China's "Clinician AD Diagnosis and Treatment Attitude Report" was released to help break the obstacles to early diagnosis of Alzheimer's disease

On November 5, sponsored by the Psychiatry and Mental Health Branch of the Chinese Geriatrics Association, co-organized by the Brain Hospital Affiliated to Guangzhou Medical University and the Third Affiliated Hospital of Sun Yat-sen University, the Geriatric Psychiatry Group of the Psychiatric Branch of the Chinese Medical Association, the Geriatric Working Committee of the Psychiatrist Branch of the Chinese Medical Doctor Association, the Geriatric Psychiatry Sub-Alliance of the South China Psychiatric Specialist Alliance, Guangzhou Mental Health Association, The "8th China Geriatric Medicine and Technology Innovation Conference and 2022 China Geriatric Psychiatry and Mental Health Academic Conference" hosted by the Neuropsychology Group of the Neurology Branch of Guangdong Medical Association and supported by Roche China was launched online.

With the theme of "Innovating Research Perspectives and Expanding Disciplines", the conference invited Yu Xin, President of the Psychiatry and Mental Health Branch of the Chinese Geriatrics Society and Professor of Peking University Sixth Hospital, Jiang Wen, Secretary of the Discipline Inspection Committee and Deputy Secretary of the Party Committee of the National Center for Mental Health and Mental Health Prevention and Treatment, Xia Qing, Deputy Director of the Medical Department of Beijing Medical Award Foundation, Professor Wang Huali of Peking University Sixth Hospital, Chairman of Alzheimer's Disease Branch (ADC) of China Geriatric Health Association, Chief Physician of PLA General Hospital Xie Hengge, Secretary of the Party Committee of Brain Hospital Affiliated to Guangzhou Medical University Ning Yuping, Professor of Neurology of Peking University First Hospital Sun Yongan, Director of Alzheimer's Disease Diagnosis and Treatment Center of Shanghai Jiao Tong University School of Medicine, Professor Xiao Shifu, Shanghai Mental Health Center, Yu Enyan, head of the geriatric psychiatry group of the Psychiatric Branch of the Chinese Medical Association, professor of Zhejiang Provincial Cancer Hospital affiliated to the University of Chinese Academy of Sciences, chairman of the Geriatric Working Committee of the Psychiatrist Branch of the Chinese Medical Doctor Association, and professor of the First Affiliated Hospital of China Medical University, and many other experts and scholars conducted in-depth discussions
on the prevention and control of mental health of the elderly such as actively coping with aging, early prevention and early treatment, and standardized management.

The conference released the first "Survey Report on Doctors' Early Diagnosis Attitude of AD" in China, which was a large-sample survey report
on the attitudes and diagnosis and treatment behaviors of nearly 2,000 clinicians across the country on the early diagnosis of Alzheimer's disease.
From the perspectives of doctors specializing in cognitive impairment and community doctors, the report is of great significance
for understanding the gap between diagnosis and treatment guidelines and actual clinical practice, and promoting the solution strategies of early diagnosis and treatment obstacles in the field of Alzheimer's disease.

The threshold of diagnosis and treatment has moved forward, and it is urgent to break the obstacles to early diagnosis of AD

Cognitive impairment (commonly known as dementia) is a public health problem that cannot be ignored in an aging society, the most common of which is Alzheimer's disease (AD).

Dementia affects more than 55 million people worldwide, with more than 10 million new cases every year, of which AD is one of the most common types of dementia in the elderly, accounting for about 60%~80% of elderly dementia patients ^[]
。 Professor Yu Xin of Peking University Sixth Hospital pointed out that with the acceleration of China's aging process, China has entered an aging society in advance, and we have a large number of elderly mental and mental health problems to deal with, and AD prevention and treatment will not only be an important issue
for the medical community but also for the whole society.

The prevention and treatment of AD is a worldwide problem, and the first reason is that it is difficult to diagnose
early.
AD has an insidious onset and slow progression, which is easily mistaken by patients and their families for senile memory loss, resulting in neglect of medical treatment, resulting in unclear onset time of the main complaint, which brings great challenges
to diagnosis.

Professor Yu Enyan, Zhejiang Cancer Hospital affiliated to the University of Chinese Academy of Sciences, said: "From subjective cognitive decline, mild behavioral impairment, mild cognitive dysfunction, to moderate and severe neurocognitive impairment, and finally dementia, this is a continuous disease spectrum of cognitive impairment gradually progressing and evolving, and a considerable evolution process is the best period
for us to carry out early intervention.
" "At the same time, monoclonal antibody drugs for the treatment of early AD will release phase III study data at the end of this year, which is expected to provide a new option
for early treatment of early AD patients.
"

Professor Wang Huali of Peking University Sixth Hospital mentioned at the conference, "The scope of geriatric psychiatry in China is constantly changing, and the most typical change is 'disease threshold forward'
.
Therefore, Alzheimer's disease should also strengthen the recognition of early signs of dementia, further promote the process of incorporating memory physical examination into health examination, and achieve 'forward movement of diagnosis and treatment threshold' and grasp the 'golden window period'.
Strengthen clinical standardized diagnosis and treatment management
.
”

However, in actual clinical practice, the current situation of early diagnosis and treatment of AD is not optimistic
.
According to published data, the medical treatment rate of various types of dementia, including AD, in China is only 26.
9%, and the clinical missed diagnosis rate is as high as 76.
8%.

"The average interval between the first appearance of obvious cognitive symptoms and the first visit of AD patients in China is about 2 years, and even in memory clinics with a high level of diagnosis and treatment, diagnostic delays are very common, and the best treatment and intervention period is often missed
。 Professor Wang Huali added that the lack of understanding of the early symptoms of the disease by patients and their families, and a strong sense of "stigma" about this mental illness, are also the main reasons why AD is not detected in time
。

Standardize the attitude of diagnosis and treatment, and create a new era of early AD diagnosis research for clinicians in China 

Clinicians, including cognitive impairment specialists and community physicians, are the most important part
of the pathway for patients with AD.
The "Survey Report on Doctors' Early Diagnosis Attitude of AD" released by the conference for the first time conducted a questionnaire survey on 659 specialists with dementia and cognitive impairment and 1288 community doctors from 31 provinces, autonomous regions and municipalities directly under the central government.
Previously, there was no large-sample survey in China to understand the definition and attitude
of specialists towards early AD diagnosis.
Xia Qing, director of Beijing Medical Award Foundation, emphasized: "The release of the Report will surely provide a scientific basis
for us to optimize the early diagnosis path of Alzheimer's disease and formulate Alzheimer's disease prevention and control policies in the future.
" ”

Cognitive impairment specialists are the main force in the diagnosis and treatment of dementia and cognitive impairment, and they have the deepest understanding
of the factors that prevent patients from accessing early treatment.
Professor Wang Huali, the main drafter of the report, said that the report shows that specialists fully affirm the importance and benefits of early diagnosis of AD patients, and 95.
3% of them believe that "the elderly in the care service system should accept AD.
" Early diagnosis assessment", 94.
7% of specialists believe that "early diagnosis of AD can enable patients to get early intervention"
.

Although the early diagnosis attitude of specialists is very positive, there is still a rift
with clinical practice.
For example, 46% of specialists said that they did not want to diagnose patients with early-stage AD when the efficacy of the drug is uncertain, and another 14.
1%.
The specialist surveyed is neutral on
this.
Ning Yuping, Secretary of the Party Committee of the Brain Hospital Affiliated to Guangzhou Medical University, said, "Emphasizing early treatment and standardizing the early diagnosis attitude and early diagnosis and treatment mode of specialists for AD is very necessary for further moving forward the window of clinical diagnosis and treatment, which can effectively delay the course of AD and improve.
" AD progress
.
”

In addition to specialists, with the advancement of national medical reform and graded diagnosis and treatment, community doctors will also play an important role
in the diagnosis and treatment of AD patients in the future.
The survey found that community doctors have a strong awareness of early AD screening, but community doctors' insufficient ability to screen AD has formed a shackle for early diagnosis of AD
.
On the one hand, community doctors' limited understanding of risk factors, assessment and diagnosis, and etiology of diseases is an influencing factor
for community doctors to make independent judgments on cognitive impairment.
On the other hand, the lack of primary medical security also affects the role
of community doctors in early screening and diagnosis.

In this regard, Professor Wang Huali made suggestions for the future work of community doctors: "First, we should strengthen the public education of early signs of AD and improve the public's scientific understanding of early diagnosis, treatment and prevention of Alzheimer's disease; Second, it is necessary to build grassroots memory clinics, promote the application of early screening and evaluation tools in grassroots institutions, and improve the accessibility of early screening; Third, strengthen grassroots training to enhance grassroots doctors' awareness of accurate diagnosis methods; Fourth, it is necessary to open a two-way referral channel to provide early treatment options for patients diagnosed with AD early; Fifth, we should accelerate the transformation of innovative achievements in the research and development of AD markers and improve the availability of early diagnosis
.
”

"Understanding the attitude and concept of specialists towards early diagnosis and treatment, as well as the mastery and treatment attitude of community doctors on AD disease, can help clarify the obstacles in the current diagnosis and treatment path
.
" Understanding the current diagnosis and treatment behavior of specialists with dementia and cognitive impairment can help to assess the gap
between diagnosis and treatment guidelines and current clinical practice.
Professor Yu Xin concluded that these data will help medical institutions and governments to follow up their work to explore solutions to overcome the obstacles to early diagnosis and treatment of AD, and provide strong support
for further promoting the improvement of AD prevention and treatment in China.

Ms.
Pu Cunying, head of Roche's Diagnostic Medical Science Affairs Department, said: "The key to changing the lives of Alzheimer's patients is: early screening, early diagnosis and early treatment
.
Roche is committed to improving the prognosis of AD patients and providing holistic solutions
in the AD pathway.
It is hoped that in the future, Roche can continue to work with all sectors of society to build an AD prevention and control system and help achieve the national
healthy aging strategic goal.
”

Resources

1, Global Burden of Disease Study (GBD 2019).

2, TIAN Jinzhou, XIE Hengge, WANG Luning, et al Guidelines for the diagnosis and treatment of Alzheimer's disease dementia in China (2020 edition)[J].
Chinese Journal of Geriatrics, 2021,40(03):269-283

3, Alzheimer's Disease Branch Research Group of the National Geriatric Health Association, Alzheimer's disease screening and diagnosis framework for Chinese groups; Chinese Journal of Internal Medicine, Vol.
58, No.
2, February 2019, 91-101

4，Wang HL et al.
, J Glob Health.
2019 Dec; 9(2):020321