Interview with Prof. Ying Han: New advances in early diagnosis and treatment of Alzheimer's disease

With the aging of the population, the incidence of Alzheimer's disease (AD) is increasing year by year, and the early capture of AD has become the goal of Healthy China 2030
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On October 20, 2021, the "2021 Alzheimer's Disease Prevention and Treatment Hot Issues Seminar (2)" hosted by the Department of Neurology, Xuanwu Hospital, Capital Medical University, and the National Geriatrics Clinical Medicine Research Center-China AD Preclinical Alliance will be online Held in the form of
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After the meeting, Yimaitong had the honor to interview the chairperson of this conference, Professor Han Ying, to explain the new progress in early diagnosis and treatment of AD.
This article is organized as follows
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Yimaitong organizes reports, please do not reprint without authorization
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Yimaitong: At present, the clinical diagnosis and treatment of Alzheimer's disease (AD) is difficult to find.
Once diagnosed, it is a difficult problem in the middle and late stages
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In order to realize the early diagnosis of AD, it is important to understand the latest biological standards of AD
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In this regard, could you briefly talk about the latest biological standards for diagnosing AD? Professor Ying Han is based on the latest biological standard for AD diagnosis published by the National Institute of Aging AD Association in 2018, which is the ATN framework
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A refers to Amyloid-β, that is, amyloid β, abbreviated as Aβ
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Aβ is a necessary condition for the qualitative diagnosis of AD
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If amyloid is positive, it means that AD has pathological changes and entered the AD continuous disease spectrum
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If it has the clinical features of subjective cognitive decline, then it is AD preclinical SCD
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T refers to Tau, mainly phosphorylated Tau
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Positive phosphorylation of Tau, plus Aβ positive, can diagnose AD
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If there is only A, regardless of whether T and N are positive, it means that it has entered the AD continuous disease spectrum
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With Tau, AD can be diagnosed
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N refers to neurodegeneration, which is only quantitatively meaningful for AD
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When the diagnosis of AD, the speed of progression (longitudinal), and the severity of the disease (lateral) be embodied by N
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For example, by observing hippocampal atrophy by NMR, the medial temporal lobe atrophy score is 0, indicating that the hippocampus structure is normal; 1 point represents mild hippocampal atrophy; 2 points represent moderate hippocampus atrophy; 3 points represent severe hippocampus atrophy; 4 points represent hippocampus Extremely atrophy
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The severity of brain atrophy can be judged by the medial temporal lobe atrophy score
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N is a quantitative change, it can be checked at two different time points to observe the progress of the disease
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If it is tested once, the severity of the disease can be observed
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 At present, there are mainly two internationally recognized A detection methods
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One is to look at cerebrospinal fluid Aβ through lumbar puncture, especially the ratio of Aβ 42/Aβ 40 is more meaningful
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The other is to use amyloid PET to determine whether A is positive.
If it is positive, it is considered to have AD pathological changes and enter the AD continuous disease spectrum.
With Tau positive, AD can be diagnosed
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Yimaitong: With the continuous development of science and technology, what new progress has been made in the early treatment of AD? Prof.
Han Ying On June 7, 2021, the US FDA approved the release of the disease-modifying drug Aducanumab, which is a monoclonal antibody targeting Aβ for the treatment of AD.
Diagnosis and early treatment
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Before using Aducanumab, the patient's amyloid should be checked first, and only patients with positive amyloid can use the drug
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The domestically-produced original research drug Mannote Sodium, which was launched in December 2019, can also be used for pre-clinical AD patients
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Because AD patients need long-term medication to keep the disease from progressing
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The current drugs used to treat AD are equivalent to pressing the "pause button
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The earlier and longer the "pause button" is pressed, the better the prognosis for the patient, which can ensure the patient's quality of life and maintain the patient's dignity
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 In short, the advent of mannite sodium and Aducanumab filled the gap in the preclinical drug treatment of AD
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It provides a powerful weapon for us to achieve three-early prevention
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Yimaitong: To implement effective prevention and treatment of AD, the focus is on early diagnosis, early intervention and raising public awareness
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In order to enhance the public's awareness and attention to early AD, how to better conduct AD science? Only when Professor Han Ying conducts extensive and continuous publicity through multiple channels and multiple methods can more people understand AD
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Due to the lack of awareness of AD, especially the young and middle-aged people generally believe that AD is a disease that only the elderly can suffer
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In fact, after 80s in 2050, they will be 60 years old collectively
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Although the onset of AD is in old age, it actually occurred decades ago
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When you are young and middle-aged, if you check amyloid, you will find that there is amyloid deposit in the cerebral cortex.
This time is called preclinical
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Only amyloid deposits without any other symptoms, this time is called the preclinical stage of stage 1
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When the patient is over 60 years old and feels that his memory has continued to decline in the past 5 years, and feels very worried about this, he enters the second stage of AD preclinical stage
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If it can be discovered at this time, diagnosed in time, and treated with standardized treatment, there is hope to block the course of AD and transform AD from an incurable disease into a preventable and controllable chronic disease like diabetes and hypertension
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Because the common people do not know enough about AD in the pre-clinical stage, they miss the best period for early diagnosis and treatment of AD
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Therefore, if you want to completely cure AD, you need to carry out extensive popular science propaganda
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Only when everyone knows that there is only subjective cognitive decline in the preclinical stage of AD, and the seven clinical features of subjective cognitive decline are well known, can it be possible to achieve early diagnosis and treatment of AD
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Expert profile Prof.
Ying Han, Chief Physician, Professor, and Doctoral Supervisor, Department of Neurology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases (Xuanwu Hospital)-Chairman of China AD Preclinical Alliance, First Chairman of Beijing Cognitive Neuroscience Society Xuan Wu Director of the International Collaborative Research Center for Neuropsychiatric Diseases of the Hospital, Chinese Journal of Neurology and other domestic and foreign academic journals, reviewers and review experts, National Natural Science First Review Expert, National Natural Science Foundation of China, key project host, published 143 papers in domestic and foreign academic journals