"The Lancet" Prevention Report: Change these 12 points as soon as possible, 40% of dementia can prevent World Alzheimer's Day

▎Alzheimer's disease, editor of WuXi AppTec's content team, is the most common form of dementia
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Every September is World Alzheimer's Disease Awareness Month, and September 21 is World Alzheimer's Day (World Alzheimer's Day)
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According to WHO estimates, more than 55 million people currently suffer from dementia, which means that 8.
1% of women and 5.
4% of men over the age of 65 suffer from the disease
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By 2050, the number of patients is expected to reach 139 million, and most of us may be affected by dementia and Alzheimer's disease to some extent
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"Dementia not only deprives millions of people of their memory, independence and dignity, but also takes away loved ones we are familiar with
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" said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization
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On the occasion of World Alzheimer's Day, we and readers will review the special report "Dementia Prevention, Intervention and Care" published by the authoritative medical journal "The Lancet" last year
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At the same time, we select some of the latest developments related to Alzheimer's disease this year to share with readers
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"The Lancet" special report: Change 12 points as soon as possible, 40% of dementia can be prevented.
"The Lancet" published a special report on "Dementia Prevention, Intervention and Care", proposing that changing 12 risk factors can prevent or delay up to 40 % Of cases of dementia, in addition, provide advice on the diagnosis and treatment of dementia
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The report is co-authored by 28 world-leading dementia experts, and relevant recommendations are derived through a comprehensive review of all the best evidence in the field
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Screenshot source: The Lancet report shows that about 50 million people worldwide suffer from dementia, and this number is expected to continue to increase, especially in low- and middle-income countries
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However, in some countries, such as the United States, the United Kingdom, and France, the proportion of patients with dementia is declining, which may be related to changes in education, nutrition, medical care, and life>
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Dr.
Lon Schneider, chair of the report’s expert group and co-director of the Alzheimer’s Research Center at the University of Southern California, said: “The strategy to avoid dementia is to start as early as possible and throughout your life.
Action at any time is worthy of encouragement.
of
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"on the basis of the 2017 edition of the report, in particular, the report proposes three new risk factors: excessive drinking middle-aged, head injuries, old age and exposure to air pollution
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Specifically, the report divides the 12 modifiable risk factors into prevention points for early, middle, and old age according to age stages, and lists the proportions of dementia cases that can be attributed to each factor
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Early years (<45 years old): low education (7.
1%); middle-aged years (45-60 years old): hearing loss (8.
2%), traumatic brain injury (3.
4%), hypertension (1.
9%), excessive drinking (0.
8%) And obesity (0.
7%) in old age (>65 years): smoking (5.
2%), depression (3.
9%), lack of social interaction (3.
5%), lack of exercise capacity (1.
6%), air pollution (2.
3%) and diabetes (1.
1%) Among them, low education in the early years, deafness in the middle age, and smoking in the later years are the risk factors that are most closely associated with dementia
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The report also highlights 9 recommendations for policymakers and individuals to prevent dementia: From the age of 40, pay attention to maintaining systolic blood pressure below 130 mmHg
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Reduce hearing loss, protect ears from high noise, and encourage the use of hearing aids among the hearing impaired
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Reduce exposure to air pollution and secondhand smoke
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Prevent head injuries (especially for high-risk occupations)
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Limit alcohol intake and drink no more than 210ml or 168g of pure alcohol per week
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Stop smoking and support others to stop smoking
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Provide primary and secondary education for all children
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Maintain an active life, entering middle age or even later life
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Reduce obesity and diabetes-related diseases
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It is estimated that on a global scale, the above 9 risk factors affect 35% of dementia cases, and the impact is even greater in China, accounting for 40% of all dementia cases
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The expert group said that the actual value may be higher than the estimated value, and this has not yet been included in the three additional risk factors
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Image source: 123RF Of course, the report also pointed out that not all dementias are completely preventable
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Therefore, the report also provides recommendations for the management of patients with dementia, and calls for the provision of comprehensive, individualized and evidence-based intervention and care for patients with dementia
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In terms of diagnosis, although the abnormal deposition of amyloid and tau is an important pathological feature and is related to the increased risk of cognitive impairment, it is currently difficult to use for individual diagnosis.
Many people with these physiological abnormalities but normal cognition will not develop Into dementia
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However, the report also pointed out that our understanding of the etiology and pathology of dementia is changing
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Blood biomarkers are expected to promote and improve the diagnosis of dementia in the future, and may be more widely used than markers in cerebrospinal fluid and brain imaging
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After diagnosis, the care of patients with dementia should include physical and mental health, social integration and support
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Among them, maintaining the physical health of dementia patients is critical to their cognition.
Dementia patients often have more physical health problems than their peers, but they often have difficulty taking care of themselves
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In terms of drugs, cholinesterase inhibitors have a moderate effect in improving the cognition and activities of daily living in patients with mild to moderate Alzheimer's disease
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Memantine can be used for moderate or severe Alzheimer's disease .

However, the improvements that existing drugs can bring are limited
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For dementia patients with neuropsychiatric symptoms, psychotropic drugs are usually ineffective and may produce serious adverse reactions.
Psychosocial interventions should be the first choice
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For patients with mild to moderate dementia, aerobic exercise and strength training are difficult to reduce cognitive impairment, but they can improve their physical fitness
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In addition, attention should be paid to elderly people who are not diagnosed with dementia but often have delirium and confusion.
Delirium is a common phenomenon in patients with dementia and can lead to cognitive decline.
Appropriate sensory stimulation, ensure fluid replacement, and avoid infection.
Will reduce the occurrence of delirium
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At the same time, considering the pressure of family care members, it is recommended that family care members who are at risk of depression and anxiety also provide intervention
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Image source: 123RF dementia brings a heavy burden to the patient's family and society
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As our understanding of risk factors continues to accumulate, as well as the continuous development of testing, diagnosis and treatment, we hope that more people can "curate the disease", get high-quality care after illness, and improve the quality of life
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Selected Research Progress in Alzheimer's Disease Research by Xuanwu Hospital Team: How common is dementia in the elderly in China? What factors can help prevent? Professor Jia Jianping’s team from the Department of Neurology, Xuanwu Hospital of Capital Medical University published a paper in The Lancet Public Health, and pointed out that the prevalence of dementia adjusted for age and gender is about 6.
0%, of which the prevalence of Alzheimer’s disease was 3.
9%, the prevalence of vascular dementia was 1.
6%, and the prevalence of other dementias was 0.
5%
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In addition, the overall prevalence of mild cognitive impairment is approximately 15.
5%
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Dementia and mild cognitive impairment have similar risk factors
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Have to face: old age, gender (female) and parental dementia history factors
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At the same time, there are 9 risk factors that can change: rural residents, short education, widowed or divorced or living alone, smoking, high blood pressure, hyperlipidemia, diabetes, heart disease, and cerebrovascular disease
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In contrast to such a large patient population, most patients with dementia are not diagnosed and adequately treated, and they lack professionally trained caregivers to take care of them
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BMJ 100 thousand people study: work "brain burn", will it not be easy to get dementia in the future? "The more you use the brain, the more flexible it is" is a common saying in life
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Does this also benefit the prevention and treatment of dementia? The British Medical Journal (BMJ) recently published an international study covering nearly 100,000 people.
The results show that people who are more “brain-burning” at work have a lower risk of developing dementia in old age
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The research adopted the concept of "cognitive stimulation".
The "active" tasks classified as cognitive stimulation include high-demand tasks and highly decision-making tasks; conversely, low-stimulus "passive" tasks are those with low requirements.
And there is a lack of work that does not require decision-making
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The study also found that the possible reason for this association is that cognitive stimulation at work is related to lower levels of certain disease-causing proteins
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Alzheimer's disease has very different symptoms? "Nature-Medical" research revealed that one of the typical pathological features of the four subtypes of Alzheimer's disease is the abnormal accumulation and diffusion of tau protein in the brain
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This study revealed four different diffusion modes of tau protein, which lead to different symptoms and prognosis in patients
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Moreover, these subtypes are quite common, and none of them dominates
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Future research will further confirm these four models, and is expected to provide insights for individualized treatment
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Subtype 1: Accounted for 33%
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The tau protein spreads mainly in the temporal lobe and mainly affects memory
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Subtype two: accounting for 18%
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The tau protein diffuses in the rest of the cerebral cortex
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Patients have fewer memory problems, but more difficult executive functions
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Subtype 3: Accounted for 30%
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The accumulation of tau protein occurs in the visual cortex, and the processing of visual space by the patient's brain will be affected.
It is difficult to accurately determine the position of oneself, and it is also difficult to distinguish the shape, contour, distance, and location of objects
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Subtype 4: It accounts for 19%.
Tau protein diffuses asymmetrically in the left hemisphere, which mainly affects language ability
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Image source: 123RF3 "The Lancet": Diabetes and cognitive impairment are inextricably linked, and the combined diseases need to be effectively managed.
Nervous system damage is a common chronic complication of diabetes, and the risk of cognitive impairment and dementia in diabetic patients is also Will increase
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In the "Lancet" "Diabetes and Brain Health" series, 3 studies from different perspectives described the complex interaction between the central nervous system and insulin regulation, as well as the screening and prevention of high-risk groups
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A simple blood test can efficiently diagnose Alzheimer’s disease.
The "Lancet-Neurology" published important progress research shows that the detection of p-tau217 and p-tau181 through blood can effectively diagnose Alzheimer’s disease.
It can distinguish Alzheimer's disease from other neurodegenerative diseases such as FTLD
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Compared with complicated imaging tests such as PET, blood tests are easier to obtain and promote
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The research team said, “The tests we use are currently limited to research, but hope that within a few years, there will be an opportunity to be promoted for clinical use
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"Reference material (you can swipe up and down to view) [1] The world has not solved the problem of dementia.
Retrieved September 18, 2021, from https:// failing-to-address-dementia-challenge[2] Gill Livingston, et al.
, (2020).
Dementia prevention, intervention, and care: 2020 report of the Lancet Commission.
The Lancet, DOI: 10.
1016/S0140-6736(20 )30367-6[3] Mika Kivimäki, et al.
, (2021).
Cognitive stimulation in the workplace, plasma proteins, and risk of dementia: three analyses of population cohort studies.
BMJ, DOI: 10.
1136/bmj.
n1804[4 ] Elisabeth H Thijssen, et al.
, (2021).
Plasma phosphorylated tau 217 and phosphorylated tau 181 as biomarkers in Alzheimer's disease and frontotemporal lobar degeneration: a retrospective diagnostic performance study, DOI: https://doi.
org/10.
1016/S1474 -4422(21)00214-3[5] Vogel, JW, Young, AL, Oxtoby, NP et al.
Four distinct trajectories of tau deposition identified in Alzheimer's disease.
Nat Med (2021).
https://doi.
org/10.
1038/s41591-021-01309-6[6] Longfei Jia, et al.
, (2020).
Prevalence, risk factors, and management of dementia and mild cognitive impairment in adults aged 60 years or older in China: a cross-sectional study.
The Lancet Public Health, DOI: https://doi.
org/10.
1016/S2468-2667(20) 30185-7 Disclaimer: WuXi AppTec's content team focuses on introducing global biomedical health research progress
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