Professor Mingwei Wang: Early AD screening requires 4 major issues

*For medical professionals to read only for reference Who? How? Keep these in mind! September 21, 2021 is the 28th World Alzheimer's Day.
The theme is "Know Dementia, Know Alzheimer's"-Knowing the enemy and knowing the past The Alzheimer's Disease Branch (ADC) of the Health Care Association planned a series of expert interview activities.
This issue specially invited Professor Wang Mingwei from the First Hospital of Hebei Medical University
.

Alzheimer's disease (AD) is a chronic and progressively aggravated cognitive impairment disease with a high incidence and disability rate, which brings a serious economic burden to the patient’s family and society.
For AD, early screening Inspection and diagnosis are particularly important
.

So, how to do early screening and diagnosis in clinical practice? AD early screening and early diagnosis, who are the focus of attention? ■ Focus on the elderly.
Professor Mingwei Wang said that for the early screening and diagnosis of AD, we must first focus on the elderly
.

Big data research shows that as the population ages, the prevalence of AD will become higher and higher.
About half of the elderly over 80 will have cognitive impairment
.

Therefore, in the outpatient clinic, when receiving elderly patients, it is necessary to consider whether they have the possibility of AD and give appropriate clinical evaluation
.

■ Looking for a middle-aged person who is at risk of early onset, Professor Mingwei Wang said that AD is a chronic disease that gradually progresses over time.
This may be a long-term process, or even without any performance for a long period of time.
We also call it the "platform period
.
"
Of course, before we enter aging, some people have shown early symptoms of AD, or are at risk of early onset of AD
.

So, what are the early onset risks of AD? For example: family history, obesity, lack of exercise, head injury, severe anxiety, depression, long-term stress, and lack of sleep for a long time
.

Middle-aged people at these risks should be screened early and regularly
.

How to perform AD "efficient" screening in outpatient clinics? Outpatient clinics are the first line of medical work in the whole hospital.
Improving the efficiency of outpatient clinics is of great significance to improving patient satisfaction and medical experience.
For the early diagnosis of AD, Professor Wang Mingwei shared several types of high-efficiency methods based on his many years of clinical experience.
Screening methods
.

■ Preliminary and quick judgment-the clock drawing test Professor Wang Mingwei introduced that in daily clinical work, patients should have a preliminary judgment, and the clock drawing test is recommended
.

The clock drawing test (CDT) seems simple, but it has a good correlation with the Concise Mental State Scale (MMSE) that we usually use, and has high specificity and accuracy, and can screen 80% -90% of dementia patients
.

Figure 1: Diagram of the clock drawing test CDT is a single neuropsychological test.
The tester is required to draw a clock dial on white paper and write the number indicating the time in the correct position, and then use the needle to mark the designation Time
.

The test can evaluate the tester's visual space, perception, writing motor ability, semantic memory and execution ability.
The test is simple but comprehensive
.

The most commonly used and simplest method for evaluating CDT results is the 4-point method: (1) Draw a closed circle: 1 point (2) The position of the number is correct: 1 point (3) The 12 numbers are all missing and correct: 1 point (4) Pointer Position is correct: 1 point evaluation: 4 points-normal cognitive level; 3 points-mild decline in cognitive level, 0-2 points-moderate to severe decline in cognitive level
.

■ Patient self-evaluation or provided by family members——AD8/Mini-Cog Professor Mingwei Wang said that in clinical practice, in addition to CDT, the AD8 self-evaluation scale and the Mini-Cog (Mini-Cog) are also very simple and practical Scale
.

AD8 is a screening tool that asks the tester for cognitive impairment.
It helps to screen the tester's cognitive status by answering 8 simple questions
.

The AD8 scale is not affected by the patient’s age, education, gender, race, and does not require baseline materials.
It can be self-assessed or assessed by the insider.
The scoring method is simple and time-consuming.
If the question is “yes”, score 1 point.
"No", score 0 points.
By scoring, you can very sensitively detect the early cognitive changes of many common dementia diseases
.

Figure 2: AD8 specific items and description Mini-Cog is a simple, effective, time-saving and easy-to-manage cognitive measurement tool that can screen out early cognitive impairment
.

The scale mainly includes three items: instant recall, short delay recall and clock drawing test
.

It takes about 3-5 minutes, and only a short time of training is needed for the evaluation
.

Mini-Cog is not affected by the level of education, and mainly evaluates the patient's memory and executive function
.

Mini-Cog test: 1.
Please listen carefully and remember 3 unrelated words, and then repeat
.

2.
Ask the examiner to draw the shape of the clock on a blank sheet of paper, mark the number of the clock, and give the subject a time to mark it on the clock
.

(11:10 or 8:20 is the most commonly used, more sensitive than others)
.

3.
Ask the subject to say the 3 words given earlier
.

Evaluation: After completing the CDT test, 1 point (0-3 points) for each recalled word
.

0 points: Can not remember one of 3 words, it is regarded as dementia; 1~2 points: Can remember 1-2 words, CDT is correct, cognitive function is normal; CDT is incorrect, cognitive function is impaired; 3 points: Able to remember 3 words and normal cognitive function
.

■ Routine System Scale——Professor MMSE/MoCA Wang Mingwei introduced that the Concise Mental State Scale (MMSE) is the most popular and commonly used dementia system scale at home and abroad, including time and place orientation, language, calculation, immediate and short-term Auditory memory, structural imitation and other items, a full score of 30, time-consuming 5-10 minutes, affected by the education level of the tester, high school education or above, less than 26 points is cognitive decline, the lower the score, the worse the cognition
.

The Montreal Cognitive Assessment (MoCA) scale is an assessment tool used to screen for mild cognitive impairment (MCI)
.

Compared with MMSE, the scale is slightly more difficult and more comprehensive
.

Anxiety and depression cannot be ignored Professor Wang Mingwei said that depression caused by anxiety and depression is a very important differential diagnosis of AD.
In clinical work, it is necessary to timely determine whether the patient has anxiety or depression
.

For anxiety and depression, the 90-second 4-question method can be used for preliminary assessment
.

If you think there is a problem, it is recommended to do a system scale for further testing
.

Figure 3: Anxiety and depression assessment (90 seconds 4 questions method) other screening and identification methods Professor Wang Mingwei introduced, in addition to scale screening, hematology examinations, imaging examinations, and more precise genetic testing are all relevant to cognition The diagnosis of the disorder is very important
.

Commonly used blood tests include: vitamin B12, blood sugar, immune inflammation indicators, sex hormones and thyroid function
.

For patients with a family history, Aβ42, P-tau and T-tau and other people in the family should also be screened
.

In terms of imaging examinations, CT and MRI can be normal for early AD patients, and different degrees of brain atrophy appear with the development of the disease
.

Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) are imaging techniques that have been studied in recent years.
AD patients will have low metabolism in the temporal and parietal lobes to aid diagnosis
.

Looking forward, Professor Wang Mingwei said that AD is a common chronic disease of the elderly.
In addition to large hospitals, grassroots and community hospitals also need to strengthen their understanding and grade screening
.

Simple scales and quick questionnaires can help grassroots doctors find more early-stage AD patients.
When further diagnosis is needed, patients can be transferred to the top three hospitals for more detailed examinations
.

The grassroots hospitals and the tertiary hospitals cooperate with each other to jointly help the chronic disease management, early diagnosis and early intelligence of AD
.

 Expert profile Wang Mingwei Professor, Chief Physician, Professor, Doctoral Supervisor, Honorary Discipline Director of Neurology, and an expert who enjoys special allowances from the State Council
.

Director of Hebei Provincial Laboratory of Brain Aging and Cognitive Neuroscience, and leader of Hebei Provincial Key Discipline (Geriatrics)
.

Vice Chairman of the Alzheimer's Disease Society of the Chinese Geriatric Health Association, Member of the Standing Committee of the Psychosomatic Medicine Branch of the Chinese Medical Association, Member of the Parkinson's Disease Group of the Neurology Branch of the Chinese Medical Association, Chairman of the Psychosomatic Medicine Branch of the Hebei Medical Association, Hebei Middle-aged and Elderly Health Care Association Director and other positions
.

The main research directions are brain aging and brain health, degenerative diseases of the nervous system in the elderly, and psychosomatic diseases
.

Won 4 Hebei Science and Technology Progress Awards, 18 professional books for translation, writing and editing, and more than 140 first author or corresponding author papers, including 26 SCI papers
.