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    Home > Active Ingredient News > Study of Nervous System > The most beautiful leading readers-the editor-in-chief interprets the "Guidelines for the Prevention and Treatment of Senile Dementia in China"

    The most beautiful leading readers-the editor-in-chief interprets the "Guidelines for the Prevention and Treatment of Senile Dementia in China"

    • Last Update: 2022-08-15
    • Source: Internet
    • Author: User
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    After 14 years of reading, the "Guidelines for the Prevention and Treatment of Senile Dementia in China" (2021) carry the tradition of the 2007 edition, add new research results, clinical practice methods and experience, and finally appear in the Chinese Medical Association Psychiatry Branch of the Geriatric Psychiatry Gro.
    Under the leadership of Professor Yu Enyan, it took two years and was launched in 2021, which gathered the efforts and expectations of exper.
    On the basis of emphasizing scientificity, advancement, applicability, operability, and emphasis on diagnosis and treatment, this guideline highlights the three major characteristics of "prevention", "early intervention", and "home management and rehabilitation", and emphasizes the concept of whole-course manageme.
    Let's follow Professor Yu into the guide and taste its originality! 01 The concept of cognitive impairment continuum guides early intervention, and the whole management concept is in line with the current status of dementia prevention and treatment in Chi.
    The concept of cognitive impairment continuum guides early interventi.
    Senile dementia refers to dementia that occurs in old age (over 65 years old) due to various reaso.
    Dementia from presenile onset to old age is sometimes referred to as senile dementia in gener.
    Cognitive impairment in dementia patients is mostly a slowly progressive process, especially in degenerative brain dement.
    Pathological changes may occur before significant clinical symptoms appe.
    Based on this, the disease is divided from three different grades of mild, moderate and severe, to the classification of a continuum of cognitive impairment: subjective cognitive decline (SCD), mild behavioral impairment (MBI) and/or mild cognitive impairme.
    cognitive impairment (MCI), moderate and severe neurocognitive impairme.
    From mild impairment of cognitive function to dementia is a continuous spectrum and a slow and gradual irreversible proce.
    The best time for early intervention is when the SCD and MCI stages have not yet reached the level of dement.
    The whole management of dementia is feasible and realist.
    At present, the number of dementia patients in my country has accounted for more than 20% of the total number of patients in the wor.
    Alzheimer's disease (AD) is the most common type of dementia, accounting for about 60% to 70% of dementi.
    The prevalence of AD in people aged 65 and over in China was 21%-9%, with an annual incidence rate of 82%, and the prevalence increased with a.

    Senile dementia has become a major challenge that China needs to address in order to achieve healthy agi.

    Preventing and reducing the incidence of senile dementia and improving the quality of life of senile dementia patients and their caregivers have become major livelihood and social problems in Chi.

    The management of dementia patients has expanded from clinical diagnosis and treatment to risk management, clinical diagnosis and treatment, community rehabilitation, life care, and caregiver support, covering almost the entire course of the disease management, providing early identification, early diagnosis, early treatment, early prevention, e.

    Work creates conditio.

    Referring to China's hierarchical diagnosis and treatment system and the national basic public health service system, it is feasible and realistic to actively promote the whole-process management of dementia patients based on the communi.

    02 Focusing on the management of controllable risk factors for dementia and actively carrying out the management of controllable risk factors for primary, secondary and tertiary prevention is the focus of dementia preventi.

    More than half of the global dementia burden is due to underlying, modifiable risk factors, including diabetes, midlife hypertension, midlife obesity, low physical activity, depression, smoking, and low educati.

    The factors are not independent, and the above risk factors can be greatly reduced or the incidence of dementia can be greatly reduced by strengthening education and improving life>
    Primary and secondary prevention is the key to dementia preventi.

    Primary prevention is etiological prevention, the purpose is to eliminate various pathogenic factors, avoid or reduce the influence of pathogenic factors, and prevent the occurrence of dement.

    It is the top priority of prevention work and the most active and proactive preventive measure, but it is also the weak link of current prevention wo.
    Including the management of physical exercise, smoking cessation, dietary intervention, alcohol consumption, cognitive training, social activities, weight, hypertension, diabetes, dyslipidemia, depressive disorders, special sensory (visual and auditory) disorders,e.

    Secondary prevention is a measure taken to prevent or slow down the development of dementia, including early detection, early diagnosis and early treatment, so it is called "three early" prevention and is the best window period for dementia treatme.

    Early screening should be carried out for high-risk groups for early diagnosis and early treatme.

    Early intervention is better for MCI and dementia patien.

    Tertiary prevention is the clinical management and life care of dementia, the purpose is to enable patients to receive systematic treatment and care guidance to improve the quality of li.

    Including standardizing clinical management, strengthening patient care, improving the quality of life of patients, and assisting caregive.

    03A comprehensive assessment of ABC symptoms is the basis of dementia treatme.

    Biomarkers help the diagnosis of dement.

    A comprehensive understanding of the specific manifestations and severity of "ABC" symptoms (decreased activities of daily living, mental and behavioral symptoms, and cognitive decline) is helpful for judging whether there is Dementia, the severity of dementia (MCI or dementia), the cause of dementia, e.

    are of great significance and are also the basis for rational treatment of dement.
    Table 1 Summary of commonly used ABC symptom assessment tools for dementia Note: MMSE: Mini-Mental State Examination; MoCA: Montreal Cognitive Assessment Scale; CDT: Clock Drawing Test; ACE: Andenbrooke Cognitive Test; AVLT: Listening to Visual Word Learning Test ;CVLT: California Vocabulary Learning Test; DSR: Story Delayed Recall; BNT: Boston Naming Test; VFT: Verbal Fluency Test; test; VOSP: Visual Object and Spatial Perception Test; ADAS-cog: Alzheimer's Disease Rating Scale Cognitive Subscale; SIB: Severe Impairment Rating Scale; CDR: Clinical Dementia Scale; GDS: Global Decline Scale; DRS: Mattis Dementia Assessment Scale; CANS-TAB: Cambridge Neuropsychological Examination Automated Edition; BEHAVE-AD: Behavioral Pathology Rating Scale for Alzheimer's Disease; NPI: Neuropsychiatric Symptom Questionnaire; CMAI: Cohen-Mansfield Agitation Questionnaire; GDS : Emotion Rating Scale; FBI: Frontal Lobe Behavior Questionnaire; ADL: Abilities of Daily Living Scale; FAQ: Social Activity Scale; FAST: AD Functional Assessment Scale; with the development of science and technology, imaging, genetic testing and Some promising biomarkers are also gaining attenti.

    Imaging studies are essential for the diagnosis of dementia and are sometimes important for diagnosis and differential diagnos.

    Structural imaging (such as CT, MRI) is a commonly used method, and all patients with cognitive impairment should undergo routine brain structural imaging; functional imaging is currently mainly used in clinical research, and there are difficulties in routine clinical u.

    Conditional units should actively carry out molecular imaging examinations (such as 18F-FDG, PET, DAT) to improve the accuracy of the diagnosis of neurodegenerative diseas.

    Biomarkers are indicators that can be objectively detected and evaluated, which can reflect the biological process of individuals in normal or pathological conditions or the biological response to treatment, and have a specific role in diagnosing .
    Biomarkers of β-amyloid (Aβ) and tau protein can significantly improve the accuracy of AD diagnosis and effectively predict the transformation of SCD or MCI to dementia, but considering the invasiveness of cerebrospinal fluid (CSF) detection and the invasiveness of PET examinati.

    Factors such as low penetration, standardization of detection and analysis processes, and economic cost have not yet been fully implement.

    Therefore, for patients with difficulties in early diagnosis or differential diagnosis, and in the case of considering the application of disease-modifying drugs in the future, it is recommended to detect biomarkers of Aβ and tau by CSF or PET; MRI brain atrophy biomarkers are used for the diagnosis of .

    , Differential diagnosis and assessment of disease progression can all provide help, and it is recommended to perform routine testing in qualified units; FDG PET has the significance of early identification and differential diagnosis of dementia caused by neurodegenerative diseases or inflammatory diseases, and is recommended in qualified uni.

    The unit of 10000000000000001 detects patients with difficult early or differential diagnosis; the detection of peripheral blood biomarkers is promising for the clinical diagnosis of AD in the future, but it is still in the exploratory stage and is not a routine examination for the clinical diagnosis of dement.

    People with dementia who have a family history of dementia should have genetic testing to confirm the diagnos.

    04 The treatment of dementia is based on classic drugs, emphasizing multidisciplinary collaboration, and rehabilitation treatment througho.

    The classic drug treatment of dementia is mainly based on reducing abnormal glutamatergic neurotransmission or improving the function and level of acetylcholine in the brain, mainly including NMDA receptor antagonists and AChE.

    For moderate to severe AD, memantine can be used, and the combination of memantine and AChEIs can also be us.

    For patients with BPSD, the principle of individualized treatment is followed, and non-drug therapy and cognitive-promoting drugs (such as memantine) are the first choi.
    Actively carry out multidisciplinary consultation and collaborati.

    Elderly patients often suffer from multiple diseas.

    Therefore, risk assessment of comorbidities, optimization of treatment plans, and active prevention and treatment of complications can help improve patients’ cognitive function and quality of li.

    Dementia patients with chronic diseases such as blood pressure, diabetes and dyslipidemia are provided with corresponding multidisciplinary treatment to reduce the impairment of cognitive functi.

    The rehabilitation of dementia requires comprehensive measures, and the process is long until the end of life, so it must be carried out under the guidance of occupational rehabilitation therapists on the basis of comprehensive and comprehensive evaluati.

    Rehabilitation of dementia mainly includes a series of comprehensive rehabilitation methods and intervention measures for the core symptoms of dementia such as cognition, behavior and social function state, following the principle of "tailor-made", to improve the patient's cognitive and living ability as much as possible, and improve the quality of life and self-efficacy to maintain their independence in li.

    Guideline recommendations: Cognitive training and rehabilitation can improve partial or overall cognitive function in patients with dementia; non-specific occupational therapy, multidisciplinary therapy, cognitive stimulation such as music or art therapy, and exercise can help maintain social participation in dementia patients sex and improve caregiver satisfacti.

    05Insist on individualized home care and pay attention to the peaceful care in the terminal stage of senile dement.

    Care is the basis for treatment and rehabilitation, especially for patients with BP.

    The impact on the quality of life of patients is crucial, and palliative care is particularly important for patients in the terminal stage of dement.

    Home care: For serious BPSD problems, it is recommended to take countermeasures based on the community environment and BPSD risk assessment to prevent harm to patients themselves, caregivers and society; it is recommended to take relevant measures for medical-related home care, and take medicines according to specific scenarios Compliance issues; it is recommended to measure the patient's body weight regularly, and take relevant measures according to the assessment of the patient's dietary nutritional status to reduce the occurrence of malnutrition and diet-related adverse even.
    At the same time, attention should be paid to the safety issues in the process of eating; it is recommended to make appropriate modifications according to the patient's condition and the home safety environment to improve the safety and convenience of the living environment and prevent accidents; it is recommended to take measures such as wearing a sign card with you to prevent you from being unable to find it after getting lo.

    Palliative care: For patients in the terminal stage of dementia, that is, when the dementia has progressed to the most severe stage, memory and other cognitive abilities are severely impaired, and activities of daily living are lost, requiring complete care from others, and palliative care is particularly important at this ti.

    The principle of palliative care is to reduce pain and maintain the dignity of the patient, and to improve the comfort of the patient as the goal, and provide positive physical, psychological, spiritual and other care and humanistic care to the patie.

    Use antibiotics; continue oral feeding instead of indwelling nasogastric tube or gastrostomy; use drugs for pain relief and symptomatic treatment; stop useless drugs; give music and other methods to soothe the patient,e.

    06 Empowering caregivers and reducing the burden of care Currently, dementia patients in China are still mainly cared for at ho.

    Long-term care of dementia patients brings heavy burdens to caregivers and seriously affects the quality of life of caregive.

    The psychosomatic state of caregivers determines the patient's quality of life, so it is recommended to empower caregivers, including empowering education and supportive services; forming a multidisciplinary team, including psychiatrists, psychologists, community nurses, social workers, senior caregivers, volunteers, e.

    to provide empowering education and assistan.

    This helps to improve the self-efficacy of caregivers, promote positive psychology, and exert their subjective initiative, thereby improving care outcom.

    Summary "Guidelines for the Prevention and Treatment of Senile Dementia in China" (2021), in the spirit of inheritance and innovation, combine the latest research results at home and abroad in recent years with China's specific national conditions and practic.

    It focuses on the importance, concepts and methods of prevention, rehabilitation, home care and whole-course management, providing practical guidance and reference for front-line clinical and scientific researchers, benefiting more senile dementia patients, and contributing to a healthy Chi.

    streng.
    Expert Profile Professor Yu Enyan Chief Physician, Professor, Doctoral Supervisor Physician, winner of Outstanding Contribution Award for Chinese Mental Health Work Chairman of Chinese Mental Health Association Geriatric Mental Health Professional Committee Vice Chairman of China Alzheimer's Association (ADC) Vice Chairman of China Geriatric Health Medical Research Association Geriatric Cognition and Mental Disease Branch Vice-chairman of Anti-aging Research Branch of China Association for Geriatric Health Care Medicine, Deputy Head of Oncology Psychology Collaborative Group of China Cancer Foundation, Executive Director of Chinese Mental Health Association, Standing Committee Member of Psychiatry Branch of Chinese Medical Association Chairman of Zhejiang Rehabilitation Medicine Association Chairman of Zhejiang Provincial Medical Association Psychiatry Branch Chairman of Zhejiang Provincial Rehabilitation Medicine Association Sleep Disorder Professional Committee Chairman Chinese Journal of Medicine, Chinese Journal of Psychiatry, Chinese Journal of Gerontology, and JNNP Chinese Edition References: Yu Eny.

    Guidelines for the Prevention and Treatment of Senile Dementia in China [.

    Beijing: People's Health Publishing House, 20211
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