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*Only for medical professionals to read and refer to the full cycle-a new perspective on Alzheimer's disease.
Alzheimer's disease (AD) is a neurodegenerative disease with progressive cognitive impairment as its core clinical manifestations.
In the past 30 years, its diagnostic criteria have been continuously introduced, which has greatly improved the accuracy of diagnosis.
There are more systematic clinical guidelines and consensus on the prevention, diagnosis and treatment of the disease.
Now let us all study and sort it out together, absolutely dry! At present, according to the severity of cognitive impairment, it is generally divided into preclinical stage, mild cognitive impairment (MCI) and dementia.
The main basis for staging includes whether there are detectable clinical symptoms (preclinical stage-clinical stage), whether cognitive impairment affects the ability of daily living (MCI-dementia), and the severity of dementia (mild, moderate, and severe dementia).
Alzheimer’s disease—pre-clinical stage▌ Diagnosis of AD pre-dementia stage (Pre-dementia stage) is a new concept, this stage may have AD pathophysiological changes, no or clinical symptoms, including pre-clinical AD (Pre-clinical AD) stages of AD) and AD-derived mild cognitive impairment due to AD (MCI due to AD).
Both of these stages are included in the concept of pre-stage AD dementia.
In 2011, the National Institute on Aging-Alzheimer's Association (National Instituteon Aging-Alzheimer's Association, NIA-AA) formally proposed a conceptual framework for preclinical AD.
This standard analyzes preclinical AD, including the first stage: asymptomatic cerebral amyloidosis; the second stage: amyloid positive + synaptic dysfunction and/or early neurodegeneration, such as CSF Decrease in tau protein, MRI reveals characteristic brain atrophy, etc.
; the third stage: amyloid positive + evidence of neurodegeneration + very slight cognitive decline.
The 2007 IWG (International Working Group, IWG) and the 2014 IWG-2 diagnostic criteria also described preclinical AD in detail.
The standard divides preclinical AD into two subtypes, namely the asymptomatic risk period of AD (the patient already has objective evidence of brain amyloidosis and neurodegeneration with imaging or biomarkers, but the patient’s clinical manifestations and Neuropsychological examinations have not yet reached the standard of MCI) and pre-symptoms of AD (patients who carry PSEN1, PSEN2, APP and other common genetic disease-causing gene mutations or other disease-causing genetic genes, but do not meet the diagnostic criteria of MCI).
According to the "2018 Chinese Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Impairment (6): Pre-Dementia in Alzheimer's Disease", the NIA-AA standard recommends more detailed staging and description of the preclinical stage, including the normal group and SNAP The group (suspected non-AD group) is more suitable for the development of pre-clinical AD research.
▌ Intervention patients in this phase have not yet experienced significant clinical symptoms and cognitive impairment.
Therefore, for pre-clinical AD patients, the focus is on adopting comprehensive preventive measures to delay or reduce the clinical incidence of AD, mainly for AD Prevention of related risk factors, life>
"2018 Chinese Dementia and Cognitive Impairment Diagnosis and Treatment Guidelines (6): Alzheimer's pre-dementia stage" recommendation: Intervention and control of risk factors in the pre-dementia stage of AD, combined with cognitive training may delay cognitive decline ; The diet before AD dementia is the Mediterranean diet (A-level recommendation).
Alzheimer's disease-mild cognitive impairment▌ The diagnosis of MCI refers to the progressive decline in memory or other cognitive functions, but does not affect the ability of daily living, and does not meet the diagnostic criteria for dementia.
The MCI criteria was first established by Petersen in 1999.
It is proposed, but the standard is mainly for the diagnosis of amnestic MCI, which is too limited for the diagnosis of MCI.
In 2003, the IWG revised the MCI standard, which is currently the most widely used MCI diagnostic standard.
The standard divides MCI into 4 subtypes (single cognitive domain forgetting type, multiple cognitive domain forgetting type, single cognitive domain non-forgetting type, and multi-cognitive domain non-forgetting type).
In addition, the etiology is updated.
Comprehensive elaboration, including AD, cerebrovascular disease, Lewy body disease, frontotemporal degeneration, etc.
The NIA-AA 2011 standard, the Alzheimer’s Association (ADA) 2011 standard, and the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) 2013 standard respectively deal with the diagnostic criteria for MCI and MCI caused by AD.
Has been updated, but its basic content is consistent with the 2003 MCI diagnostic criteria.
Only on the basis of the above diagnostic criteria, biomarkers including Aβ deposition, cerebrospinal fluid tau protein levels and other neurological damage markers have been added.
According to the "2018 Chinese Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Impairment (5): Diagnosis and Treatment of Mild Cognitive Impairment", it recommends that MCI be diagnosed in accordance with the above-mentioned international standards.
The diagnosis basis includes 4 main points: ①Patients or insiders may have Experienced clinicians find cognitive impairment; ②There is objective evidence of cognitive impairment; ③Maintain independent ability of daily living; ④The diagnostic criteria for dementia have not yet been reached.
▌ The intervention MCI stage is the earliest stage of objective cognitive impairment in AD patients.
Although the patient’s instrumental ability of daily living may be slightly affected, the patient’s life independence is still acceptable.
At present, the main MCI guidelines or expert consensus at home and abroad are MCI recommends the use of comprehensive intervention measures that combine non-drug therapy and drug therapy; non-drug therapy: mainly includes moderate physical exercise, intervention in life behavior, cognitive training, and socializing.Drug therapy: including ergot alkaloid preparations, ginkgo biloba extract, cholinesterase inhibitors, glutamate receptor antagonists, etc.
However, drug therapy has limited efficacy in patients with amnestic MCI.
At present, the advantages and disadvantages of drug treatment of MCI are still To be discussed.
The "2018 Chinese Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Impairment (5): Diagnosis and Treatment of Mild Cognitive Impairment" recommends: Actively search for the cause of MCI, with a view to targeted treatment of treatable causes; according to the existing evidence-based medical evidence, The efficacy of drugs for the treatment of MCI needs to be further confirmed (level A recommendation).
Alzheimer's disease—dementia stage▌ The first internationally recognized diagnostic standard for AD is the National Institute of Neurology, Speech Disorders and Stroke-Alzheimer's Disease and Related Association (NINCDS-ADRDA) published in Neurology in 1984 standard.
The DSM-IV-R standard updated in 2000 is also widely used.
In 2007, IWG published a revised version of the NINCDS-ADRDA diagnostic criteria, the IWG-1 diagnostic criteria.
In this new standard, biomarkers are included in the diagnosis of AD for the first time, and it is proposed that AD is a continuous process, emphasizing that impairment of episodic memory is the core symptom of AD.
In 2011, NIA-AA issued AD diagnostic criteria guidelines, namely NIA-AA diagnostic criteria.
The diagnostic criteria divide AD into three stages, and the preclinical asymptomatic stage of AD is also included in AD, which greatly advances the diagnosis time of AD.
In 2014, IWG published a revised version of the 2007 standard, the IWG-2 standard.
For the first time, AD biomarkers are divided into diagnostic markers and progress markers.
According to the recommendations of the "2018 Chinese Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Impairment (2): Guidelines for the Diagnosis and Treatment of Alzheimer's Disease", it is recommended that the clinical diagnosis of AD be based on the standards proposed by the 1984 NINCDS-ADRDA or the 2011 version of the NIA-AA.
Both of these two standards divide the diagnosis of AD into two steps: first, meet the diagnostic criteria of "dementia"; then, according to the clinical onset of AD, the characteristics of objective cognitive impairment assessment results, biomarkers, and the combination/exclusion of other possible causes In the case of cognitive impairment, the possibility of dementia caused by AD is graded.
▌ Intervention in the "2018 Chinese Dementia and Cognitive Impairment Diagnosis and Treatment Guidelines (2): Alzheimer's Disease Diagnosis and Treatment Guidelines" recommends: ① Patients with a clear diagnosis of AD can choose cholinesterase inhibitor ChEIs (including donepezil, rivastigmine, plus (Rantamine, etc.
) treatment (A grade recommendation); ②When the application of a certain ChEIs treatment is ineffective or cannot be tolerated due to adverse reactions, according to the patient's disease level, the degree of adverse reactions can be exchanged for other ChEIs or replaced with patches for treatment (B Level recommendation); ③ChEIs have a dose-effect relationship.
Patients with moderate to severe AD can choose high-dose ChEIs as therapeutic drugs, but the principle of titration at low doses should be followed (expert consensus); ④Patients with a clear diagnosis of moderate to severe AD can Memantine or memantine combined with donepezil and rivastigmine are used for the treatment.
For severe AD patients with obvious psycho-behavioral symptoms, the combination of ChEIs and memantine is especially recommended (level A recommendation). Figure 1: Alzheimer's disease staging and diagnosis reference materials: [1] 2018 China Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Impairment (5): Diagnosis and Treatment of Mild Cognitive Impairment "Chinese Medical Journal" 2018, 98 (17) 10.
3760/cma.
j.
issn.
0376-2491.
2018.
17.
003[2]2018 Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Impairment in China (6): Pre-Alzheimer's Disease Dementia "Chinese Medical Journal" 2018, 98 (19) 10.
3760/ cma.
j.
issn.
0376-2491.
2018.
19.
001[3]2018 Guidelines for the diagnosis and treatment of dementia and cognitive impairment in China (2): Guidelines for the diagnosis and treatment of Alzheimer's disease "Chinese Medical Journal" 2018, 98 (13) 10.
3760/cma.
j .
issn.
0376-2491.
2018.
13.
004[4]SPERLING RA, AISEN PS, BECKETT LA, et al.
Toward defining the preclinical stages of Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease[ J].
Alzheimers Dement, 2011, 7(3): 280-292.
[5] Yang Qing, Jia Jie.
Interpretation of Alzheimer's disease-related guidelines and expert consensus-a new perspective on full cycle rehabilitation[J].
Chinese Medicine Journal, 2021, 01: 22-27.
Alzheimer's disease (AD) is a neurodegenerative disease with progressive cognitive impairment as its core clinical manifestations.
In the past 30 years, its diagnostic criteria have been continuously introduced, which has greatly improved the accuracy of diagnosis.
There are more systematic clinical guidelines and consensus on the prevention, diagnosis and treatment of the disease.
Now let us all study and sort it out together, absolutely dry! At present, according to the severity of cognitive impairment, it is generally divided into preclinical stage, mild cognitive impairment (MCI) and dementia.
The main basis for staging includes whether there are detectable clinical symptoms (preclinical stage-clinical stage), whether cognitive impairment affects the ability of daily living (MCI-dementia), and the severity of dementia (mild, moderate, and severe dementia).
Alzheimer’s disease—pre-clinical stage▌ Diagnosis of AD pre-dementia stage (Pre-dementia stage) is a new concept, this stage may have AD pathophysiological changes, no or clinical symptoms, including pre-clinical AD (Pre-clinical AD) stages of AD) and AD-derived mild cognitive impairment due to AD (MCI due to AD).
Both of these stages are included in the concept of pre-stage AD dementia.
In 2011, the National Institute on Aging-Alzheimer's Association (National Instituteon Aging-Alzheimer's Association, NIA-AA) formally proposed a conceptual framework for preclinical AD.
This standard analyzes preclinical AD, including the first stage: asymptomatic cerebral amyloidosis; the second stage: amyloid positive + synaptic dysfunction and/or early neurodegeneration, such as CSF Decrease in tau protein, MRI reveals characteristic brain atrophy, etc.
; the third stage: amyloid positive + evidence of neurodegeneration + very slight cognitive decline.
The 2007 IWG (International Working Group, IWG) and the 2014 IWG-2 diagnostic criteria also described preclinical AD in detail.
The standard divides preclinical AD into two subtypes, namely the asymptomatic risk period of AD (the patient already has objective evidence of brain amyloidosis and neurodegeneration with imaging or biomarkers, but the patient’s clinical manifestations and Neuropsychological examinations have not yet reached the standard of MCI) and pre-symptoms of AD (patients who carry PSEN1, PSEN2, APP and other common genetic disease-causing gene mutations or other disease-causing genetic genes, but do not meet the diagnostic criteria of MCI).
According to the "2018 Chinese Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Impairment (6): Pre-Dementia in Alzheimer's Disease", the NIA-AA standard recommends more detailed staging and description of the preclinical stage, including the normal group and SNAP The group (suspected non-AD group) is more suitable for the development of pre-clinical AD research.
▌ Intervention patients in this phase have not yet experienced significant clinical symptoms and cognitive impairment.
Therefore, for pre-clinical AD patients, the focus is on adopting comprehensive preventive measures to delay or reduce the clinical incidence of AD, mainly for AD Prevention of related risk factors, life>
"2018 Chinese Dementia and Cognitive Impairment Diagnosis and Treatment Guidelines (6): Alzheimer's pre-dementia stage" recommendation: Intervention and control of risk factors in the pre-dementia stage of AD, combined with cognitive training may delay cognitive decline ; The diet before AD dementia is the Mediterranean diet (A-level recommendation).
Alzheimer's disease-mild cognitive impairment▌ The diagnosis of MCI refers to the progressive decline in memory or other cognitive functions, but does not affect the ability of daily living, and does not meet the diagnostic criteria for dementia.
The MCI criteria was first established by Petersen in 1999.
It is proposed, but the standard is mainly for the diagnosis of amnestic MCI, which is too limited for the diagnosis of MCI.
In 2003, the IWG revised the MCI standard, which is currently the most widely used MCI diagnostic standard.
The standard divides MCI into 4 subtypes (single cognitive domain forgetting type, multiple cognitive domain forgetting type, single cognitive domain non-forgetting type, and multi-cognitive domain non-forgetting type).
In addition, the etiology is updated.
Comprehensive elaboration, including AD, cerebrovascular disease, Lewy body disease, frontotemporal degeneration, etc.
The NIA-AA 2011 standard, the Alzheimer’s Association (ADA) 2011 standard, and the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) 2013 standard respectively deal with the diagnostic criteria for MCI and MCI caused by AD.
Has been updated, but its basic content is consistent with the 2003 MCI diagnostic criteria.
Only on the basis of the above diagnostic criteria, biomarkers including Aβ deposition, cerebrospinal fluid tau protein levels and other neurological damage markers have been added.
According to the "2018 Chinese Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Impairment (5): Diagnosis and Treatment of Mild Cognitive Impairment", it recommends that MCI be diagnosed in accordance with the above-mentioned international standards.
The diagnosis basis includes 4 main points: ①Patients or insiders may have Experienced clinicians find cognitive impairment; ②There is objective evidence of cognitive impairment; ③Maintain independent ability of daily living; ④The diagnostic criteria for dementia have not yet been reached.
▌ The intervention MCI stage is the earliest stage of objective cognitive impairment in AD patients.
Although the patient’s instrumental ability of daily living may be slightly affected, the patient’s life independence is still acceptable.
At present, the main MCI guidelines or expert consensus at home and abroad are MCI recommends the use of comprehensive intervention measures that combine non-drug therapy and drug therapy; non-drug therapy: mainly includes moderate physical exercise, intervention in life behavior, cognitive training, and socializing.Drug therapy: including ergot alkaloid preparations, ginkgo biloba extract, cholinesterase inhibitors, glutamate receptor antagonists, etc.
However, drug therapy has limited efficacy in patients with amnestic MCI.
At present, the advantages and disadvantages of drug treatment of MCI are still To be discussed.
The "2018 Chinese Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Impairment (5): Diagnosis and Treatment of Mild Cognitive Impairment" recommends: Actively search for the cause of MCI, with a view to targeted treatment of treatable causes; according to the existing evidence-based medical evidence, The efficacy of drugs for the treatment of MCI needs to be further confirmed (level A recommendation).
Alzheimer's disease—dementia stage▌ The first internationally recognized diagnostic standard for AD is the National Institute of Neurology, Speech Disorders and Stroke-Alzheimer's Disease and Related Association (NINCDS-ADRDA) published in Neurology in 1984 standard.
The DSM-IV-R standard updated in 2000 is also widely used.
In 2007, IWG published a revised version of the NINCDS-ADRDA diagnostic criteria, the IWG-1 diagnostic criteria.
In this new standard, biomarkers are included in the diagnosis of AD for the first time, and it is proposed that AD is a continuous process, emphasizing that impairment of episodic memory is the core symptom of AD.
In 2011, NIA-AA issued AD diagnostic criteria guidelines, namely NIA-AA diagnostic criteria.
The diagnostic criteria divide AD into three stages, and the preclinical asymptomatic stage of AD is also included in AD, which greatly advances the diagnosis time of AD.
In 2014, IWG published a revised version of the 2007 standard, the IWG-2 standard.
For the first time, AD biomarkers are divided into diagnostic markers and progress markers.
According to the recommendations of the "2018 Chinese Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Impairment (2): Guidelines for the Diagnosis and Treatment of Alzheimer's Disease", it is recommended that the clinical diagnosis of AD be based on the standards proposed by the 1984 NINCDS-ADRDA or the 2011 version of the NIA-AA.
Both of these two standards divide the diagnosis of AD into two steps: first, meet the diagnostic criteria of "dementia"; then, according to the clinical onset of AD, the characteristics of objective cognitive impairment assessment results, biomarkers, and the combination/exclusion of other possible causes In the case of cognitive impairment, the possibility of dementia caused by AD is graded.
▌ Intervention in the "2018 Chinese Dementia and Cognitive Impairment Diagnosis and Treatment Guidelines (2): Alzheimer's Disease Diagnosis and Treatment Guidelines" recommends: ① Patients with a clear diagnosis of AD can choose cholinesterase inhibitor ChEIs (including donepezil, rivastigmine, plus (Rantamine, etc.
) treatment (A grade recommendation); ②When the application of a certain ChEIs treatment is ineffective or cannot be tolerated due to adverse reactions, according to the patient's disease level, the degree of adverse reactions can be exchanged for other ChEIs or replaced with patches for treatment (B Level recommendation); ③ChEIs have a dose-effect relationship.
Patients with moderate to severe AD can choose high-dose ChEIs as therapeutic drugs, but the principle of titration at low doses should be followed (expert consensus); ④Patients with a clear diagnosis of moderate to severe AD can Memantine or memantine combined with donepezil and rivastigmine are used for the treatment.
For severe AD patients with obvious psycho-behavioral symptoms, the combination of ChEIs and memantine is especially recommended (level A recommendation). Figure 1: Alzheimer's disease staging and diagnosis reference materials: [1] 2018 China Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Impairment (5): Diagnosis and Treatment of Mild Cognitive Impairment "Chinese Medical Journal" 2018, 98 (17) 10.
3760/cma.
j.
issn.
0376-2491.
2018.
17.
003[2]2018 Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Impairment in China (6): Pre-Alzheimer's Disease Dementia "Chinese Medical Journal" 2018, 98 (19) 10.
3760/ cma.
j.
issn.
0376-2491.
2018.
19.
001[3]2018 Guidelines for the diagnosis and treatment of dementia and cognitive impairment in China (2): Guidelines for the diagnosis and treatment of Alzheimer's disease "Chinese Medical Journal" 2018, 98 (13) 10.
3760/cma.
j .
issn.
0376-2491.
2018.
13.
004[4]SPERLING RA, AISEN PS, BECKETT LA, et al.
Toward defining the preclinical stages of Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease[ J].
Alzheimers Dement, 2011, 7(3): 280-292.
[5] Yang Qing, Jia Jie.
Interpretation of Alzheimer's disease-related guidelines and expert consensus-a new perspective on full cycle rehabilitation[J].
Chinese Medicine Journal, 2021, 01: 22-27.
