Early treatment of Alzheimers' patients means their home life can be improved, at least temporarily. However, the fact that many such patients are not themselves aware of or down play the cognitive difficulties they face can make this difficult. In his doctoral thesis, Haroun Jedidi focussed on this complex and troublesome symptom, known as 'anosognosia'.

Neuropathologically speaking, Alzheimer's disease is characterised by the presence in the brain of two types of neurodegenerative lesions: extracellular amyloid plaques and degenerative intracellular neurofibrillary lesions. For the past twenty years or so, symptomatic treatments have been available. However, their success has been mixed, insofar as their beneficial action is variable and is often limited in time, coupled with not insignificant side effects. Moreover, not all patients respond in an obvious way.

Alongside medical treatment, patients are offered cognitive rehabilitation techniques. In specific cases, this involves using the faculties which the individual has retained to help them to bridge some of their difficulties with daily activities, thus extending their independence as long as possible. Through these treatments, some patients re-learn for example, how to use a mobile phone or to cook, activities which they found difficult before. These patients thus gain self-confidence within their environment.

One thing is sure: whether in terms of medical treatment, which is currently symptomatic but which in the future may be curative, or cognitive rehabilitation treatment, early detection of Alzheimer's disease improves functional prognosis. Early intervention means the environment can be adapted to the increasing difficulties which the patient encounters and encourages a more positive attitude among patients and their loved ones as their illness develops. Based on the theory that the disease will be curable in the future, early intervention puts the disease's progress in check from the first symptoms and, although it cannot restore lost faculties, stabilises patients' conditions before their  memory, cognition and/or behaviour deteriorates considerably.

Self-awareness

When a patient is unaware of his or her deficits (whether these be physical or cognitive), or only has limited awareness of them, we talk about anosognosia. This phenomenon is encountered fairly often in dementia - Alzheimer's disease, frontal dementia, frontotemporal dementia, etc. -, but also in other diseases. For example, when, following a cerebral vascular accident, lesions in cerebral regions affecting representation of the body in space lead to a clinical diagnosis of hemispatial neglect: the patient disregards an entire part of their body and their environment without being aware of it. 'Thus, they may for example only shave one side of their face', explains Dr Haroun Jedidi, assistant at the Liège CHU Neurology Department and FNRS Research Fellow at the Cyclotron Research Centre at the University of Liège.