alzheimer’s, we rarely think of the kidneys.

And yet their role is increasingly evident.

Chronic kidney disease does not affect urinary function alone.

A kidney that loses efficiency profoundly changes the balance of the entire body.

The following increase:

• inflammation;
• oxidative stress;
• vascular changes;
• anemia;
• buildup of toxic substances.

All of these factors can also affect brain function.

It is therefore not surprising that patients with chronic kidney failure more frequently have memory difficulties and a higher risk of cognitive decline.

This is one of the reasons why monitoring kidney function is not only a nephrological measure, but an investment in overall health.

Diet: the brain is protected at the table too

There is no single food capable of preventing Alzheimer’s.

There is, however, a dietary pattern that continues to show benefits in most scientific studies: the Mediterranean diet.

Fruit, vegetables, whole grains, legumes, fish, extra virgin olive oil and nuts help reduce inflammation and protect cardiovascular health.

At the same time, it is advisable to limit consumption of:

• simple sugars;
• ultra-processed foods;
• saturated fats;
• sugary drinks.

A proper diet helps control blood pressure, blood sugar and cholesterol, all factors that are also closely linked to brain health.

Physical activity: the “medicine” that should never be missing

Among all preventive strategies, exercise continues to be one of the most effective.

Walking, cycling, swimming or doing regular physical activity improves circulation in the brain, reduces inflammation and promotes the production of substances that protect neurons.

The World Health Organization recommends at least 150 minutes of moderate physical activity per week.

Athletic performance is not required.

Consistency is far more important than intensity.

Sleeping well means protecting the brain

In recent years sleep, too, has become one of the protagonists of prevention.

During nighttime rest, the brain clears many waste substances produced during the day.

These include part of the beta-amyloid, the protein involved in the development of Alzheimer’s.

Sleeping too little or poorly for long periods can disrupt this delicate brain “cleaning” mechanism.

For this reason, chronic insomnia, sleep apnea and other sleep disorders always deserve a specialist evaluation.

Keeping the mind in training

Just as exercise keeps muscles in shape, mental activity helps the brain preserve its functions.

Reading, studying a foreign language, learning a musical instrument, playing chess, keeping up an active social life and cultivating new interests all help build what specialists call cognitive reserve.

A greater cognitive reserve allows the brain to compensate for any neurodegenerative damage for longer.

New drugs against Alzheimer’s: a new phase of research

In recent years, innovative drugs directed against the beta-amyloid protein have been developed.

These therapies are not a definitive cure and are not indicated for all patients.

They can, however, in selected cases and in the early stages of the disease, help slow its progression.

Their use requires a very early diagnosis, strict selection criteria and careful monitoring by specialist centers.

It is an important change because it confirms once again how essential it is to recognize symptoms in the early stages.

Early diagnosis today is much more precise

Today the diagnosis of Alzheimer’s is not based on memory tests alone.

The neurologist integrates a great deal of information:

• specialist examination;
• neuropsychological assessment;
• brain magnetic resonance imaging (MRI);
• laboratory tests;
• biomarkers, when indicated;
• assessment of cardiovascular and metabolic factors.

The aim is to understand whether the symptoms really result from a neurodegenerative disease or from potentially reversible conditions.