[World Alzheimer's Day] Identification of "Substitute Cognitive Decline", rejecting "Alzheimer's Disease"

September 21 is the World of Alzheimer's Disease Day

There are currently about 10 million patients with Alzheimer's disease (referred to as AD), and it is expected to exceed 40 million by 2050. Only fully understand AD and identify the "subjective cognitive decline" in time, and no longer regard it as an inevitable symptom of aging. Early diagnosis and early wisdom can press the pause keys of AD progress.

Han Yan

Chief Physician of Neurology, Xuanwu Hospital of Capital Medical University

Professor doctorate instructor

I am Han Yan, a clinical doctor at the Neurology Department of Xuanwu College of Capital Medical University. I am glad to share with you my perception of Alzheimer's disease for more than 30 years.

My mother -in -law's mother -in -law was smart and strong when she was young. After retiring, she stayed at home all day and was unhappy. She lost three or four. When she couldn't find something, she suspected that the people around them stolen it. They went out of the nanny and often became furious because of a small matter. When he was young, he was judged. However, she worked at Peking University Hospital, as the son of a heart disease expert, and never admitted that her mother was sick, and thought that her mother was just old. Eight years later, the mother forgot herself, couldn't take care of her, and would play her own bowel movements, so her son realized that the mother had dementia.

In the past two years, his son has also appeared in his mother. He has been stolen and his memory is not as good as before. Is this the old -fashioned confusion? Will this be the same when people are old? Nothing. The latest data show that there are 55 million dementia patients in the world, and there will be a new patient every three seconds, 60%to 80%of them are Alzheimer's disease, which is caused by AD.

There are currently about 10 million AD dementia patients in my country, and it is expected to exceed 40 million by 2050, and the situation is very severe. AD is mainly manifested in cognitive function and mental behavior abnormalities. It is the third largest disease to death after the cardiovascular and cerebrovascular disease and malignant tumors. As aging continuously intensify, in the near future, countless families will face heavy burdens. Experts at home and abroad have basically reached a consensus. The key to AD prevention is to discover early. So how much do Chinese people know about early AD?

Our Xuanwu Hospital National Elderly Disease Clinical Medicine Research Center, China AD clinical alliance, United League member units and Beijing Cognitive Neuroscience Society. After this online survey, the "Alzheimer's Clinical Clinical Clinical Clinical Clinical Clinical was launched. Research on the Investigation of Chinese People Awareness and Subjective Institute. The data shows that 78%of those who know that AD have clinical clinical periods, it seems that there are a lot of them. However, only 17%are willing to go to medical treatment for this. Why is there such a deep gap between action and knowledge? The reason is that because there is no real understanding of AD and its harm, I just know the name of the disease. To this end, we need a action to increase the intensity of publicity and popularization, so that Chinese people not only know the name of the disease, but also know the symptoms of early AD.

Alzheimer's disease English is Alzheimer ’s Disease, referred to as AD for short, because the brain cells of human thought, emotion and behavior of human thought, emotional and behavioral changes have gradually died, resulting in a period of dementia when daily life and work cannot be taken care of. It is also commonly known as "Alzheimer's Alzheimer" because of the elderly. Please note that Alzheimer's is not the name of the disease, but a symptom. It is a group of symptoms that cannot take care of daily life due to cognitive damage. Alzheimer's disease is the name of the disease. It can be seen that AD is not the same as Alzheimer's Alzheimer's, but causes the most common disease of Alzheimer's.

In 1906, when Dr. Alzheimer first reported his first AD patient, we had reason to be pessimistic, because not to talk about treatment at that time, even if the diagnosis could not be opened before his lifetime, he could not achieve a determined diagnosis.

However, with the continuous improvement of science and technology, especially the birth of molecular imaging, we can now see the gold standard diagnosis of AD through PET through PET. Determined diagnosis in early clinical. After the treatment of adhesive choline inhibitors and NMDA receptor antagonists, we have ushered in the gaps of intestinal flora and monoclonal antibody targeted drugs, filling the gap in the pre -clinical drug treatment of AD, not only achieved the realization Past clinical diagnosis and in early clinical treatment. Now we all know that AD has a continuous disease spectrum. If we can only diagnose in the dementia period, it is the level of diagnosis and treatment in the twentieth century. After entering the 21st century, we can diagnose AD in the early stages of dementia and even the clinical stage.

In 2018, the National Institute of Aging of the United States, the AD Association divided the AD disease throughout the six stages. Phase 1 and 2 constitute a 20 -year clinical stage. At this stage 1, Aβ is positive. At this time, if Aβ is checked, you will find that AD pathological changes have been found, and the AD continuous disease spectrum has been entered. However, at this time, patients will not feel. The earliest stage that patients can identify themselves are stage 2, because at the occurrence of stage 2, the subjective cognition that patients can feel themselves decline in themselves. At the beginning of AD pathology, because we have brain and cognitive reserves, and the brain has a compensation function, the brain cells will not lose compensation before the death of more than 50%, and there will be obvious clinical symptoms. However, at this time, the patient will have the feeling of declining memory. In addition, the depression, anxiety, delusional thoughts, victims, or unreasonable psychological behaviors of the elderly may occur.

In the past, we only noticed that the clinical stage of AD 2 will have changes in cognitive function. In fact, slight mental behavior abnormalities are also the symptoms that may occur in the early stages of AD clinical 2. Correctly identifying the symptoms of subjective cognitive decline, it is possible to block the course of AD disease, transform the AD from the symptoms of cure into a chronic disease that can be controlled like diabetes. And dignity, elegant and old.

To do this, we need to have a subjective cognitive decline in the minds of each of us, otherwise, even if you feel that the memory is decreased than before, you will not think about it. Old confused, people will do this when they are old, and they will miss the golden window for early treatment. Subject cognitive decline is not treated, and after five to ten years, it will gradually advance to stage 3, 4, 5, and 6.

At stage 3, the daily life and work of patients are basically normal. The work that has been mastered in the past can still be done, but the efficiency is decreased. Mainly manifested as mild cognitive dysfunction. The above corresponds to the coronary magnetic resonance examination. The red arrow refers to the hippocampus. The hippocampus is the first damaged brain area of ​​AD. The MTA indicates that the inner temporal lobe atrophy is used to evaluate the degree of sea horse atrophy. The MTA score has gradually increased from zero to 4, respectively, indicating that hippocampus atrophy from scratch, from light to middle, heavy, and extremely heavy.

At the stage 3, patients can't remember what the individual just experienced. Even after reminding, they cannot be recalled, just as they have never happened at all, or they can only recall it. However, the memory of Chen Sesame Rotten Valley in his youth can make the family mistakenly think that the patient's memory is very good. On the contrary, that is the long -term memory retained in the forehead, and the new memory is formed by the hippocampus.

The new occurrence of new occurrence indicates that the hippocampus is damaged and it has reached the stage of loss. It is too late to find it at this time, because the death of brain cells cannot be regenerated, and the lost brain function cannot be recovered. To put it plainly, the course of AD is irreversible. AD treatment is just equivalent to pressing the pause key. Therefore, the earlier the pause key is pressed, the more brain function is reserved, the better the treatment effect will be.

The key to previous AD treatment is not to find too late. It is easy to understand with cancer metaphorical metaphor. In the early stages of clinical clinic, 1 and 2, like early cancer, 3, 4, mid -term, 5, 6, and late stages. When I think of going to the hospital for treatment, more than 80%of patients have entered the stage of medium and severe dementia. For example, cancer has reached the advanced stage. At this time, the treatment effect is not good. We will be discouraged and mistakenly think that AD cannot prevent control. The mother of a heart disease expert mentioned earlier was discovered until the late stage, and he was currently in the stage of 2 or 3. As long as you check the neural psychological scale and Aβ, you can clearly diagnose.

Early discovery was for early treatment. I am fortunate to participate in the "SCD Features" published by the SCD International Working Group in 2020, which is a necessary information to suggest that we have the risk of AD disease from a clinical perspective. There is no need to check the tall instrument. As long as the patient and family members who are familiar with the patient, that is, the person familiar with the matter, can conduct self -risk assessment, simple and practical.

1. Be sure to have a sense of memory decline

2. This feeling appeared in the past five years

3. This feeling appears at the age of 60 and later

Fourth, I am worried about this feeling, I am afraid that I will suffer from AD

Fifth, this feeling continues to exist

6. Because this feeling is actively medical treatment, even if it is normal, it does not indicate that it is not explained. You need to monitor dynamic monitoring. Check it once a year.

7. Those familiar with the matter also confirmed that patients have symptoms such as decreased memory or mild mental behavior abnormalities. Among them, Article 4 is the most important. As long as there is worry, they must pay great attention and check Aβ in time. Early SCD. Time is the brain, and the diagnosis is clear as soon as possible, which is conducive to starting treatment as soon as possible, protecting our brain, and protecting our memory.

Let me give you an instance that happened to me. Teacher Mo Ran just passed her 66th birthday two days ago. The memory of her feelings has decreased than before. For almost five years, because of family history, I am worried about the quality of life of her future life. I hope to find a more professional doctor for treatment. Finally, one day she saw our subjective cognitive decline in WeChat public account, discovered our SCD first screen self -test, etc., and added my WeChat according to the figure, and asked for diagnosis.

I suggest that she check the full set of neural psychology tables, MRI, PET, and she is normal after checking the measuring table, and then ask me if I can remove the SCD in the early stages of clinical clinical? Of course, what is easy to misunderstand that the common people think that as long as they involve AD, they must have abnormalities, and they must even be demented.

I mentioned earlier that AD is not the same as dementia. Alzheimer's only 4, 5, and 6 stages in the six stages of AD, and before it, there are 1, 2, and 3. There is self -feelings, objective examinations can be completely normal, and there is no difference between people who are normal from the perspective of the neurosometer. Therefore, in the early stages of AD, Aβ needs to be checked. If Aβ is negative, AD can be removed.

She checked PET and was unfortunate. The result was positive. The coronary magnetic resonance MTA was 2 points. It can be seen how powerful her brain compensation function is. Haima has atrophy in moderation, and clinically is only the stage of subjective cognition decline. Time is the brain, and treatment should be started as soon as possible. I said to her: You caught up with good times, there are medicines in the early stage of clinical practice, and drug intervention and non -drug intervention can be carried out at the same time. She is a patient with good compliance and self -discipline. In addition to taking the medicine on time every day, she can also fix Tai Chi, do eight -stage brocade, participate in community choirs and other activities. advertising.

The family members in the group can find the answer in my previous popular science. The family members of the patient who just entered the group thought she was my student or medical assistance, and sometimes she also clarified: I am also a patient, a patient in the early stage of clinical cognition of Professor Han. , Exercise the brain to prevent abolition from shrinking. In this way, while she insisted on helping everyone every day, she practiced her own cognitive training. Let us all bless her with a good quality of life in the future, and will not enter the middle and late stages like her mother, because she presses the pause keys in the early clinic.

For young and young people present, AD prevention is best to start from the source. To treat the disease without disease, each of us is the best medical treatment.

AD is a disease that can be controlled. In 2020, the Liuye knife magazine published twelve types of anti -controllable risk factors. If we can notice and control in life for life, we can reduce the risk of dementia by 40%.

As early as 10 years ago, the National Institute of Aging of the United States-AD Association pointed out that if it can be identified and intervened in the clinic in the early stage of clinical practice, it can be delayed by 50%of the progress of the disease and reduced the number of AD dementia in the future by 57%, which saves half of it. Medicine spent. Drugs that can be used for pre -clinical treatment in the past two years have come out, and doctors have been diagnosed and treated in the early stages of clinical clinical.

Everything is ready, only Dongfeng, Dongfeng is the timely medical treatment of patients with AD in the early period of clinical AD. If everyone can seek medical treatment in time, the doctor is confident to reduce the number of AD dementia patients expected to occur in 2050 in 2050. Doctors are most worried about the lack of knowledge of Chinese people. They only know the advanced ADs. I do n’t know that the early AD still has 20 years of clinical clinical period.

For young and young people present, they will collectively enter the age of 60 after the 80s in 2050. Pay attention to the early AD, and do a good job of taking the medicine as the family, but also yourself. Therefore, to prevent problems before, when you are young, you can't think that it is an age -dependent disease, and I am still early. Only by correcting the decline in subjective cognition correctly and preventing early prevention can early diagnosis and early wisdom and wisdom "wisdom".

In the end, I want to emphasize that only the whole society fully recognizes that AD is a disease, and no longer regards it as an inevitable symptom of aging. Note that even if the elderly in the family appear slightly changes, the subjective cognition declines correctly. Once it is determined that the AD clinical clinical period should start treatment as soon as possible, and press the pause of AD progress. Healthy aging is our goal of struggle. Let us start from when we are young, and start to be healthier, more active, and more meaningful.

- END -