In 1967, Marta Cinta was a star dancer at the new York City Ballet. Almost fifty years later, in 2014, she arrived in a retirement home in Alicante, Spain, with a diagnosis of Alzheimer’s disease. She spent the last years of her life there until March 2020, the date of her death.
When she entered the institution, many people certainly thought there was “nothing left”. But one day, a therapist of the Música Para Despertar initiative (Music for awakening, in French, editor’s note) decided to play the music of the famous ballet The Lac des Cygnesfrom Piotr Ilitch Tchaikovski, and Marta’s reaction moved all of Spain.
The artist of Spanish origin began to dance in his wheelchair, moving his arms with a delicacy which seemed impossible for a person suffering from his illness.
Marta’s dancing at an already advanced stage of the disease made the possibility of redirecting the treatment of Alzheimer’s disease: what if the heart of the problem resided in the way we understand the capacities available to the elderly who suffer from this disease?
Define intrinsic capacities
To provide answers to this question, we refer to the concept of intrinsic capacities first, introduced in 2015 by the world Health Organization (WHO) in its “World Report on Aging and Health”. According to report authors, the concept refers to all the physical and mental capacities of an individual at a given moment, and not only to his deficits and his diseases.
Since then, the WHO has identified five main dimensions around intrinsic capacities: locomotion, cognition, psychological state, vitality and sensory capacities (defined by hearing and vision of the person).
A more positive approach
Currently, the elderly consult a doctor when an obvious decline in their capacities has already been noted or when an adverse event occurs. However, scientific data show that functional decline can manifest itself before the appearance of obvious clinical symptoms of dementia. In addition, we know that this decline can be delayed, or some of its inverted aspects, if appropriate interventions are implemented.
https://www.whatsupdoc-lemag.fr/article/alzheimer-le-sang-peut-il-vraiment-parler-pour-le-cerveau
In this logic, intrinsic capacities focus on the evaluation of the capacities which are maintained (and not those which are lost), which can be particularly crucial in neurodegenerative diseases such as Alzheimer’s disease.
Anticipation as a strategy
Alzheimer’s disease, which is a chronic and progressive neurodegenerative pathology, has traditionally been addressed from a perspective which is concentrated only and exclusively on memory loss. However, this conception can be considered to be reductive, because it minimizes the deterioration of the person and makes invisible capacities that remain intact, such as sensory, psychological or motor capacities.
The approach based on intrinsic capacities research precisely the opposite: to observe, prevent and preserve. In fact, early detection of deficiencies concerning certain capacities or others can help to set up individualized and effective interventions which help maintain adequate intrinsic capacities longer.
In addition, deterioration in one of the areas of intrinsic capacity can cause a chain reaction. For example, an unique hearing loss can lead to social isolation, which can affect mood and promote a more sedentary lifestyle.
Improve the life of people with Alzheimer’s disease
According to the “2023 global report on Alzheimer’s disease”, about 40 % of dementia cases could be avoided or delayed by acting on 12 risk factors throughout life, including education, sedentary lifestyle, hypertension or hearing health.
-(This report is published by Alzheimer Disease International, or Adi, an international federation of associations devoted to Alzheimer’s disease and dementia all over the world. Adi claims “official relations” with WHO, editor’s note)
These factors are present from the early stages of life. As a result, prevention is not only of the health system, but also public policies, communities and educational establishments.
Acting at these different levels does not require complex clinical interventions, but rather individual and community strategies that help strengthen the intrinsic capacities of these people. We will cite, for example, the promotion of physical activity, which strengthens the locomotor dimension; the implementation of cognitive therapies and sensory stimulation, which contribute to improving cognition; Or the creation of meeting places for the elderly, because of their importance for the management of the psychological aspect.
Ultimately, beyond clinical trials and the search for new biomarkers, intrinsic capacities could become a powerful weapon to anticipate the effects of Alzheimer’s disease and improve the lives of patients.
A longitudinal study in which the trajectory was analyzed in terms of intrinsic capacities of nearly 15,000 people has shown that decline in fields such as locomotion and cognition is strongly predictive of the appearance of dementia, invalidity and mortality.
Objective: to preserve autonomy
We have seen the usefulness of intrinsic capacities to understand Alzheimer’s disease according to a new approach. They are also positioned as one of the main concepts to understand healthy aging. This is what asserts The decade for healthy aging (2020-2030), a document that presents the WHO strategy in aging and health.
This report defines healthy aging as ” The process of developing and maintaining functional skills that allows the elderly to enjoy a state of well-being. Functional skills are the capacities that allow individuals to be and do what they consider valuing ».
The authors also point out that the quality of life of the elderly and their families, as well as the communities in which they live, is the main objective of healthy aging.
To achieve this, the WHO offers four key areas of action to go from a model of dependence to an active participation model:
- Change the way we conceive age and aging;
- Create communities that support the capacities of the elderly;
- Provide integrated and person -centered care;
- Guarantee access to long -term care when necessary.
https://www.whatsupdoc-lemag.fr/article/lecanemab-contre-alzheimer-entretien-avec-le-pr-bruno-dubois-nous-sommes-dans-une-phase
Knowing and understanding the dimensions that make up the intrinsic capacities and risk factors that influence the appearance and progression of dementia would make it possible to develop strategies aimed at preserving the physical and mental capacities of the elderly. For example, by means of targeted activities such as functional training or cognitive stimulation.
In addition, the integration of evaluations of intrinsic capacities throughout life could improve understanding of the links between processes underlying aging and adhesion to healthy lifestyles.
Encourageing these habits would not only increase the benefits provided by their practice, but also to promote their long -term maintenance, by promoting active, healthy and independent aging.
