Basis Of The Psycho Social Crisis And Sensory Recognition System Blockade Theory For Alzheimer's Disease
K Sanchez, J Salgado, D Ruiz
alzheimer, attention, behavior, disintegration, neural nets, recognition, senses
K Sanchez, J Salgado, D Ruiz. Basis Of The Psycho Social Crisis And Sensory Recognition System Blockade Theory For Alzheimer's Disease. The Internet Journal of World Health and Societal Politics. 2006 Volume 4 Number 1.
Behavioral and sensorial deficits were frequently reported associated with Alzheimer's illness. We determine predictive power, sensibility and specificity of sensorial deficits and deficient behavior factors in the areas Functionality, Behavioral social relations, Affective net, Abstract entity's dynamism, Coping deficit of personal losses, Vital motivation, Interest and initiative, and Sensorial perception disposition.
A prospective longitudinal study was followed with a cohort of 237 cases both gender Mild Cognitive Impairment's cases and after were rigorously screened to ensure they did nor meet criteria for dementia in comparison of. social active healthy elders. Both groups were followed during six years and a diagnostic evaluation for Alzheimer's disease determined at the end of two years. Statistical regression logistic analysis was applied with de SPSS 10.0. Deficient behavior factors in different areas appear with different power predictive values in the order sensorial perception deficit, coping deficit of personal losses, apathy, affective isolation, de-motivation, introversion, poor dynamism with abstract entities, some kind of depression and secondary status/ dependence/exclusion/auto-exclusion. The sensorial recognition deficit appears as the strong predictive factor. All factors can be cluster under the idea of a personal active isolation and coherent with this way voluntary recognition deficits contribute to produce synapse disruption, neuronal death and the corresponding neural nets progressive disintegration.
This work was supported in part by University and private Alzheimer's Associations funds.
Several non biological factors were reported in the last 25 years, like social and personal behaviors, cultural, economics and educative factors that seems associated with the process named Alzheimer (1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40), obtained by means of the application of epidemiologic methodology. Nevertheless, some results seem contradictory, but actually now a large number of factors appear as clearly associated with Alzheimer and its counterparts as protective:
Other social and familial factors had been reported last time, but yet remains uncertain, as for example pair status, family low income, introversion familial behaviors, and others.
Conde-Sala (41) report recently the father death before the twenties as a possible new risk factor, and we also meet with several cases of several painful losses that occurred 30 or 50 years ago, and at present revival in coincidence of an at present another loss.
All these studies were carried out under epidemiological methods that are quite useful to determine circumstances, scenarios and factors that can be as associated to the problem, but doesn't establish causalities.
These methods also are applied to biological factors like gene alleles, toxics and chemical contaminants, and subject to the same uncertain causalities.
Moreover, the well known and frequent studies on brain
Something like that occur with level of education and Alzheimer's risk: most of the elderly in developed countries with an education's high schooling appear as having a low risk for Alzheimer, but there are persons with Alzheimer that had reach a high schooling, as a Nobel prize, for example.
At present the entire hypothesis about the genetic or anatomy pathologic origin of the Alzheimer's process are controversial in order to different facts.
Yet the modern genetic theory remains valid in spite of several
Moreover, putting this gene in a mouse (transgenic mouse), protein
This takes to think about a fundamental participation of the non biological factors in the installation of this type of dementia, in addition to the reports of good results that give psychological and psychiatric treatments in its early phases (61,62,63,64).
The weak capacity to determine causalities in epidemiologic research can improve something determining the predictive power of the different factors and this can be obtained with longitudinal prospective studies of cohort, to which it is applied statistical techniques of logistic regression. And this it has been the method followed in the present investigation.
Subjects and methods
The study has been made from the university data base created in 1994 for epidemiologic multi factorial studies of elderly dwelling in the media river basin of the Uruguay River (Uruguay, Argentina and Brazil).
From this were selected 237 individuals (Women 67,5%, Average age 74.4 years), with previous clinical history of Mild Cognitive Impairment but without dementia, and followed in different groups during six years from 1994 to 2005 in three steps of two years.
Also other so many greater adults with normal aging were included in the study belonging to diverse social groups like retirements and pensioned, groups of dance and folk, European origin's collectivities associations, and others.
Both groups were followed during six years applying a protocol directly or with the help to their relatives or most near caregivers to evaluate the different factors as in previous studies (34, 35), and applying also the simple home sense tests that were described later.
Those evaluated in this protocol is around the factors that have the same intrinsic logic keys like
The protocol evaluates eight areas: Functionality, Behavior of social entailment, Affective net, Dynamics of relation with abstract entities, Coping of personal losses, Vital motivation, Interest and initiative and Perceptive sensorial disposition.
The deficit variants of these areas were enunciated respectively as the followings: [
This last variable would correspond with
The functionality represents the basic nucleus of modality of affective and social entailment and to the auto construction, and their deficit forms are enunciated as [
The senses of the vision, hearing, smell, touch and taste were proved with a simple
Vision was tested offering a well-known relative's picture (no response), and the attention independent component by a way a strong flash of light (response); auditory function speaking normally (no response) and then with a strong auditory signal (response); taste offering a piece of sweet fruit jelly and immediately a neutral jelly (no response), and then a piece of wormwood (response), smell offering their preferred perfume (no response) and then a piridin vapor (response) and tactile by soft touching the hands and then with a cold air on one hand. The sense of the equilibrium, body perception and the space location can not be proved satisfactorily yet. A sensorial perceptive blockade is standpoint when at least three senses were affected.
At the end of every period of two years both groups were examined to make the clinical diagnosis and application of criteria NINCDS/ADRDA for Alzheimer by a geriatric physician and neurologist specialized in dementias in the elderly.
Data analysis: Inferential statistics and modelization analysis was performed with of SPSS v. 10.0 Windows program. Before introducing the nine factors in the model the multi co linearity was examined.
Table 1. Demographic profile of both groups of participants, with Mild Cognitive Impairment non Dementia (MCInoD) and Normal Aging ones (NA). Average and standard deviation.
The MANOVA analysis determined a
At the end of each stage the number of cases of both groups diagnosed with Alzheimer appears in Table 2.
Under a categorization Alzheimer versus dementia a logistic regression analysis were performed in order to evaluate behavior's factors power in predicting the dementia of Alzheimer type. In this analysis the age, genre, schooling, familial income and MMSE's values were controlled in the model, and only this last appeared with significant differences.
The relative importance of the different factors has been evaluated by logistic regression.
The cases of Alzheimer were codified like 1 and the normal ones like 2. The variables entered as a block and are continua in the metric one of
As is usual, in order to quantify the importance of the additional measures in the prediction of the dementia incidence, sensitivity, specificity and the corresponding predictive values were calculated for each behavior factor. Sensitivity represents the proportion of people with dementia by accurate clinical diagnosis to those who the logistic regression equation classifies like with dementia, whereas the specificity is the proportion of people without dementia by accurate clinical diagnosis to those who the procedure describes like without dementia.
The different values were transformed to
The behavior factors considered here, notably the perceptive sensorial blockade, have more or less predictive power. Both [
Nevertheless these results, the deficits in the senses in Alzheimer's cases that have been reported for more than two decades, always they have been taken like only as an epiphenomenon of dementia, and not a key question.
Only recently has been established that the deficits are in the identification or recognition component of senses, and that the corresponding peripheral reactive components remains without affecting until reach to the last phases of the process. Diverse authors agree in which these deficits can be used for a precocious detection of Alzheimer, and is intended now to develop an accessible
The deficits take place in the diverse senses, reason by which it can be presumed that respond to interference in a general regulatory mechanism, that it can well be the attention-dependent and attention-independent mechanism (65,66,67) of the attentional modulation, to which all we resorted daily to modulate the excesses of stimuli in the directions that haven't interest for us.
The active isolation or capsulation idea has arisen by way of detect a temporarily sequential of the different behavior factors, not only those studied here considered but others also reported from several research groups. By means of a semiotic analysis it has arisen that the concept of active isolation or capsulation can be the goal concept that includes to all those factors, like secondary status, dependence, exclusion or auto exclusion, in order to follow by some type of depression, introversion, affective isolation, weak social network, poor relation with abstract entities, apathy, de-motivation, and culminating in the blockade of the identification components of senses by way of an extremist shut off of the attentional modulation concluding in a strong recognition failure.
Elementary logic indicates that whom carrier the appropriate
In such a manner this locates this type of dementia within already more than a centennial alternative paradigm that it establishes that
Under the model proposed in this paper it's possible to explain the influence of retirement plus marginalization in the elderly, why the population prevalence are greater in urban cultures than in satisfactory stable rural ones, why until now all the hypothesis of genetic, anatomic or organic basis have failed , why the psychiatric or psychological interventions acts successfully in the early phases, why some biochemical and histo-pathological findings are compatible with this model, since they can well be epiphenomenon of the progressive neuronal death, the dissolution of the neuronal networks and the interruption for long time of its normal function on the brain, why it can be happen as much in the young adult as in the very greater adult, why the powerful plural affective nets have a protective effect, why belonging to maintained networks of socialization has also so much such protective power, and so on.
We thank for the economic and logistic support of the network of relatives of Alzheimer who in the past twelve years tied with our research center. Also we are thankful to the University of Murcia, Spain; to the University of the Republic in Montevideo, Uruguay; to the Maimónides University, Buenos Aires, Argentina; and to the University of California at Berkeley. Gratefulness specially extends to the post graduate students who collaborated in the study and the professionals who contributed in honorary form in the tasks that were required.