Prof. Xu Jun: Active prevention, the risk of AD-related dementia can be reduced by up to 40%!

*Only for medical professionals to read for reference.
Know your confidant and prevent Alzheimer's disease as soon as possible
.

 Expert profile Professor Jun Xu is the chief physician, professor, doctoral supervisor, leader of the Beijing Youth Top-notch Team, and academic leader of the Cognitive Impairment Specialty in the Neurology Center of Beijing Tiantan Hospital, Capital Medical University
.

Doctor of Medicine, post-doctorate at the University of Pittsburgh (3 years), mainly engaged in the clinical diagnosis and treatment and pathogenesis of cognitive disorders
.

Published 31 SCI papers as the first or corresponding author, presided over 5 projects from the National Natural Science Foundation of China and 20 projects at the ministerial and provincial level-with a total funding of more than 10 million
.

As the first completer, he was granted 2 invention patents, 5 software copyrights, and 4 provincial and ministerial awards
.

Published 3 monographs and participated in editing/translating 6 monographs
.

Vice President of Cognitive Disorder Branch of Chinese Geriatrics Society, Vice Chairman of Brain Health Branch of Chinese Stroke Society, Leader of Brain Health Nutrition Cooperation Group of Chinese Medical Association Branch of Parenteral and Enteral Nutrition
.

In the elderly population over 60 years old in China, the prevalence rate of dementia is 6.
04%, and Alzheimer's disease (AD) occupies a major position in dementia patients (prevalence rate is 3.
94%) [1]
.

Based on this data, there are 15.
07 million people with dementia in China aged 60 and over, of which 9.
83 million are AD patients.
.
.
easy to forget things, mess around, get lost in familiar places, have difficulty dealing with financial problems, and change emotional personality.
.
.
.
These are the familiar early symptoms of dementia
.

According to the clinical staging of AD specified in the "Guidelines for the Diagnosis and Treatment of Dementia in Alzheimer's Disease in China (2020 Edition)", once such symptoms appear, it indicates that AD patients have progressed to the middle stage of the disease (stage 4) [2]
.

Is it possible to find signs of AD early in the disease and intervene to prevent patients from developing dementia? The answer is yes
.

Every September is World Alzheimer's Month.
Taking this opportunity, the "medical community" specially invites Professor Xu Jun from Beijing Tiantan Hospital, Capital Medical University, to share his views on early screening and prevention of AD
.

(Professor Xu Jun interview video) Using biomarker detection, AD can be discovered 10-15 years in advance.
The theme of this year’s Alzheimer’s disease month is "Know Dementia, Know Alzheimer's".
Combining this theme, Professor Xu Jun talked about The difference between AD and dementia: "Dementia and AD are intersecting each other.
AD actually includes the'preclinical stage', the'mild cognitive impairment stage' and the dementia stage with obvious symptoms, and before the obvious symptoms occur In fact, it is difficult to use clinical scales to diagnose AD
.

"The prevention and treatment of AD is a worldwide problem.
The primary reason is that it is difficult to diagnose early, but with the participation of biological markers and imaging, early diagnosis is not impossible
.

Prof.
Xu Jun pointed out: “In the stage of mild cognitive impairment, the symptoms of patients are often not obvious.
The scale can only be used as a reminder.
The true diagnosis should be made with the objective knowledge of the patient’s cognitive function and biological markers
.
The
latest Research data shows that markers of brain Aβ deposition can be detected 10 years before the onset of symptoms, while the detection of cerebrospinal fluid tau protein, especially phosphorylated tau-181/217, can be 10-15 years earlier than the onset of symptoms.
Therefore, the best time for early detection of AD should be 40-50 years old
.

"The research standard for the diagnosis of AD (IWG-2, 2014) defines amnestic or non-amnestic symptoms as the "core feature" of AD, and the detection of AD biomarkers is defined as the "supporting feature
.
"
National Institute of Aging .
The (NIA-AA) standard divides these biological markers into two categories: one is the markers of brain Aβ deposition (cerebrospinal fluid Aβ42 reduction and Aβ-PET imaging), and the second is the biomarker of neuronal damage (Cerebrospinal fluid tau protein increased, FDG-PET showed decreased glucose metabolism in the temporal parietal cortex, structural MRI showed atrophy of the basal, medial or lateral temporal lobe, and atrophy of the medial parietal cortex) [2,3]
.
The
"detection method" is Xu The second key word for early diagnosis mentioned by Professor Jun, early structural imaging features, such as brain tissue atrophy detected by MRI, is of positive significance for the early diagnosis of AD.
In addition, cerebrospinal fluid lumbar puncture has always been a routine method for the diagnosis of AD, but Because lumbar puncture is an invasive examination, it may face patient compliance problems
.

Some new technical methods also help early screening, such as the non-invasive blood flow detection project MRI arteries routinely carried out by national research centers such as Tiantan Hospital and Xuanwu Hospital Spin-labeled perfusion (ASL) can detect abnormal cerebral blood flow in patients early, and can also screen AD patients 10-15 years before the onset of symptoms
.

"Clinical detection methods can be used to diagnose early AD, mainly including Cerebrospinal fluid lumbar puncture, structural imaging and molecular imaging (Aβ-PET and tau-PET), in the next 3-5 years, the combination of blood biomarkers will also be widely used in clinical practice
.

With the improvement of scales and the development of new technologies such as speech recognition, there may be other detection methods for early detection of AD in the future
.

"Professor Xu Jun concluded
.
The
best time window to prevent AD-related dementia is at the stage of mild cognitive impairment.
" Diagnose with biological markers and give reasonable intervention at the stage of cognitive disorder
.

"Speaking of early treatment, Professor Xu Jun believes that although patients with dementia symptoms still have treatment opportunities, they have missed the best time window for intervention
.

In 2017, the international journal "The Lancet" published a white paper, pointing out Risk factor intervention (nutrition support, chronic disease control, etc.
) at the stage of cognitive impairment can reduce the risk of AD-related dementia by up to 35%.
This data is increased to 40% in the 2020 "Lancet" special issue
.

Professor Xu Jun said: “These two sets of data are shocking.
To prevent AD from progressing to dementia, the period of mild cognitive impairment is the best time window.
At this stage, reasonable nutritional support is provided, and chronic diseases such as cardiovascular and cerebrovascular diseases are controlled.
It can effectively prevent the occurrence of AD-related dementia.
More importantly, if the AD-related biological markers (Aβ and tau protein) can be managed by targeted drugs at this stage, it can also effectively prevent the occurrence of AD-related dementia
.

"New concept of AD prevention: low education level, chronic non-communicable diseases (cardio-cerebrovascular disease, type 2 diabetes, etc.
) and gender (female) are considered to be the three major risk factors for non-familial AD
.

In addition to gender , Other risk factors can be incorporated into the AD prevention system, combined with the latest flow regulation data and clinical research, Professor Xu Jun introduced the latest AD prevention concept-full life cycle management, AD as a chronic non-communicable disease Management and control
.
The
whole life cycle management mainly consists of 3 parts: (1) Prenatal and postnatal care (2) Education: school-age, adolescence and youth receive education to increase knowledge reserves and improve basic cognition
.

(3) Chronic disease Risk management and control: middle-aged and elderly people manage the risk of chronic diseases such as cardiovascular and cerebrovascular diseases through healthy and scientific life>
of
chronic disease risk management .
Chronic disease risk management is the most content in the whole life cycle management.
Part
.

In terms of vascular health, Professor Xu Jun pointed out: “Without vascular health, there will be no brain health.
In addition to the well-known “three highs”, abnormalities in homocysteine ​​indicators can also damage vascular health
.

Therefore, in addition to regular monitoring of various indicators In addition, you should also pay attention to supplementing vitamin B complex, such as folic acid, to protect blood vessel health and prevent the occurrence and progression of AD
.

" Professor Xu Jun also talked about the importance of nutritional support: "In the early stage of AD, patients may suffer from decreased taste and chewing function.
Loss and other reasons cause a single dietary structure, which is not conducive to the prevention of dementia.
Nutritional support can be used as a first-line method for the prevention of AD-related dementia
.

"Preventing the occurrence of dementia is to maintain brain health through a healthy life>
.

” Professor Xu Jun concluded: “Under this background, it is necessary to It is clear that there is no so-called'magic medicine' for treatment of AD and dementia, and there is no process of'one-click restart'.
Instead, life>
.

” The message was Alzheimer’s month.
Professor Xu Jun also expressed his good expectations and wishes to AD patients through the “medical community”: “I hope all AD patients And his family members face the reality, treat the disease in a correct way, put a proper mental attitude to deal with the disease, and don't hide the disease and avoid doctors; early diagnosis and treatment can actively respond to the disease and achieve a state of coexistence with the disease
.

”References: [1] Jia L, Du Y, Chu L, et al.
Prevalence, risk factors, and management of dementia and mild cognitive impairment in adults aged 60 years or older in China: a cross-sectional study.
Lancet Public Health.
2020;5(12):e661-e671.
doi:10.
1016/S2468-2667(20)30185-7.
[2] Tian Jinzhou, Xie Hengge, Wang Luning, Wang Yinhua, Wang Huali, & Shijing, et al.
(2021 ).
Guidelines for the diagnosis and treatment of dementia in Alzheimer's disease in China (2020 edition).
Chinese Journal of Geriatrics, 40(03), 269-283.
[3] Cognitive Impairment Branch of Chinese Geriatrics Association, & Care and Management of Patients with Cognitive Impairment Expert consensus writing group.
(2020).
Comprehensive management of the ability of daily living and psycho-behavioral symptoms and cognitive function of patients with Alzheimer's disease.
Chinese expert consensus (2019).
Chinese Journal of Geriatrics, 039(001), 1-8.
* This article is only used to provide scientific information to medical and health professionals, and does not represent the platform's views