Can you get old without dementia? The world's first Alzheimer's prevention guidelines have been published.

Heavy prevention guidelines are coming out.according to the world Alzheimer's disease report 2018, every three seconds, there is one dementia patient in the world.at present, there are at least 50 million dementia patients in the world, which is expected to reach 152 million by 2050, of which about 60% - 70% are Alzheimer's disease (AD).there are about 10 million AD patients in China, and it is estimated that more than 40 million AD patients will be diagnosed in China by 2050.this has become a major public health problem that seriously affects the health and quality of life of the global population. There is no specific treatment forto prevent or reverse the progress of AD. However, more and more epidemiological studies show that AD can be prevented. Effective control of risk factors and rational utilization of protective factors can significantly reduce the incidence rate and prevalence of AD.unfortunately, there is no international evidence-based medical evidence to guide the practice of this major brain disease which seriously threatens human health.in response to this urgent need, the clinical research team of Professor Yu Jintai from Huashan Hospital Affiliated to Fudan University, academician Bruno vellas, chairman of the international society of Geriatrics, Professor Paul s aisen and professor can Zhang of Harvard Medical School, Professor Serge Gauthier of McGill University in Canada and John of Cambridge University in the United States are in line with this urgent need Professor suckling, Jacques touchon, University of Montpellier, France and Sandrine Andrieu, third University of Toulouse; EE heok Kua and Lei Feng, National University of Singapore; Evangelos Evangelou, University of yoanina, Greece; and Vincent, Chinese University of Hong Kong Professor Mok, Professor Jia Jianping of Xuanwu Hospital of Capital Medical University, Professor Wang Yanjiang of Daping Hospital of the Third Military Medical University, pan an of Tongji Hospital of Huazhong University of science and technology, Professor Tan LAN of Qingdao Municipal Hospital of Qingdao University, Professor Dong Qiang of Huashan Hospital Affiliated to Fudan University, etc The world's first international guideline for evidence-based prevention of AD.the guideline is of great significance for the formulation of ad prevention strategies. Recently, the research results were published in the Journal of Neurology, neurosurgery and psychiatry (jnnp), a sub Journal of the British Medical Journal (BMJ), under the title of "evidence-based prevention of Alzheimer's disease" The results of the study have attracted wide attention of the international medical community.this study lasted more than five years. 243 observational prospective studies (OPSS) and 153 randomized controlled trials (RCTs) meeting the criteria were selected from 44676 studies. A systematic study and meta-analysis were conducted on 104 influencing factors and 11 interventions. Evidence for evidence-based medicine was developed according to the grade criteria Level and recommendation level.among them, the evidence level is divided into A-level Evidence & gt; B-level Evidence & gt; C-level evidence; the recommendation level of relevant intervention is divided into level I recommendation (strong recommendation), level II recommendation (weak recommendation) and level III recommendation (not recommended).finally, according to the evidence-based medicine standards, the prevention guidelines for AD were formulated, and 21 recommendations were formed (see Table 1).Table 1: guidelines for the prevention of Alzheimer's disease: preliminary clinical recommendations * Note: for some influencing factors, we can't give too detailed suggestions (especially the specific dosage and treatment course), and we need to design good trials to repeat the validation in the future (key studies).in addition, these suggestions can not avoid the limitations of existing studies and the unpredictability of follow-up studies.in randomized controlled trials, some interventions such as physical exercise cannot achieve absolute blindness or allocation concealment, which inevitably results in high risk of bias.therefore, we believe that statistically significant results are more reliable than risk levels.
The international research team led by Professor Yu Jintai proposed level I recommendations for 19 influencing factors / interventions, 10 of which have A-level evidence level, including: ① people over 65 years old should keep body mass index within a certain range, not too thin; ② more cognitive activities, such as reading, playing chess and other stimulating mental activities (3) to maintain a healthy lifestyle and avoid diabetes, we should closely monitor the cognitive impairment of diabetic patients; 4) protect the head and avoid trauma; 5) people under 65 years old should maintain a healthy lifestyle and avoid suffering from hypertension; 6) avoid the occurrence of orthostatic hypotension, and closely monitor the cognitive function of patients with orthostatic hypotension; 7 To maintain good mental health, we should closely monitor the cognitive function of patients with depressive symptoms; (8) to relax and avoid excessive tension; (9) to receive education as much as possible in the early years; (10) to regularly detect the level of blood homocysteine; for patients with hyperhomocysteinemia, vitamin B and / or folic acid treatment should be applied, and their cognitive function should be closely monitored Conclusion of this intervention is consistent with the results of other studies. At present, the treatment of lowering homocysteine is considered to be the most promising preventive measure for AD. the other 9 influencing factors / interventions have B-level evidence level, including: (1) people under 65 years old should lose weight, and BMI should be kept in the range of 18.5-24.9; (2) people over 65 years old should be alert to weight loss, and if there is a trend of BMI decline, their cognitive function should be closely monitored; ③ adhere to regular physical exercise; ④ do not smoke and avoid exposure to smoke in the environment Grass smoke, for smokers should take various ways to quit smoking as soon as possible; ⑤ ensure adequate and good sleep, timely diagnosis and treatment when sleep disorders occur; ⑥ maintain a healthy lifestyle, rational drug use, avoid cerebrovascular disease, for stroke patients, especially patients with cerebral hemorrhage, should closely monitor their cognitive function changes, and take effective preventive measures to protect their recognition To maintain a healthy and strong body in old age, we should closely monitor the cognitive function of the increasingly frail population; 8) maintain a good state of cardiovascular system, and use drug treatment for patients with atrial fibrillation; and (9) take food or supplement vitamin C. nearly two-thirds of these recommendations are closely related to cardiovascular risk factors and lifestyle, which shows the importance of maintaining good cardiovascular and cerebrovascular status and healthy lifestyle to prevent ad. the study also noted that two interventions were not recommended for ad prevention: estrogen replacement therapy (level A2 evidence) and acetylcholinesterase inhibitors (Level B evidence). the study also systematically classified the age groups of the 19 influencing factors / interventions recommended by level I in the human life cycle (see Figure 1). Figure 1: the x-axis shows the mean age (solid circle) and average age range (short horizontal line) of the total sample including the observational prospective study; the y-axis represents the relative risk (RR); Oh orthostatic hypotension, CVD cerebrovascular disease, IMT intimal thickness. 1; 2. For adolescents (6-15 years old), education should be given as much as possible in order to prevent ad; 3. For middle-aged and young people (15-65 years old), obesity, smoking, sleep disorder, diabetes, cerebrovascular diseases (cerebral microbleeds, carotid intima hyperplasia) should be avoided in order to prevent ad Physical exercise, weight loss, vitamin C intake and healthy lifestyle should be realized; 4; In order to prevent ad, the risk factors that should be avoided are weight loss, smoking, sleep disorder, diabetes, cerebrovascular disease (cerebral microbleeds, carotid intima thickening, stroke, etc.), head injury, weakness, orthostatic hypotension, depression, atrial fibrillation, hyperhomocysteinemia. The protective factors should be realized are not too thin to maintain body mass index, and exercise Exercise, cognitive activity, vitamin C intake, healthy lifestyle. Professor Yu Jintai suggested that the combination of the above multiple evidence-based clinical recommendations may be the best choice for the prevention of AD. in the future, large-scale real-world studies should be carried out to explore the optimal combination of multiple recommendations for grade I recommendation of A-level evidence, and focus on those who have not yet developed disease but have high risk of dementia (such as aope ε 4 carriers, high polygenic score, and Patients with family history of dementia and positive amyloid protein should establish a comprehensive and individualized optimal ad prevention strategy as soon as possible. this project is supported by the major research program of the Ministry of science and technology of the people's Republic of China and the major science and technology special project of "brain and brain like intelligence" in Shanghai. source: Wenhui article author: Tang Wenjia, Chen diligent editor: Zhang Li, Li Wenjie, did you like it? 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