Professor Lu Shen: Early diagnosis and early treatment make the future of patients different

*Only for medical professionals to read for reference AD ​​patients can also have a bright future
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As the problem of population aging in our country is getting worse, the prevalence of cognitive dysfunction represented by Alzheimer's disease (AD) has increased significantly, and the need for prevention and control has become more and more prominent.
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The theme of the 2021 World AD Month event is: Know Dementia, Know Alzheimer's
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How to achieve the goal of "early diagnosis and early wisdom"? In this issue, we invite Professor Lu Shen from Xiangya Hospital of Central South University to discuss feasible strategies for AD diagnosis and treatment based on clinical experience and evidence-based evidence
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This patient made me very unforgettable.
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Professor Shen Lu first recalled a case that made her very unforgettable.
This was a case of a young, highly educated, and high-income patient who changed his personality after divorce and became stubborn, paranoid, and unreasonable.
, But family members and patients think it is an anxiety and depression state related to divorce
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However, it wasn't until a patient with a computer professional background actually made a miscalculation that the family felt that something was wrong and went to the hospital for an examination
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I regret to find that at this time the patient’s cognitive dysfunction has reached a state of moderate impairment, and the disease progressed very quickly.
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As a patient in a kosher family, the family members have a certain understanding of AD, but they still misunderstood it for a long time.
Delayed treatment due to affective disorders.
If you see a doctor early and give active drug and non-drug interventions, the patient’s cognitive impairment may decline more slowly, and he can maintain a state of self-care without special care for longer.
His future may be better.
Better
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Professor Lu Shen pointed out that the first symptom of many AD patients is near memory loss, which is manifested as forgetting things, repeating questioning, and losing things.
Some patients have personality changes as their outstanding performance, such as the actor Su Daqiang in the TV series "Everything is Good" , A particularly selfish, paranoid, and hard-to-talk old man is actually a typical AD personality change
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If children find that the elderly in the family have similar problems, they should take them to see a doctor as soon as possible to determine whether they are AD.
"Early diagnosis and early intelligence" may start with the attention and care of family members
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Intervene these risk factors to reduce the risk of disease.
The development trend of AD prevalence in different countries is different.
Developed countries show a downward trend, while developing countries show an upward trend.
This is due to the high disease awareness and primary prevention strategies in developed countries.
Perfect
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The incidence of AD in China is still on the rise in recent years, and the rate of consultation is still at a low level
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At the national level, a number of initiatives have been issued, such as the "Exploring Special Service Work Plan for the Prevention and Treatment of Alzheimer's Disease", and a major project of "Brain Science and Brain-like Research" to promote the early diagnosis and treatment of neurodegenerative diseases and the construction of cohort
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Through activities such as AD Day and AD Month, cognitive specialists will also conduct intensive health education for the public and carry out a series of popular science activities, so that the general public can understand the importance of early diagnosis and early treatment of cognitive dysfunction, and will make diagnosis and treatment before the threshold.
Move
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In clinical practice, Professor Shen also adopted a variety of "down-to-earth" screening strategies
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For example, health education is given to younger children, and then they can drive older parents to see a doctor
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With the help of various community cohorts, advance AD ​​early screening work and so on
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What can be seen at present is that in recent years, the public’s awareness of AD has gradually increased.
More patients with milder illnesses, such as those with mild cognitive impairment, come to see a doctor early, instead of seeing patients with severe illness in the past, and patients get early After intervention, the condition tends to be more stable and the disease progresses more slowly
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At present, there are domestic and foreign guidelines for AD prevention.
If the relevant risk factors are intervened early, the patient's risk of AD can be reduced by about 1/3
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Related risk factors include: hypertension, diabetes, dyslipidemia, overweight or obesity, cardiovascular and cerebrovascular diseases, low education, depression, sleep disorders, loss of smell, hearing and vision [1]
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Taking active interventions for the above risk factors, such as advocating "live and learn", and use auxiliary equipment to improve the problem of hearing loss, help reduce the risk of disease and delay the age of onset
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It's not just a neurologist's business.
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Professor Shen Lu pointed out that the diagnosis of AD not only relies on neurologists, but also requires many efforts
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For example, when community doctors first diagnose patients, they can use AD8 Early Dementia Screening (AD-8) to assess the patient’s AD risk through 8 simple questions, and make timely referrals when problems are found
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The
family members of the patients are also responsible for the diagnosis of AD.
It plays an important role.
Once family members are found to have forgotten recent affairs, decline in communication and comprehension or calculation skills, or personality changes, they should see a doctor early
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At present, major hospitals generally have opened memory clinics or AD special disease clinics, through a series of Systematic examinations, such as scale testing, cranial magnetic resonance, blood testing, lumbar puncture or PET-CT if necessary, can diagnose AD patients in time and give active treatment
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In addition, AD accounts for about 60% of neurodegenerative dementia Lewy body dementia and frontotemporal dementia are common types of dementia second only to AD, and may overlap with AD.
The etiology of some patients with neurodegenerative dementia may be genetically related
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Professor Shen Lu’s research group has been enrolled in more than 2,000 groups.
In the case of neurodegenerative dementia, it was found that the proportion of AD patients with a family history of known mutant genes was about 6% to 7%, and the proportion of patients with frontotemporal dementia was about 23%
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Some patients with special phenotypes were also found, such as neuronal nuclear inclusion disease, Huntington's disease and so on
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This part of the patients with genetic-related dementia appears early, progresses quickly, and may also be accompanied by certain psycho-behavioral symptoms and Parkinson-like symptoms
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This result suggests that some dementia patients (such as young patients, patients with family history, and patients with special phenotypes) are required to undergo genetic testing.
Once diagnosed, their blood-related family members should also be tested at this location.
Early intervention before the symptoms of pathogenic mutations may be able to delay the onset and delay the progression of the disease, so as to achieve accurate diagnosis and treatment
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At the end of the interview, Professor Lu Shen emphasized a misunderstanding in the current diagnosis and treatment of AD-AD is not without treatment and no medicine can be cured.
After the early diagnosis, if you take medication on time and actively perform cognitive rehabilitation, you can get family support and keep it well.
Attitude, the patient's condition can often remain stable for a period of time.
With regard to the theme of AD month today—knowing the enemy and knowing the past, early diagnosis and early wisdom, AD patients can also have a bright future
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 Expert profile Shen Lu, chief physician and professor, Department of Neurology, Xiangya Hospital, Central South University
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Mainly focus on the diagnosis, differential diagnosis, standardized treatment and pathogenesis of Alzheimer's, Parkinson's disease and genetic diseases of the nervous system
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References: [1] Chinese Dementia and Cognitive Impairment Diagnosis and Treatment Guidelines Writing Group, Chinese Medical Doctor Association Neurologist Branch Cognitive Impairment Disease Professional Committee.
Chinese Alzheimer's Disease Primary Prevention Guidelines.
Chinese Medical Journal, 2020, 100( 35):2721-2735.