Every three seconds, there is one more Alzheimer's disease patient in the world. You must be alert to cognitive decline.
Experts emphasize that active prevention and intervention can effectively delay the development of the disease and improve the quality of life of patients
Creative picture/Beijing News reporter Wang Yuanzheng
Global aging is increasing, and the incidence of Alzheimer's disease (AD) is also showing an increasing trend. In 2019, the International Alzheimer’s Association estimated that there are more than 50 million people with dementia including Alzheimer’s disease worldwide. By 2050, this number will reach 152 million, that is, it will be new every 3 seconds. Add one more patient.
The number of patients with Alzheimer's disease in China not only ranks first in the world, but also has one of the fastest growth rates in the world. It is estimated that there are currently more than 10 million dementia patients in China. By 2050, the number of patients in China will reach about 40 million, most of whom are patients with Alzheimer's disease. However, the consultation rate of patients with Alzheimer's disease in my country is only 25%-26%, and the number of patients who really receive standardized treatment is even less, only about 20%. Many experts have called for the earlier treatment of Alzheimer's disease, the better, and early recognition of symptoms and early intervention can prevent the rapid development of the disease, prolong the survival time of patients, and improve the quality of life.
1 Facing the three "low" causes so far unclear
Alzheimer's disease is a progressive neurodegenerative disease with insidious onset. Clinically, it is characterized by general dementia such as memory impairment, aphasia, apraxia, agnosia, impairment of visual spatial skills, executive dysfunction, and personality and behavior changes. The etiology is still unknown. Feng Tingyi, chief physician of the Department of Neurology of Shanghai First People's Hospital and senior doctor of Alzheimer's disease, pointed out that if Alzheimer's disease is not recognized early and effective interventions are given, the survival period of many patients is only 5-10 years. As the disease progresses, patients may suffer from dementia, even their basic ability to live independently will be affected, symptoms such as bedsores, malnutrition, etc. will appear, triggering death from other medical diseases.
The incidence of Alzheimer's disease gradually increases with age. According to statistics, the incidence rate of people over 65 years old is 5%, and the incidence rate over 80 years old is over 30%. At the same time, Alzheimer's disease is also showing a younger trend. According to media reports, survey data has shown that the average age of patients in large cities such as Tianjin, Shanghai, and Guangzhou has advanced from 65 to 55 in 20 years. Some experts believe that this may be related to diet, stress and environmental pollution. Heavy drinking will affect the brain, and prolonged stress may also lead to the early appearance of Alzheimer's disease.
In my country, Alzheimer's disease is in the three "lows": low cognition, low medical visit rate, and lower rate of receiving treatment.
"When I first opened the memory clinic, there were no patients. Even now, many patients have not come to see the clinic." Hu Hua, the chief physician of the Department of Neurology of the Second Affiliated Hospital of Soochow University, said frankly. Ten years, and now the number of patients has only increased to 20 or 30 per day.
The cause of the "three lows" may be mainly related to the forgotten, neglect and misunderstanding of patients and diseases by society.
The first domestic "Survey Report on the Survival Status of Alzheimer's Disease Patients' Families" released on January 9 this year showed that 85% of Alzheimer's patients' families believe that memory decline in the elderly is a natural aging process and no treatment is necessary. Leading to delayed visits. 50% of delayed visits are related to feelings of helplessness/powerlessness, such as limited time and energy of family members, inconvenient medical visits, lack of ability to pay, taking into account the treatment of other diseases, and not knowing where to go for treatment.
Insufficient medical resources are also one of the reasons for the low rate of consultation. Feng Tingyi pointed out that community hospitals and medical institutions in small cities may not even have basic examination methods, and doctors have limited knowledge of Alzheimer's disease, all of which have led to a decline in the diagnosis rate of the disease.
2 Taking medicine + nursing to delay the development of the disease
Cognitive decline is the first external symptom of Alzheimer's disease observed by the human eye. Cognitive function refers to the process by which the human brain receives external information, processes it, and converts it into internal mental activities, thereby acquiring knowledge or applying knowledge. It includes memory, language, visual space, execution, calculation and comprehension judgment.
Alzheimer’s disease first affects the recent memory part of cognitive function. For example, if you go out to buy vegetables and forget to pay, you want to buy five kinds of vegetables and only buy three kinds of vegetables. This early symptom is easily overlooked. It is often mistaken as a normal aging phenomenon.
Hu Hua pointed out that elderly people in the early stages of Alzheimer’s disease generally show increasing difficulty in language expression; obvious memory loss, especially short-term memory; getting lost in familiar places; lack of initiative and enthusiasm in doing things; showing depression or Aggression; loss of interest in previous hobbies and activities, etc.
"If the elderly around you have these symptoms, you should go to the hospital for regular screening and timely intervention, so as not to miss the best time to see a doctor and delay treatment. Ageing, cerebrovascular disease, three highs, diabetes, Alzheimer's disease Family history is a factor that needs to be paid attention to in time. The annual physical examination, if you belong to the above population, you need to do cognitive function testing." Hu Hua said.
People with a family history of Alzheimer's disease should pay more attention to the initial symptoms of cognitive decline. "Alzheimer's disease can be diagnosed at an early stage, which has a lot to do with the patient's or the patient's family's awareness of the disease." Feng Tingyi added.
Studies have shown that if Alzheimer's disease can be detected as soon as possible and treated in time, through "medication + nursing + cognitive training", it can effectively delay the development of the disease, which is the most wise choice for patients and their families. For the prevention and intervention of Alzheimer’s disease, the National Health Commission has released core information in 2019: form a healthy lifestyle, reduce the risk of disease, know the early signs of Alzheimer’s disease, seek medical attention in time, actively treat, and do a good job Family care, safeguarding the dignity and basic rights of patients, caring for caregivers, and creating a friendly social atmosphere, in order to enhance the prevention awareness of the whole society, and gradually reduce the growth rate of the prevalence.
3 Insufficient care capacity, lack of resources, single service
The "Survey Report on Family Living Conditions of Alzheimer's Disease Patients" shows that the living conditions of Alzheimer's patients and their families are not optimistic. The spouse is the most common caregiver for Alzheimer's disease, and 68.69% of the caregivers have their health affected. 60% of families will not take the initiative to talk about the patient's condition, and 80% of them think that even if they talk about it, they will get some comfort, and nothing will change. This reflects the lack of Alzheimer's disease care resources and service capabilities .
Experts pointed out that insufficient care capacity, lack of resources, and single treatment services are the main dilemmas faced by the care of Alzheimer's patients in my country.
"For the patient, there may be no pain at all in the later stage, because there is not much memory, and no one knows anyone; for the family, it is watching the disease develop and the pain they endure is even greater." Feng Tingyi Pointed out that as the course of the disease progresses, patients with Alzheimer's disease may slowly decline to 18, 10, two or three years old until they are like a baby. In the end, they may be lying in bed, unable to take care of themselves, and require family members to stay at home. To accompany for a long time.
In addition, people who care for Alzheimer's disease may also be subjected to violence and aggressive behavior from some patients, especially male patients. Some patients’ children are not around or need to go to work and cannot take care of them personally. After being beaten, external caregivers will be unable to bear and leave. Patients have only the option of "being sent to a nursing home." However, the current nursing homes are mixed, with large gaps in the level of rehabilitation care and high prices, which are a heavy economic burden for many families.
Hu Hua said frankly that due to lack of manpower and funds, many Alzheimer's disease prevention and control policies cannot be implemented for a long time. Doctors can only give patients and their families relevant knowledge of science and conduct scale tests. However, many doctors are reluctant to join in the prevention and treatment of Alzheimer's disease because there are few drugs for the disease, the treatment is not effective, and it cannot be cured immediately. "Take Suzhou as an example. In a city with a population of six or seven million, the number of doctors treating Alzheimer's disease can be counted clearly in one palm," said Hu Hua.
Cognitive rehabilitation for Alzheimer’s disease is currently far from being done. For patients in the pre-disease stage, doctors hope that patients or their family members will realize that in addition to taking medicine, they can also perform special treatments. Cognitive training and rehabilitation, such as playing games to open the brain.
4 Difficulties in drug research and development
In the medical world, the treatment of Alzheimer's disease is like a difficult peak to climb. The difficulty of drug development and the high failure rate are well known.
Data shows that in the past 20 years, major pharmaceutical companies around the world have invested hundreds of billions of dollars in research and development, and more than 320 drugs that have entered clinical research have failed.
Among them, 40% died in the early clinical stage, 39% announced failure in the mid-term clinical trial, and 18% failed in the late-stage clinical trial, including well-known pharmaceutical companies such as Roche, Eli Lilly, AstraZeneca, Merck, Johnson & Johnson. In March 2019, the new drug Aducanumab (Aducanumab) developed based on the hypothesis of Aβ deposition and Tau protein was terminated due to poor clinical trials. Although the researchers reanalyzed the trial data and found that long-term use of high doses can improve the cognitive function of patients, and formally submitted a new drug marketing application this year, but the controversy of the data and obvious side effects still make the industry very promising. cautious.
The repeated failures of drug research and development have made the academic community continue to search for new pathogenesis hypotheses and new strategies for the treatment of Alzheimer's disease. A report issued by the Pharmaceutical Research and Manufacturers Association of America (PhRMA) in 2018 pointed out that despite the tremendous efforts, only 6 Alzheimer’s disease drugs have been approved by the US Food and Drug Administration (FDA) for marketing, respectively in 1993 Tacrine approved in 1996, donepezil approved in 1996, rivastigmine approved in 2000, galantamine approved in 2001, memantine hydrochloride approved in 2003, memantine/donepezil compound preparation approved in 2014, and Nine drugs have been approved for marketing in countries other than the United States.
On November 2, 2019, the National Medical Products Administration officially approved the listing of the national class I new drug Mannite Sodium Capsules (trade name "Nine Phase One"), filling the market for no new drugs in the treatment of Alzheimer's disease in the past 17 years Whitespace. The drug regulates the imbalance of the intestinal flora, reshapes the immune homeostasis of the body, reduces the production of metabolites of the intestinal flora, especially phenylalanine and isoleucine, reduces peripheral and central inflammation, and reduces Aβ deposition and Tau hyperphosphorylation improves cognitive function.
■ Popular Science Questions and Answers
How to intervene when symptoms of cognitive decline appear? Hu Hua, Feng Tingyi, and Guo Qihao, director of the Department of Geriatrics, the Sixth People's Hospital of Shanghai Jiaotong University, gave detailed explanations from many aspects to help patients' families identify Alzheimer's disease early, diagnose early, and intervene early.
Q: How to prevent the occurrence and development of diseases?
Feng Tingyi: Patients should reduce bad living habits, live a regular life, keep enough sleep, and perform intellectual stimulation activities, including reading and playing chess, avoid stress, depression and head trauma, and avoid diabetes and high blood pressure in middle and later ages And weight gain. If memory loss occurs, the patient's thinking ability and motivation in life are reduced, and he needs to give him some cognitive exercises. Encourage his family to teach him how to remember, such as checking the date every day, recording what he did, and repeating it at night , Recall, these are all physical treatments.
Q: How to detect cognitive decline?
Guo Qihao: Many people refuse to see a doctor because of their stigma. At this time, the cognitive function scale is an important way to understand the condition. The way of scale assessment has been established in foreign countries. There are some foreign institutions that conduct self-assessment of the scale for all the elderly in the city and archive it as a health management file. Self-assessment once a year can see the changes in scores. This is used to judge the degree of cognitive decline and to manage disease development. This scale has low promotion cost, high accessibility and high sensitivity, and can detect the degree of cognitive decline at an early stage.
Q: When is the key to treating AD?
Guo Qihao: The course of Alzheimer's disease is mainly divided into:
In the preclinical stage, there may be a slight decline in cognitive function, but the objective cognitive examination is within the normal range. At this time, the brain has undergone pathological changes such as Aβ deposition.
The second stage, mild cognitive impairment (MCI), is manifested as a progressive decline in memory or other cognitive functions.
The third stage is the dementia stage. Because cognitive decline in the preclinical stage is not easy to detect, early screening and early treatment are essential.
Q: How to intervene in cognitive decline?
Feng Tingyi: Alzheimer's disease patients will have so-called senile plaque deposits in their brains. Now some drugs can delay the deposition of senile plaques and calcified plaques and delay the development of the disease.
Guo Qihao: The latest research has found that the imbalance of the intestinal flora can promote the infiltration of peripheral immune cells into the brain, thereby enhancing the activation of microglia, causing cognitive decline and Aβ protein deposition. Chinese innovative drugs based on the brain-gut axis theory have been successfully developed, providing new ways to improve cognitive function and intervene in cognitive decline.
Q: Does the severe stage still need intervention?
Feng Tingyi: No matter what stage the patient is in, he should intervene. If we intervene in patients with mild and moderate levels, we can at least guarantee that it will not occur or delay as much as possible the patient’s complete loss of life ability. If it is a severe patient, the intervention can at least allow the patient to have a relatively good living condition and standard of living, and also extend the patient's survival period. It is not clear how much the patient’s survival period will be extended after early intervention. But what is certain is that if there is no intervention, the survival period of such patients is often only five to ten years.
A10-A11 edition written by Wang Kara, reporter from Beijing News