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Ülkemizde ve dünyada yaşlı nüfus büyük bir hızla artmaya devam ediyor. Günümüzde tüm dünyada 44 milyon bunama hastası var. Türkiye İstatistik Kurumu verilerine göre 2023 yılında ülkemizin 65 yaş üstü yaşlı nüfus oranının %10’un üzerine çıkacağı ve bunama hastalıklarının sıklığının büyük bir hızla artmaya devam edeceği tahmin ediliyor. Bu artış trendi sürerse 2050 yılında hasta sayısının tüm dünyada 135 milyona çıkması bekleniyor. Her yıl 21 Eylül günü Dünya Alzheimer Günü olarak kabul ediliyor.

Dünya Alzheimer Günü nedeniyle 19 Eylül’de Türkiye Alzheimer Derneği bir toplantı düzenledi. Dünya Alzheimer Günü basın toplantısında Türkiye Alzheimer Derneği Başkanı Prof. Dr. Işın Baral Kulaksızoğlu, Türkiye ve Almanya Alzheimer Derneklerinin, Aizheimer’s Disease International (ADI) tarafından 2014’te kardeş dernek ilan edildiğini bildirerek bu işbirliği hakkında bilgi verdi. Toplantıda Alzheimer’da yeni bulunan proteinler, yaşam tarzının Alzheimer hastalığı üzerine etkisi, gelişmiş ülkelerde Alzheimer’in azalmasının olası sebepleri gibi yeni bilgilerin yanı sıra Türkiye Alzheimer Derneğinin faaliyetleri de aktarıldı.

Türkiye Alzheimer Derneği merkezinde gerçekleştirilen toplantıda Türkiye’nin de dahil olduğu 84 ülkeden üyesi olan Dünya Alzheimer Örgütü’nün (ADI) Dünya Alzheimer 2014 Raporu açıklandı.

Prof. Dr. Işın Baral Kulaksızoğlu, bu salgın denebilecek durum karşısında özellikle yaşlı nüfusa sahip gelişmiş ülkelerin alarma geçerek eylem planları oluşturduklarını ifade etti. 2012 yılında oluşturulan ve G8 zirvesinde de taslak olarak kabul edilen ABD Ulusal Alzheimer Planına göre 2025 yılında Alzheimer hastalığının (AH) önlenmesi ve etkili bir şekilde tedavisi hedefleniyor. Özellikle hastalık açısından risk yaratan durumların azaltılması ve koruyucu olduğu bilinen faktörlerin desteklenmesinin bu salgını azaltabilmesi bekleniyor.

 

Sıklık azalsa da yaşlı nüfus artıyor

Başkan Yardımcısı Prof. Dr. Haşmet Hanağası tüm dünyada Alzheimer ve bunama hastalarının sayısı artsa da gelişmiş ülkelerden (ABD, Almanya, Hollanda, İsveç ve İngiltere) gelen umut verici yeni verilere bakıldığında yaşlılarda bunama hastalığının görülme sıklığında geçmişe oranla azalma olduğunu ifade etti. Prof. Hanağası “Tıp dünyasında oldukça ünlü olan Framingham çalışmasında 30 yıl önceki yaşlılara göre şimdiki yaşlılar arasında yeni bunama hastası görülme sıklığında %44’e varan azalma mevcuttur. Araştırmacılar bu düşüşü eğitim düzeyinin artması, daha fazla zihinsel işlev gerektiren iş kollarının artması, hipertansiyon ve hiperkolesterolemi gibi damarsal risk faktörlerinin daha yaygın olarak kontrol altına alınması, sigara tüketiminin azalmasına bağlamaktadır. Günümüzde artan şeker hastalığı ile daha etkin mücadele ile bu oranın daha da azalması mümkün olabilir. Gelişmekte olan ve gelişmemiş ülkelerdeki hastalık oranlarının düştüğüne dair henüz bir veri yoktur” şeklinde konuştu.

 

Alzheimer hastalığından korunma genç yaşlarda başlıyor

Yönetim Kurulu Üyesi Prof. Dr. Haşmet Hanağası Alzheimer hastalığından korunma hakkında şunları söyledi: “Alzheimer hastalığında genç yaştan itibaren risk faktörleri ve koruyucu faktörlerin birbirleri ile yarıştığı ve orta yaşlarda risk faktörlerinin azaltılarak fiziksel ve zihinsel aktivitelerin arttırılmasının yararlı olduğu bilinmektedir. Bu yıl Dünya Alzheimer Kongresinde sunulan yeni bulgulardan birisi de orta yaşlarda daha fazla kart oyunları, dama oynayanlar ve bulmaca çözenlerin beyinlerinin daha hacimli olduğu ve bu kişilerin zihinsel yetilerinin bu aktiviteleri yapmayanlara göre daha iyi bulunduğu şeklindedir.”

 

Alzheimer’den korunmak için her yaşta aktif olmak gerek

“Orta yaşlarda koruyucu faktörlerin etkisi daha aşikar iken, risk altındaki yaşlılarda koruyucu faktörlerin ve risk faktörlerinin düzenlenmesinin yararlı etkisinin olup olmadığı bilinmiyordu. Bu soruya cevap olarak 2 yıl boyunca İskandinav ülkelerinde 1260 yaşlı kişi (60-77 yaş arası) ile yapılan bir çalışma, yaşlı kişilerde beslenme önlemleri, zihinsel egzersiz, sosyal aktiviteler ve kalp sağlığı önlemleri ile yaşlılardaki zihinsel gerilemenin azaltılabileceği ve bunamanın kısmen önlenebileceğini göstermiştir. Böylelikle düzenli beslenme, daha sosyal bir hayat ve zihinsel egzersizlerin hastalığa karşı etkili yöntemler olduğu bilimsel olarak ispatlanmıştır ve yaşlılar bu konuda yönlendirilmeli ve sağlık politikaları bu bilgiler ışığında oluşturulmalıdır.”

 

Ancak 90 yaşa gelirseniz hipertansiyon zararlı bir bulgu değil

Prof. Dr. Haşmet Hanağası, farklı yaşlardaki hakkında sorulara “Bu sene ortaya çıkan oldukça ilginç bulgulardan birisi de 90 yaş ve üstü bireylerde tansiyon yüksekliğinin koruyucu bir faktör olduğunun saptanmasıdır. Oysa orta yaş ve 90 yaş altındaki kişilerde tansiyon yüksekliği Alzheimer hastalığı açısından ciddi bir risk faktörüdür. Bu ilginç bulgu her yaşta risk faktörlerinin değiştiğini ve dinamik olduğunu göstermektedir. Bu dinamik duruma bir diğer örnek de Mayo Clinic tarafından yapılan çalışmalarda orta yaşlarda (50-65 yaş) yapılan fiziksel aktivitenin Alzheimer hastalığı açısından koruyucu olmasına karşın 70 yaş ve üstü kişilerde fiziksel aktivitenin koruyuculuğu konusunda bazı şüphelerin olmasıdır. Güncel bilgiler ışığında orta yaşlarda tempolu yürüyüşler gibi fiziksel aktiviteler özendirilmelidir” diye cevap verdi.

 

Alzheimer hastalığının erken tanısı için araştırmalar hızla sürüyor: Yöntemler deneysel de olsa umut vaat ediyor

Alzheimer tanısının nasıl konduğuna dair bilgi veren Doç. Dr. Başar Bilgiç “Hastalığı tanımak günümüzde artık daha kolay hale geldi” diyerek tanı yöntemlerini sıraladı: “Gerek pozitron emisyon tomografisi gerekse de beyin omurilik sıvı analizi ile henüz hastalığa ait şikayetler başlamadan tanı konulabilmekte ve risk belirlenebilmektedir. Beyinde biriken iki protein olan amiloid ve tau proteinleri artık görüntüleme yöntemleri ile gösterilebilir hale gelmiştir ama bu yöntemlerin yaygınlaşması teknik sorunlardan dolayı oldukça zordur ve bu yöntemler pahalı yöntemlerdir. Bu amaçla çok daha kolay uygulanabilir biyolojik belirteçlere ihtiyaç vardır. Göz birebir beyinle bağlantılı bir organ olduğundan beyindeki değişimler sıklıkla kendini gözde de göstermektedir. Bu hastalıkta beyinde biriken beta-amiloid isimli maddenin son yıllarda gözde retina katmanı ve lens içinde de biriktiği saptanmıştır ve basit bir şekilde gözde bu maddenin birikimi gösterilerek hastalığın tanısının yapılabileceği öne sürülmüştür. Gözdeki bu birikim zamanla artış göstermektedir. Bu yöntem rüştünü daha fazla ispatladığında hem tanı hem de takip amaçlı olarak kullanılabilir. Benzer şekilde Alzheimer hastalarında hastalıktan önce koku alma bozukluğu belirmektedir ve koku alma yeteneği beyin hacmi ile birebir ilişki göstermektedir ve hastalık ile beraber zihinsel yıkıma paralel şekilde koku alma yeteneği de azalmaktadır. Böylelikle koku testleri ile riskli bireylerin belirlenebileceği ve hastalık takibinde kullanılabileceği öne sürülmüştür”.

 

Alzheimer hastalığında yeni bir protein bulundu

Yönetim Kurulu Üyesi Doç. Dr. Başar Bilgiç “Alzheimer hastalığında beyinde biriken iki önemli protein amiloid ve tau proteinleridir. Bu yıl ortaya konan önemli bilgilerden birisi de hastalarda bu iki protein dışında bir üçüncü protein olan TDP-43 isimli proteinin beyinde biriktiği ve zihinsel fonksiyonlar ve beyin hacmi ile ilişkili olduğudur. Tedavi girişimlerinde bu proteinin de beyinden temizlenmesi yeni ve etkili bir strateji olabilir” dedi.

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