Massimo Guido
Biography
Degree in Medicine, Medical Director Psychiatrist in the Mental Health Department of the National Health Service from 1995 to 2020, Clinical Pharmacologist, Psychoanalyst of the Italian Psychoanalytic Society/International Psychoanalytical Association. He founded the Alzheimer's Evaluation Unit in ASL Roma 4 in 2000, since 2015 Coordinator and scientific head of the ‘Permanent Structure for Cognitive Disorders/Dementia’, Operative Unit Director ‘Dementia with Severe Behavioural Disorders’ until 2023, Lecturer in Psychiatry and Psychogeriatrics at the ‘Sapienza’ University of Rome. Since 2023 Medical Director of the Kandel Centre for Predictive Medicine (Civitavecchia).
Abstract
The increase in the average life expectancy of the population has been accompanied by an exponential increase not only in chronic degenerative diseases (cardiovascular, dysmetabolic, etc.) but also in neurodegenerative diseases, particularly dementia, and an extremely significant increase in disability. This ongoing exponential increase in chronic degenerative and neurodegenerative diseases represents a ‘Global Public Health Priority’, as defined by the WHO back in 2012. Alzheimer's disease (AD) accounts for about two-thirds of all dementias. At the microscopic level, the brain of an affected individual is characterised by the extracellular presence of plaques consisting of excessive deposition of β-amyloid peptide, which is derived from the amyloid precursor protein (APP), by the enzymes β-secretase (BACE1) and γ-secretase. In addition, there is the presence of intracellular neurofibrillary tangles, due to hyperphosphorylation of the tau protein.
Approximately 1-5% of cases of the disease can be traced back to mutations in the PSEN1, PSEN2 (coding for components of γ-secretase) and APP (coding for the APP protein) genes, while in most cases it manifests itself sporadically, probably as a result of the interaction of genetic susceptibility factors, the best known of which is APOε4, and factors of environmental origin, such as lifestyle, diet and exposure to pollutants. In particular, the literature increasingly highlights how environmental factors can promote inflammation and oxidative stress capable of inducing DNA damage and impairment of DNA repair mechanisms, and also induce epigenetic alterations capable of contributing to the development of AD.
