Background
Dementias are diseases that gradually alter the brain higher functions, the cognitive functions with which we perceive reality and react to it on a daily bases. Among cognitive functions are memory, sight, speaking and understanding spoken language as well as reading and writing, perception of space and time and due responses, the capability of abstraction and sequential reasoning. The probability of having dementia doubles every 5 years once the person is 60, rising from 1% at the age of 60 to 40% in people over 85. Over the past 5 years, there has been enough scientific evidence in several fields to allow a series of statements.

There is a genetic predisposition to Alzheimer's disease, the most common kind of dementia in the world accounting for 50% of all dementias. Members of families with high recurrence of Alzheimer's and those with the APOEc-4 gene are the risk groups. Medication and some attitudes in daily life may reduce the risk and/or delay the onset of dementia. Alzheimer's can be diagnosed with a high degree of certainty. Medication and certain daily attitudes in life can also delay the further development of the disease. Smoking, high blood pressure and brain trauma can cause Alzheimer's to develop sooner. These findings are of a clinical and public health immediate repercussion because of the large number of people involved. Within the scientific and innovative features of Clinical Neurology Unit (CNU), we provide this service to the community, in special to our patients.

Ethics
Hermes Project does not subject people to any experimental treatment or procedures. What is new is the concept of preventing Alzheimer's, opportunistically claimed in certain clinics mainly of orthomolecular medicine. The Hermes Project comes as a scientific alternative for those who seek health betterment within the ethics of the Western scientific medicine. The principles followed in Hermes Project were recently established through publications in highly respected medical journals that only publish articles reviewed by experts on the subject.

It must be emphasized that an American group came to the conclusion that genetic testing for the risk analysis of asymptomatic patients is not justified. This conclusion is based on the fact that the test identifies those with the highest risk, but the certainty of developing Alzheimer's, as it is now possible to disclose for Huntington's, depends on a gene yet to be found.

Over the last 2 or 3 years, genetic testing is a well accepted procedure for patients with dementia, as the results of the treatment can be known beforehand.

The procedures recommended in Hermes Project have a real, though statistically small, effect. The outcome will be a delay of some years of the early clinical stage of dementia in Alzheimer's, so much so that those who have other symptoms do not reach this phase, or at least do not have its advanced stage.

Technical Aspects
The Hermes Project involves medical services like any other. Health insurances cover most procedures and tests required. All doctors at CNU are prepared to care for the patients. There might be problems with cheaper health insurances, as they may not cover EEG mapping and intelligence, memory and genetic testing. Individual or group packages can be negotiated. People who seek the service will be directed to scheduling an appointment to have a neurological assessment, family tree analysis and test requests.

Treating the person with Alzheimer's risk factors
Patients considered at risk will be coached on the preventive and long term nature of Hermes Project. Those who decide to carry on will be guided on how to take a formula that is manipulated in well known Chemists in the city. It contains vitamin E or alpha-tocopherol, betacarotene and diclofenac sodium. Seligiline will be recommended in special cases and estrogen will be recommended for women with low risk of cancer in the reproductive organs. Everybody will be encouraged to develop an extra interest in intellectual activities at work or, for instance, reading, study languages, start a new university, play complex board games like chess and bridge, and also to perform complex physical activities like dancing, snooker or table tennis, activities that increase the cognitive reserve and delay the clinical onset of dementia.

Early diagnosis and treatment of Alzheimer's
As soon as a behavioral or intellectual disorder starts, people who are over 60 should be investigated for Alzheimer's. A specific neurological appointment is followed by the neurological assessment of cognitive functions, blood tests, urine tests, chest X-ray, electrocardiogram and echocardiogram, electroencephalogram mapping (method: Sandmann et al 1994), MRI, SPECT brain, and executive intelligence and memory tests (Weschler method).

There are many kinds of medication that slow down Alzheimer's, among which are Aricept (donezepyl), Reminyl (galantamine, Janssen) and Exelon (rivastigmine, Novartis). These are only indicated for those who already have a final diagnosis. The Clinical Neurology Unit publishes a leaflet with the course of history of Alzheimer's and other dementias being researched.

Bibliographic references
Bickboller H, Campion D, ª Apolipoprotein E and Alzheimer Disease: genotype-specific risks by age and sex. Am J Hum Genet 1997; 60: 439-446; Sano M, ErnestoC, Thomas RG, et al. A controlled trial of seligiline, alpha-tocopherol, or both, the treatment for Alzheimer's disease. N Eng J Med 1997; 336: 1216-1222; Sandmann MC, Piana ER, Sousa DS, de Bittencourt PRM. Digital electroencephalogram mapping in the dementia of Alzheimer's and Parkinson's disease: prospective controlled study. Archives of Neuropsychiatry 54:50-56, 1996