JNNP: Professor Tulip Tai of Huashan Hospital led the development of international guidelines for evidence-based prevention of Alzheimer's disease.

According to the World Alzheimer's Disease 2018 Report, one dementia patient worldwide is born every three seconds.
currently, there are at least 50 million people with dementia worldwide, and that number is expected to reach 152 million by 2050, of which about 60-70% are Alzheimer's disease (AD).
, there are currently about 10 million AD patients in China, and by 2050, there are expected to be more than 40 million AD patients in China.
has become a major public health problem that seriously affects the health and quality of life of the global population.
There is currently no specific treatment to stop or reverse the progression of AD, but a growing number of epidemiological studies have shown that AD is preventable, that effective control of risk factors and rational use of protective factors can significantly reduce the incidence and prevalence of AD.
, there is no international evidence-based medical evidence to guide clinical practice against this serious threat to human health and brain disease.
in response to this urgent need, the clinical research team of Professor Tulip Tai of the Department of Neurology at Huashan Hospital, affiliated with Fudan University, is in association with Fellow Bruno Vellas, Fellow of the International Geriatric Society, Professor Paul S Aisen of the University of Southern California and Professor Can Zhang of Harvard Medical School, Professor Serge Gauthier of McGill University in Canada, Professor Suck Johnling of the University of Cambridge, Professor Jacques Touchon, University of Montpellier, France, and Professor Tulu Professor Sandrine Andrieu of the Third University of Singapore, Professor Ee-Heok Kua and Professor Lei Feng of the National University of Singapore, Professor Evangelos Evangelou of the University of Ioannina, Greece, Professor Vincent Mok of the University of Hong Kong Chinese and Professor Jia Jianping of Xuanwu Hospital of the Capital Medical University, Professor Wang Yanjiang of the Daping Hospital of the Third Military Medical University, Professor Pan An of Tongji Hospital of huazhong University of Science and Technology, Professor Tan Lan of Qingdao City Hospital of Qingdao University, Professor Dong Qiang of Huashan Hospital affiliated with Fudan University, and other well-known scholars in this field have systematically reviewed and analyzed the existing research evidence, and formulated the world's first international guide on AD evidence-based prevention, which is of great significance to the development of AD prevention strategy. BMJ' sub-issue, Journal of Neurology, Neurosurgery and Psychiatry, was selected by BMJ Press to publish the findings to 5,000 international media outlets around the world. It has attracted wide attention from the international medical community.
Over a period of more than five years, the study selected 243 observational prospective studies (OPSs) and 153 randomized controlled trials (RCTs) that met the criteria from 44,676 studies, conducted systematic studies and meta-analyses of 104 interventionable influence factors and 11 interventions, and developed evidence levels and recommendations for evidence-based medicine based on recommended graded assessment, development and evaluation (GRADE) criteria: evidence levels were classified as A-level evidence. Class B evidence and C-level evidence; the recommended levels for related interventions are: Level I recommendation (highly recommended), Level II recommendation (weak recommendation) and Level III recommendation (not recommended).
, based on evidence-based medical standards, AD prevention guidelines were developed, resulting in 21 recommendations (see table 1).
Table 1 Alzheimer's Prevention Guidelines: Preliminary Clinical Recommendations - Too detailed recommendations (especially specific dosages and procedures) for certain influencers are not possible, and future well-designed trials are needed to repeat validation (critical studies).
addition, the proposed recommendations cannot avoid the limitations of existing studies and the unforoability of follow-up studies.
#, certain interventions, such as physical exercise, do not achieve absolute blindness or distribution hidden, inevitably ingesting the risk of high bias.
, we believe that statistically significant results are more reliable than risk levels.
international research team led by Professor Tulip Tai made level I recommendations for 19 influencers/interventions, 10 of which had a level of A-level evidence, including: (1) people over 65 years of age should maintain a BMI at a certain level Within the range, it is not appropriate to be too thin, (2) engage in more cognitive activities, such as reading, chess and other stimulating mental activities, (3) maintain a healthy lifestyle, avoid diabetes, diabetic patients should closely monitor their cognitive decline, (4) protection Head, avoid trauma, (5) people under 65 years of age should maintain a healthy lifestyle to avoid high blood pressure, (6) avoid erect hypotension, for erect hypotension patients, should closely monitor their cognitive function status, (7) maintain good mental health State, for patients with depressive symptoms, should closely monitor their cognitive function status, (8) relax the mood, usually avoid excessive stress, (9) early years should be as much education as possible, (10) regularly test blood cysteine levels, Vitamin B and/or folic acid therapy is applied to patients with high homocysteineemia, while their cognitive function status is closely monitored (the conclusions of this intervention are consistent with other findings, and homocysteine therapy is currently considered the most promising AD preventive measure).
the remaining nine influencers/interventions have a B-level level of evidence, including: (1) weight loss for people under 65 years of age, best in the range of 18.5-24.9 kg/m2; People over 65 years of age should be alert to weight loss, if there is a downward trend in BMI, should closely monitor their cognitive function status; (3) adhere to regular physical exercise; (4) do not smoke, but also avoid exposure to tobacco smoke in the environment, for smokers should be as soon as possible Take various ways to quit smoking, (5) ensure adequate and good sleep, sleep disorders should be promptly diagnosed and treated, (6) maintain a healthy lifestyle, reasonable medication, avoid cerebrovascular disease, for stroke patients, especially those with cerebral micro-bleeding, should closely monitor their cognition Functional changes, and take effective preventive measures to protect their cognitive function; (7) to maintain a healthy and strong physique in later life, for the increasingly weak population, should closely monitor their cognitive function status; (8) to maintain a good state of the cardiovascular system, for patients with atrial fibrillation to apply medication. ;(9) Diet intake or additional vitamin C supplementation.
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 a healthy lifestyle for the prevention of AD.
addition, the study noted that two interventions were not recommended (level III recommended) for AD prevention: estrogen replacement therapy (A2 level evidence) and acetylcholinesterase inhibitors (class B evidence).
the study also systematically classified the distribution age groups of the 19 influencer/interventions recommended at level I above (see figure 1).
There is little research on interventionable influence factors and fewer data and conclusions for young people (6-15 years of age), as much education as possible for adolescents (6-15 years of age) and as much education as possible for young and middle-aged people (6-15 years of age) 15-65 years old) population, in order to prevent AD, should avoid risk factors such as obesity, smoking, sleep disorders, diabetes, cerebrovascular disease (micro-bleeding, cervical arterial thickening, stroke), hypertension, depression, mental stress, should be achieved protection Factors include physical activity, weight loss, vitamin C intake, healthy lifestyle, and for the elderly (65 years old), the risk factors to avoid in order to prevent AD are weight loss, smoking, sleep disorders, diabetes, cerebrovascular disease (cerebral micro-bleeding, neck total Arterial endometrial thickening, stroke medium), head trauma, infirmity, erect hypotension, depression, atrial fibrillation, hypermonosome cysteineemia, should be achieved the protective factors are to maintain body mass index not too thin, physical exercise, cognitive activities, Vitamin C intake, healthy lifestyle.
Figure 1:x-axis represents the average age (solid circle) and average age range (short horizontal line) of the total sample, including observational prospective studies; Professor
Tulip Tai suggests that the above combination of evidence-based clinical recommendations may be the best option for preventing AD, and that in the future, a large sample study of the real world should be conducted to explore the optimal combination of recommendations for A-level evidence recommended by Level I, focusing on people who are not yet at risk of developing the disease but at high risk of dementia (e.g., those with higher multigene scores, people with a family history of dementia, amyloid-positive people), and establish a comprehensive and integrated optimal AD prevention strategy as soon as possible.
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