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With the aging of the population, dementia has become a common disease of the elderly, of which Alzheimer's disease (AD) dementia accounts for 60% to 80%, which is the main cause of disability and death in the elderly.
The prevention and treatment of AD is a worldwide problem, the primary reason is that it is difficult to diagnose early.
To this end, a full member of the International Alzheimer's Disease Association (ADI), the Alzheimer's Disease Branch (ADC) Guidelines Group of the Chinese Geriatric Healthcare Association, formulated the first evidence-based guidelines for the diagnosis and treatment of AD dementia for use by clinicians.
1 Recommendations for Comprehensive Cognitive Evaluation in Clinical Evaluation ➤ Simple Mental State Examination (MMSE) has high performance in detecting dementia, with acceptable accuracy for mild cognitive impairment (MCI), and the best threshold and educational adjustments have been established Value (2B).
➤The Montreal Cognitive Assessment (MOCA) has high sensitivity and low specificity for detecting dementia, and has moderate performance on MCI, and has not reached consensus on the optimal threshold and educational adjustment value (2B).
➤Andenbrooke Cognitive Examination-Revised Edition (ACE-R) has higher performance in detecting dementia and MCI, and no consensus on the optimal threshold and educational adjustment value has been achieved (2B).
Recommendations for single-domain cognitive assessment ➤The Chinese version of Delayed Recall of Story (DSR) has high performance in detecting episodic memory impairment (2B).
➤The Chinese version of the Boston Naming Test-30 items (BNT-30) has medium performance in detecting language barriers (2B).
➤Drawing clock test-copy graphics (CDT-CG) has higher performance in detecting visual space structural obstacles (2B).
➤Chinese version of the connection test-B (TMT-B) has higher performance in detecting executive dysfunction (2B).
The most commonly used scales for evaluating behavioral disorders or psycho-behavioral symptoms caused by AD are the Neuropsychiatric Inventory (NPI) and the Insider Version of the Neuropsychiatric Questionnaire (NPI-Q).
NPI≥8.
0 points or NPI-Q≥10.
0 points are the same.
Sensitivity and specificity of AD are useful for distinguishing AD dementia from frontotemporal dementia (FTD) and can be used instead.
Recommendation: ➤The performance of NPI or NPI-Q in detecting mental behavior disorder is moderate (2B).
Functional assessment assesses the dysfunction or activities of daily living (ADL) caused by AD, including instrumental life function (IADL) and basic life function (BADL).
ADL≥16 points or IADL≥10 points, the sensitivity and specificity of screening AD dementia are equivalent (0.
90/0.
90, 0.
92/0.
93), and the accuracy is the same (AUC=0.
93).
When MMSE decreased by 3.
5 points or ADAS-cog increased by 7.
4 points, ADL decreased by 10 points.
IADL is also negatively correlated with MMSE and is more sensitive to the diagnosis of early AD dementia.
Recommendation: ➤ADL or IADL has high performance in detecting life dysfunction (2B).
2 Recommendations on clinical diagnostic criteria: ➤ The "Core Criteria" for the clinical diagnosis of AD dementia (NIA-AA) has high accuracy and wide applicability for the clinical diagnosis of probable and probable AD dementia (1A).
➤The clinical diagnostic criteria for severe neurocognitive disorders caused by AD (DSM-5) are more suitable for the clinical diagnosis of familial and typical AD dementia (2B).
➤The research criteria for AD diagnosis (IWG-2) can be used for clinical diagnosis of typical AD and early-onset dementia, prodromal or atypical AD (2B).
3 Recommendations for the treatment of cognitive symptoms with cholinesterase inhibitors ➤ Cholinesterase inhibitors (ChEIs) are effective for the cognitive, functional, and overall effects of mild to moderate AD dementia, and they can still benefit when used for severe AD dementia (1A ).
➤Donepezil 10mg/d can produce the best maintenance effect, with outstanding cognitive benefits and good safety (1A).
➤The 9.
5mg/d carbaradin patch can produce the best maintenance effect.
The cognitive and overall benefits are equivalent to the 12mg/d capsule, and the safety is better than that of the capsule (1A).
➤Galantamine 24mg/d can produce the best maintenance effect, the overall benefit is obvious, and the safety is good (1A).
➤When a ChEI initial drug lacks satisfactory efficacy or intolerance, switch to another ChEI to obtain similar effects to the initial drug (3C).
Recommendations for Glutamate Receptor Antagonists ➤Memantine 20 mg/d has a slight effect on the cognitive and overall effects of moderate to severe AD dementia (1A).
➤Memantine combined with cholinesterase inhibitors has a synergistic effect on cognition, overall, and behavior in the treatment of moderate to severe AD dementia (1A).
4 Recommendations for the treatment of mental and behavioral symptoms: ➤Atypical antipsychotics can alleviate the mental and behavioral symptoms caused by AD, but they all have the risk of aggravating cognitive impairment (2B).
➤Oanzapine relieves the mental and behavioral symptoms of AD, followed by risperidone, and quetiapine again (2B).
➤Pimavanserin has short-term benefits for the psychiatric symptoms of AD dementia (2B).
5 Recommendations for the treatment of traditional Chinese medicine: ➤ Chinese medicine treatment of AD dementia can be individualized treatment (3C) based on clinical staging and treatment based on syndrome differentiation.
➤Qinggong Shoutao Pill is beneficial to the cognition of AD in the prodromal stage (2B).
Ginkgo biloba extract EGb761 has a slight effect on the cognition, behavior and function of early and mid-stage AD dementia (2B).
➤Sequential therapy plus conventional western medicine has synergistic effects on AD dementia cognition and behavior (3C).
Yimaitong compiled from: Tian Jinzhou, Xie Hengge, Wang Luning, et al.
Guidelines for the diagnosis and treatment of Alzheimer’s disease in China (2020 edition)[J].
Chinese Journal of Geriatrics,2021,40(3):269-283.
DOI: 10.
3760 /cma.
j.
issn.
0254-9026.
2021.
03.
001.
The prevention and treatment of AD is a worldwide problem, the primary reason is that it is difficult to diagnose early.
To this end, a full member of the International Alzheimer's Disease Association (ADI), the Alzheimer's Disease Branch (ADC) Guidelines Group of the Chinese Geriatric Healthcare Association, formulated the first evidence-based guidelines for the diagnosis and treatment of AD dementia for use by clinicians.
1 Recommendations for Comprehensive Cognitive Evaluation in Clinical Evaluation ➤ Simple Mental State Examination (MMSE) has high performance in detecting dementia, with acceptable accuracy for mild cognitive impairment (MCI), and the best threshold and educational adjustments have been established Value (2B).
➤The Montreal Cognitive Assessment (MOCA) has high sensitivity and low specificity for detecting dementia, and has moderate performance on MCI, and has not reached consensus on the optimal threshold and educational adjustment value (2B).
➤Andenbrooke Cognitive Examination-Revised Edition (ACE-R) has higher performance in detecting dementia and MCI, and no consensus on the optimal threshold and educational adjustment value has been achieved (2B).
Recommendations for single-domain cognitive assessment ➤The Chinese version of Delayed Recall of Story (DSR) has high performance in detecting episodic memory impairment (2B).
➤The Chinese version of the Boston Naming Test-30 items (BNT-30) has medium performance in detecting language barriers (2B).
➤Drawing clock test-copy graphics (CDT-CG) has higher performance in detecting visual space structural obstacles (2B).
➤Chinese version of the connection test-B (TMT-B) has higher performance in detecting executive dysfunction (2B).
The most commonly used scales for evaluating behavioral disorders or psycho-behavioral symptoms caused by AD are the Neuropsychiatric Inventory (NPI) and the Insider Version of the Neuropsychiatric Questionnaire (NPI-Q).
NPI≥8.
0 points or NPI-Q≥10.
0 points are the same.
Sensitivity and specificity of AD are useful for distinguishing AD dementia from frontotemporal dementia (FTD) and can be used instead.
Recommendation: ➤The performance of NPI or NPI-Q in detecting mental behavior disorder is moderate (2B).
Functional assessment assesses the dysfunction or activities of daily living (ADL) caused by AD, including instrumental life function (IADL) and basic life function (BADL).
ADL≥16 points or IADL≥10 points, the sensitivity and specificity of screening AD dementia are equivalent (0.
90/0.
90, 0.
92/0.
93), and the accuracy is the same (AUC=0.
93).
When MMSE decreased by 3.
5 points or ADAS-cog increased by 7.
4 points, ADL decreased by 10 points.
IADL is also negatively correlated with MMSE and is more sensitive to the diagnosis of early AD dementia.
Recommendation: ➤ADL or IADL has high performance in detecting life dysfunction (2B).
2 Recommendations on clinical diagnostic criteria: ➤ The "Core Criteria" for the clinical diagnosis of AD dementia (NIA-AA) has high accuracy and wide applicability for the clinical diagnosis of probable and probable AD dementia (1A).
➤The clinical diagnostic criteria for severe neurocognitive disorders caused by AD (DSM-5) are more suitable for the clinical diagnosis of familial and typical AD dementia (2B).
➤The research criteria for AD diagnosis (IWG-2) can be used for clinical diagnosis of typical AD and early-onset dementia, prodromal or atypical AD (2B).
3 Recommendations for the treatment of cognitive symptoms with cholinesterase inhibitors ➤ Cholinesterase inhibitors (ChEIs) are effective for the cognitive, functional, and overall effects of mild to moderate AD dementia, and they can still benefit when used for severe AD dementia (1A ).
➤Donepezil 10mg/d can produce the best maintenance effect, with outstanding cognitive benefits and good safety (1A).
➤The 9.
5mg/d carbaradin patch can produce the best maintenance effect.
The cognitive and overall benefits are equivalent to the 12mg/d capsule, and the safety is better than that of the capsule (1A).
➤Galantamine 24mg/d can produce the best maintenance effect, the overall benefit is obvious, and the safety is good (1A).
➤When a ChEI initial drug lacks satisfactory efficacy or intolerance, switch to another ChEI to obtain similar effects to the initial drug (3C).
Recommendations for Glutamate Receptor Antagonists ➤Memantine 20 mg/d has a slight effect on the cognitive and overall effects of moderate to severe AD dementia (1A).
➤Memantine combined with cholinesterase inhibitors has a synergistic effect on cognition, overall, and behavior in the treatment of moderate to severe AD dementia (1A).
4 Recommendations for the treatment of mental and behavioral symptoms: ➤Atypical antipsychotics can alleviate the mental and behavioral symptoms caused by AD, but they all have the risk of aggravating cognitive impairment (2B).
➤Oanzapine relieves the mental and behavioral symptoms of AD, followed by risperidone, and quetiapine again (2B).
➤Pimavanserin has short-term benefits for the psychiatric symptoms of AD dementia (2B).
5 Recommendations for the treatment of traditional Chinese medicine: ➤ Chinese medicine treatment of AD dementia can be individualized treatment (3C) based on clinical staging and treatment based on syndrome differentiation.
➤Qinggong Shoutao Pill is beneficial to the cognition of AD in the prodromal stage (2B).
Ginkgo biloba extract EGb761 has a slight effect on the cognition, behavior and function of early and mid-stage AD dementia (2B).
➤Sequential therapy plus conventional western medicine has synergistic effects on AD dementia cognition and behavior (3C).
Yimaitong compiled from: Tian Jinzhou, Xie Hengge, Wang Luning, et al.
Guidelines for the diagnosis and treatment of Alzheimer’s disease in China (2020 edition)[J].
Chinese Journal of Geriatrics,2021,40(3):269-283.
DOI: 10.
3760 /cma.
j.
issn.
0254-9026.
2021.
03.
001.
