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*It is only for medical professionals to read and refer to the treatment of Aβ and other pathogenesis, which may bring a historical breakthrough in the treatment of AD
.
Expert profile Dr.
Sun Yongan, chief physician, chief physician of Peking University First Hospital, deputy director of the Department of Neurology, and master's tutor
.
Served as Deputy Chairman of the Mathematics Life Science Professional Committee of the Chinese Society of Industrial and Applied Mathematics, Deputy Chairman and Secretary-General of the Alzheimer's Disease Branch (ADC) of the Chinese Association for Geriatric Health Care, Deputy Director of the Intelligent Medical Care Professional Committee of the Chinese Association of Geriatric Health, Zhonghua Member of the Dementia and Cognitive Disorders Group of the Neurology Branch of the Medical Association, member of the Standing Committee of the Beijing Neurology Association (BNA) Cognitive Disorders and Related Diseases Committee, member of the Standing Committee of the BNA Neurorehabilitation Branch, and neuromolecular imaging of the Neurodegenerative Disease Committee of the Chinese Microcirculation Society Member of the Standing Committee of the group, member of the Neurodegenerative Disease Committee of the Beijing Society of Neurology, and member of the Vascular Cognitive Disorders Branch of the Chinese Stroke Society
.
Served as a member of the editorial board of "Chinese Journal of Cardiovascular and Cerebrovascular Diseases in the Elderly"
.
The treatment of Alzheimer’s disease (AD) is one of the biggest problems faced by modern medicine, especially the research and development of drugs for the treatment of pathogenic mechanisms.
It was once regarded as a “sinkhole”, but in the past year The progress made in the field of AD drug treatment at home and abroad is very gratifying, and it has reignited the upsurge of AD drug research and development
.
Every September is World Alzheimer’s Month.
This year’s theme is "Know Dementia, Know Alzheimer's".
The "Medical Circle" invited Professor Sun Yongan from the Department of Neurology of Peking University First Hospital to talk about the pathogenesis of AD and related drug treatment.
Topic
.
(Professor Sun Yongan Interview Video) Pay attention to the different characteristics of AD and achieve early diagnosis and treatment as far as possible.
) Will carry out a lot of work, “Before the new crown epidemic, September was the intensive start-up period of ADC’s various offline science and education activities.
The nationwide launching ceremony, the awarding event for outstanding caregivers in the "late Sangyu" period, and the "find you" tracing event in cooperation with the We Media platform, specifically targeting the prone characteristics of AD patients and the "yellow hands" to help patients go home “Environmental activities, the preparation of dementia care manuals for free distribution, etc
.
.
” The reason why it is necessary to vigorously carry out AD-related missionary work is because China is facing the enormous economic, social and medical burden brought by AD.
Cognition is still relatively limited
.
Professor Sun Yongan said that in the neurology department where he works, the number of dementia patients caused by AD has surpassed that of cerebrovascular disease, and other departments often come into contact with AD patients in their diagnosis and treatment work
.
Dementia caused by AD accounts for about 50%-70% of all dementias.
From the perspective of pathogenesis, as a chronic and progressive neurodegenerative disease, AD is an insidious onset, and the clinical feature of patients is progressive cognitive function Damage and abnormal behavior, most of them onset after 65 years of age (premature AD before 65 years of age is often related to genetic factors)
.
At the beginning of diagnosis, AD patients may have subjective cognitive dysfunction or mild cognitive impairment (MCI), showing symptoms such as slight memory loss, and have not yet experienced significant cognitive impairment and decline in basic work ability, but the disease will gradually follow Progress to the stage of dementia
.
Figure 1.
10 early warning symptoms of dementia.
Application of mining biomarkers to help accurate diagnosis of AD.
From the perspective of clinical practice, other causes of dementia may have symptoms similar to AD, so clinical When establishing the diagnosis of AD, doctors need to make full use of specific biomarkers and other tools in addition to asking for medical history and symptoms, perfecting laboratory and structural imaging examinations for identification
.
Professor Sun Yongan introduced that the existing AD diagnostic biomarkers can be divided into three categories: First, the targeted PET/CT imaging of "senile plaques" (Aβ plaques) with the help of tracers can detect some asymptomatic periods in advance.
Patients, but the cost of the examination is high and most hospitals cannot carry out the examination; the second is the detection of protein markers such as Aβ40/42 and P-Tau in cerebrospinal fluid.
However, Chinese patients and their families have low acceptance of lumbar puncture sampling, which restricts its clinical application.
Application in practice
.
The third category is the newest marker-phosphorylated-Tau 217 (P-Tau217), which will become the highlight of the Alzheimer’s Association International Conference (AAIC 2020) in 2020.
Studies have shown that it can accurately detect AD patients.
It is clearly distinguished from other neurodegenerative diseases
.
The biggest advantage of this marker is that it is simple and easy to implement, as long as it can be achieved by performing a serological examination.
In the future, adding this item in the daily physical examination can realize the early warning of the risk of AD
.
Professor Yongan Sun said that he hopes that there will be more available early screening methods to increase the rate of early diagnosis and treatment of AD, and early warning of AD risk will also help high-risk groups pay attention to their own health and avoid related risk factors in daily life.
, Pay attention to AD’s popular science education and reduce the occurrence of AD from the source
.
To capture the key to AD and try to start treatment from Aβ to clarify the pathogenesis is the key to treatment of AD.
The hypothesis of Aβ pathogenicity is still recognized as the mainstream view.
Professor Yongan Sun also recognized this hypothesis and believes that Aβ is currently causing disease.
The evidence is relatively strong
.
Since AD was first reported in the early 20th century, amyloid plaques and neurofibrillary tangles are still the main pathological changes reported in AD patients.
Since then, the gene encoding amyloid precursor protein (APP) is located on chromosome 21 It is the first gene to be found to be associated with AD.
A series of cell and animal experiments can also preliminarily confirm that the neurotoxicity of Aβ is related to the pathogenesis of AD
.
AD patients may also experience asymptomatic periods as long as 15 to 20 years before the onset of AD.
At this time, Aβ may have accumulated in the brain and begin to exert neurotoxic effects
.
However, it is not until Aβ destroys a large number of neurons and the remaining neurons cannot be compensated, the patient has clinical symptoms.
Therefore, from the pathological process, AD patients are already in the middle and late stages of the disease when they are diagnosed
.
Therefore, the treatment of AD needs to move forward, early detection and correct treatment, it is possible to press the pause button for AD onset
.
However, according to the relevant theories on the management and control of dementia risk factors published by Lancet in 2020, if twelve risk factors such as diabetes, smoking, and depression are avoided at different stages of life such as youth, middle-aged, and old, the risk of AD is expected to be reduced by 40%.
According to the calculation that there are 10 million AD patients in China, this can reduce the number of patients by about 4 million, and it is also expected to further reduce the number of MCI patients
.
The medical community at home and abroad is fully exploring various therapies to delay the progress of AD, from various non-pharmaceutical interventions to drug treatments.
The treatment of AD is no longer a "sea of despair"
.
Among them, the drug treatment of AD has changed from symptomatic treatment with cholinesterase inhibitors in the past, to in recent years, it has turned to target the pathogenic mechanism and delay the progression of the disease.
Among them, the development of therapeutic drugs targeting Aβ has always been the top priority
.
Although a number of previous clinical studies have lost ground, the U.
S.
Food and Drug Administration (FDA) has approved the first monoclonal antibody drug targeting Aβ for AD treatment in 2021.
Professor Yongan Sun believes that this is further recognized In view of the significance of the Aβ pathogenicity hypothesis and targeted therapy, "Dementia without Aβ cannot be regarded as AD
.
"
Professor Sun Yongan also said that he does not want AD patients to be ashamed of their illnesses, and should stop avoiding the disease, take the initiative to receive treatment as soon as possible, and try to change the outcome of the disease.
This is also in line with this year’s World Alzheimer’s Month.
Propaganda theme of "Diagnosis Early Wisdom"
.
*This article is only used to provide scientific information to medical and health professionals, and does not represent the platform's views
.
Expert profile Dr.
Sun Yongan, chief physician, chief physician of Peking University First Hospital, deputy director of the Department of Neurology, and master's tutor
.
Served as Deputy Chairman of the Mathematics Life Science Professional Committee of the Chinese Society of Industrial and Applied Mathematics, Deputy Chairman and Secretary-General of the Alzheimer's Disease Branch (ADC) of the Chinese Association for Geriatric Health Care, Deputy Director of the Intelligent Medical Care Professional Committee of the Chinese Association of Geriatric Health, Zhonghua Member of the Dementia and Cognitive Disorders Group of the Neurology Branch of the Medical Association, member of the Standing Committee of the Beijing Neurology Association (BNA) Cognitive Disorders and Related Diseases Committee, member of the Standing Committee of the BNA Neurorehabilitation Branch, and neuromolecular imaging of the Neurodegenerative Disease Committee of the Chinese Microcirculation Society Member of the Standing Committee of the group, member of the Neurodegenerative Disease Committee of the Beijing Society of Neurology, and member of the Vascular Cognitive Disorders Branch of the Chinese Stroke Society
.
Served as a member of the editorial board of "Chinese Journal of Cardiovascular and Cerebrovascular Diseases in the Elderly"
.
The treatment of Alzheimer’s disease (AD) is one of the biggest problems faced by modern medicine, especially the research and development of drugs for the treatment of pathogenic mechanisms.
It was once regarded as a “sinkhole”, but in the past year The progress made in the field of AD drug treatment at home and abroad is very gratifying, and it has reignited the upsurge of AD drug research and development
.
Every September is World Alzheimer’s Month.
This year’s theme is "Know Dementia, Know Alzheimer's".
The "Medical Circle" invited Professor Sun Yongan from the Department of Neurology of Peking University First Hospital to talk about the pathogenesis of AD and related drug treatment.
Topic
.
(Professor Sun Yongan Interview Video) Pay attention to the different characteristics of AD and achieve early diagnosis and treatment as far as possible.
) Will carry out a lot of work, “Before the new crown epidemic, September was the intensive start-up period of ADC’s various offline science and education activities.
The nationwide launching ceremony, the awarding event for outstanding caregivers in the "late Sangyu" period, and the "find you" tracing event in cooperation with the We Media platform, specifically targeting the prone characteristics of AD patients and the "yellow hands" to help patients go home “Environmental activities, the preparation of dementia care manuals for free distribution, etc
.
.
” The reason why it is necessary to vigorously carry out AD-related missionary work is because China is facing the enormous economic, social and medical burden brought by AD.
Cognition is still relatively limited
.
Professor Sun Yongan said that in the neurology department where he works, the number of dementia patients caused by AD has surpassed that of cerebrovascular disease, and other departments often come into contact with AD patients in their diagnosis and treatment work
.
Dementia caused by AD accounts for about 50%-70% of all dementias.
From the perspective of pathogenesis, as a chronic and progressive neurodegenerative disease, AD is an insidious onset, and the clinical feature of patients is progressive cognitive function Damage and abnormal behavior, most of them onset after 65 years of age (premature AD before 65 years of age is often related to genetic factors)
.
At the beginning of diagnosis, AD patients may have subjective cognitive dysfunction or mild cognitive impairment (MCI), showing symptoms such as slight memory loss, and have not yet experienced significant cognitive impairment and decline in basic work ability, but the disease will gradually follow Progress to the stage of dementia
.
Figure 1.
10 early warning symptoms of dementia.
Application of mining biomarkers to help accurate diagnosis of AD.
From the perspective of clinical practice, other causes of dementia may have symptoms similar to AD, so clinical When establishing the diagnosis of AD, doctors need to make full use of specific biomarkers and other tools in addition to asking for medical history and symptoms, perfecting laboratory and structural imaging examinations for identification
.
Professor Sun Yongan introduced that the existing AD diagnostic biomarkers can be divided into three categories: First, the targeted PET/CT imaging of "senile plaques" (Aβ plaques) with the help of tracers can detect some asymptomatic periods in advance.
Patients, but the cost of the examination is high and most hospitals cannot carry out the examination; the second is the detection of protein markers such as Aβ40/42 and P-Tau in cerebrospinal fluid.
However, Chinese patients and their families have low acceptance of lumbar puncture sampling, which restricts its clinical application.
Application in practice
.
The third category is the newest marker-phosphorylated-Tau 217 (P-Tau217), which will become the highlight of the Alzheimer’s Association International Conference (AAIC 2020) in 2020.
Studies have shown that it can accurately detect AD patients.
It is clearly distinguished from other neurodegenerative diseases
.
The biggest advantage of this marker is that it is simple and easy to implement, as long as it can be achieved by performing a serological examination.
In the future, adding this item in the daily physical examination can realize the early warning of the risk of AD
.
Professor Yongan Sun said that he hopes that there will be more available early screening methods to increase the rate of early diagnosis and treatment of AD, and early warning of AD risk will also help high-risk groups pay attention to their own health and avoid related risk factors in daily life.
, Pay attention to AD’s popular science education and reduce the occurrence of AD from the source
.
To capture the key to AD and try to start treatment from Aβ to clarify the pathogenesis is the key to treatment of AD.
The hypothesis of Aβ pathogenicity is still recognized as the mainstream view.
Professor Yongan Sun also recognized this hypothesis and believes that Aβ is currently causing disease.
The evidence is relatively strong
.
Since AD was first reported in the early 20th century, amyloid plaques and neurofibrillary tangles are still the main pathological changes reported in AD patients.
Since then, the gene encoding amyloid precursor protein (APP) is located on chromosome 21 It is the first gene to be found to be associated with AD.
A series of cell and animal experiments can also preliminarily confirm that the neurotoxicity of Aβ is related to the pathogenesis of AD
.
AD patients may also experience asymptomatic periods as long as 15 to 20 years before the onset of AD.
At this time, Aβ may have accumulated in the brain and begin to exert neurotoxic effects
.
However, it is not until Aβ destroys a large number of neurons and the remaining neurons cannot be compensated, the patient has clinical symptoms.
Therefore, from the pathological process, AD patients are already in the middle and late stages of the disease when they are diagnosed
.
Therefore, the treatment of AD needs to move forward, early detection and correct treatment, it is possible to press the pause button for AD onset
.
However, according to the relevant theories on the management and control of dementia risk factors published by Lancet in 2020, if twelve risk factors such as diabetes, smoking, and depression are avoided at different stages of life such as youth, middle-aged, and old, the risk of AD is expected to be reduced by 40%.
According to the calculation that there are 10 million AD patients in China, this can reduce the number of patients by about 4 million, and it is also expected to further reduce the number of MCI patients
.
The medical community at home and abroad is fully exploring various therapies to delay the progress of AD, from various non-pharmaceutical interventions to drug treatments.
The treatment of AD is no longer a "sea of despair"
.
Among them, the drug treatment of AD has changed from symptomatic treatment with cholinesterase inhibitors in the past, to in recent years, it has turned to target the pathogenic mechanism and delay the progression of the disease.
Among them, the development of therapeutic drugs targeting Aβ has always been the top priority
.
Although a number of previous clinical studies have lost ground, the U.
S.
Food and Drug Administration (FDA) has approved the first monoclonal antibody drug targeting Aβ for AD treatment in 2021.
Professor Yongan Sun believes that this is further recognized In view of the significance of the Aβ pathogenicity hypothesis and targeted therapy, "Dementia without Aβ cannot be regarded as AD
.
"
Professor Sun Yongan also said that he does not want AD patients to be ashamed of their illnesses, and should stop avoiding the disease, take the initiative to receive treatment as soon as possible, and try to change the outcome of the disease.
This is also in line with this year’s World Alzheimer’s Month.
Propaganda theme of "Diagnosis Early Wisdom"
.
*This article is only used to provide scientific information to medical and health professionals, and does not represent the platform's views
