Recently, the team of Professor Yu Jintai from the Department of Neurology of Huashan Hospital Affiliated to Fudan University and an expert group composed of well-known scholars at home and abroad in this field published the world’s first evidence-based prevention of Alzheimer’s disease (AD) international guidelines in an international authoritative journal, which triggered the industry The high degree of foreign attention has not only been widely followed up by domestic media, but many foreign media have also made extensive reports. The reason is that Alzheimer's disease has become one of the main threats to human health, and there is no specific treatment in the world that can prevent or reverse the progression of the disease.
So, what are the recommendations that can be adopted in life in the world's first evidence-based prevention guide for Alzheimer's disease? Why make these suggestions? The Yujintai clinical team assembled the recommendations of relevant experts to interpret this version of the prevention guidelines, mainly to answer: first, what is recommended (What); second, why is recommended (Why); third, how to implement (How) ). --editor
■ Yujintai
Alzheimer's disease, commonly known as "Alzheimer's disease", currently has about 10 million patients in China, and as the aging process accelerates, the affected population will become larger and larger.
More and more epidemiological studies have shown that AD can be prevented. Effective control of risk factors and rational use of protective factors can significantly reduce the incidence and prevalence of AD. Unfortunately, there is no international evidence-based medical evidence to guide clinical practice for this major brain disease that seriously threatens human health. The clinical research team of Huashan Hospital affiliated to Fudan University and well-known scholars at home and abroad formulated the world's first evidence-based prevention international guidelines for AD. The relevant research results were recently published in the sub-issues of the top international journal "British Medical Journal". According to the evidence-based medicine standards, the researchers finally formed the following recommendations, hoping to provide some hints to readers.
1. Weight management
Reason for recommendation: People under 65 should maintain a normal body mass index (BMI), through a reasonable and balanced physical exercise, calorie intake, and formal behavior plan, in order to achieve and maintain BMI within the range of 18.5-24.9 kg/m2 (for example, a For a person with a height of 1.6 meters and a weight of 50 kg, the BMI index is 50/1.6 squared = 19.53, which is within the recommended range); people over 65 years old should not be too thin. If people over 65 years old appear to lose weight, they should be close Monitor its cognitive function status.
Cause analysis: Fat metabolites in middle-aged overweight and obese patients may cause increased brain Aβ deposition, and also cause chronic diseases such as hypertension, which increases the risk of AD by about 64%. Elderly weight loss may be the preclinical manifestation of AD caused by pathological deposition in the brain. Elderly people with smaller weight changes have a 40% reduction in the risk of AD.
Measures and recommendations: Overweight and obese people under the age of 65 should control their BMI below 30 through scientific and reasonable diet and exercise. People over 65 should increase their intake of high-quality protein and maintain a BMI greater than 27, which may reduce the risk of AD. At the same time, the elderly should regularly monitor indicators such as body weight and body fat percentage, and pay close attention to changes in cognitive function if there are large fluctuations.
2. Physical exercise
Recommended reason: Everyone, especially those over 65, should insist on regular physical exercise.
Reason analysis: physical exercise can improve the cognitive function of the elderly by improving balance and reducing the number of falls. It can also promote nerve regeneration and reduce Aβ deposition in the brain. Long-term aerobic exercise can also increase hippocampal volume.
Suggested measures: physical exercise within a specific range (0-2000 kcal/week or 0-45 MET-h/week) is beneficial to AD prevention. For every increase in exercise volume by 500 kcal/week or 10 MET-h/week, the risk of AD Will be reduced by about 10%. It is recommended that middle-aged and elderly people do more aerobic exercise, choose appropriate exercise methods and arrange reasonable exercise intensity according to the results of physical examination and their own work ability.
3. Cognitive activities
Recommended reason: engage in stimulating mental activities.
Reason analysis: cognitive stimulation activities can reduce the risk of dementia by 50%, even in individuals with genetic susceptibility to dementia. The more cognitive stimulation activities are involved, the higher the brain reserve and the lower the risk of dementia.
Suggested measures: Participate in cognitive stimulation activities, such as reading, playing chess, learning new technologies, and playing brain cognitive training games, which can not only effectively prevent dementia, but also improve the overall quality of life and social participation.
4. Tobacco
Recommended reason: Do not smoke and avoid exposure to tobacco smoke in the environment. Smokers should be provided with counseling services, nicotine replacement therapy and other drug treatments to cooperate with behavioral plans or formal smoking cessation plans.
Reason analysis: Tobacco contains neurotoxins, which can directly damage neurons, cause cognitive decline, and increase the risk of AD by about 40%. Standardized management and treatment of smoking cessation can significantly reduce new cases of AD. Secondhand smoke also increases the risk of illness.
Suggested measures: For non-smokers, do not smoke, and avoid exposure to second-hand smoke in the environment. For smokers, they should be encouraged to quit smoking, take the initiative to consult medical staff for help, and formulate a formal smoking cessation plan. For stubborn smokers, nicotine replacement therapy and other drug treatments can be used to help them withdraw.
5. Sleep
Recommended reason: to ensure adequate and good sleep, consult a doctor or promptly treat sleep disorders.
Reason analysis: Sleep disorders can cause the brain to be unable to effectively remove toxic metabolic waste products (such as Aβ and tau protein) in the brain, which increases the risk of AD by about 70%. There is a U-shaped relationship between sleep time and AD. Insufficient sleep (<4 hours) or excessive sleep (>10 hours) at night can increase the risk of AD; sleep apnea syndrome, insomnia, and daytime dysfunction (such as frequent sleepiness during the day) ), too much time in bed, etc. will also increase the risk of AD.
Suggestions for measures: maintain energy during the day and appropriate night sleep duration (not less than 4 hours, not more than 10 hours), ensure good sleep quality, and actively treat sleep disorders such as insomnia and apnea syndrome.
6. Diabetes
Recommended reason: to maintain a healthy lifestyle, avoid diabetes, diabetic patients should be closely monitored for cognitive decline.
Reason analysis: The peripheral insulin resistance state of diabetic patients will cause the decrease of insulin content in the brain, interfere with the clearance of Aβ, and increase the risk of AD by about 70%. Even if the diagnostic criteria for diabetes are not met, abnormal blood glucose, glycosylated hemoglobin, and insulin levels will increase the risk of dementia. When the fasting blood glucose level is greater than 7.75mmol/L, the risk of dementia increases by 20%. Standard hypoglycemic treatment may reduce the risk of dementia. .
Measures and recommendations: Early screening of people with abnormal blood sugar, lifestyle interventions for them, and active prevention of diabetes. Diabetes patients should take medications as prescribed by their doctors, control various indicators within the normal range, and closely monitor the changes in their cognitive functions.
7. Cerebrovascular disease
Reasons for recommendation: Maintain a healthy lifestyle, use drugs reasonably, maintain a good cerebrovascular system, and avoid atherosclerosis, cerebral hypoperfusion or other cerebrovascular diseases; stroke patients, especially cerebral microhemorrhage patients, should be closely monitored Cognitive function changes, and effective preventive measures are taken to protect its cognitive function.
Reason analysis: Cerebrovascular disease can cause hypoperfusion in the brain, cause neuronal ischemia damage, and increase the risk of AD by 40%. Among them, cerebral microhemorrhage can increase the risk of AD by 70%.
Suggestions for measures: middle-aged and elderly susceptible people should control the risk factors of cerebrovascular disease, such as smoking, hypertension, hyperlipidemia, diabetes, etc., through changes in drugs and lifestyle. Patients with cerebrovascular diseases should be actively prevented.
8. Head trauma
Recommended reason: protect the head and avoid trauma.
Reason analysis: Head trauma after the age of 65 will increase the risk of AD by 35%, and the more frequent and severe the injury, the greater the risk of AD. Head trauma can directly damage the brain structure, and it can also mediate brain damage through oxidative stress.
Suggested measures: It is recommended that middle-aged and elderly people try to avoid falls and head hits in their daily lives, try to avoid dangerous scenes, such as contact sports, and take protective measures such as wearing helmets as much as possible in high-risk situations.
9. Weakness
Recommended reason: to maintain a healthy and strong body in old age; for people who are getting weaker and weaker, the cognitive function status should be closely monitored.
Cause analysis: Frailty refers to the decline of age-related body reserves and functions caused by various factors, which can cause the body's ability to respond to internal and external stresses, and may cause AD-related protein deposition, etc., which makes AD risky An increase of about 39%.
Suggestions for measures: Elderly people over 75 years old should adequately take in protein, vitamins and a variety of minerals from their diet, regularly perform aerobic exercise, regularly check physical activity and cognitive function, prevent infection, and take medication as prescribed by a doctor.
10. High blood pressure
Recommended reason: People under 65 should maintain a healthy lifestyle to avoid hypertension.
Reason analysis: middle-aged (≤65 years old) suffering from hypertension, the risk of AD increased by 38%. When the systolic/diastolic blood pressure exceeds 130/90mmHg, the risk of dementia increases significantly. Hypertension can lead to arteriosclerosis, chronic cerebral hypoperfusion and microcirculation disorders, and induce AD-related pathological changes.
Suggested measures: For middle-aged people with normal blood pressure, it is recommended to monitor blood pressure regularly, maintain a healthy lifestyle (such as quitting smoking and limiting alcohol, reducing sodium intake), avoiding emotional agitation, and actively preventing high blood pressure. For hypertensive patients, follow the doctor’s recommendation for blood pressure control levels to avoid excessive blood pressure fluctuations.
11. Orthostatic hypotension
Reason for recommendation: For patients with orthostatic hypotension, their cognitive function status should be closely monitored.
Cause analysis: Orthostatic hypotension is manifested as a 20mmHg drop in systolic blood pressure or a 10mmHg drop in diastolic blood pressure after standing compared to the supine position. Elderly people with orthostatic hypotension have an 18% increased risk of AD. Orthostatic drop in blood pressure can lead to transient cerebral hypoperfusion, which in turn leads to microcirculation disorders and induces the pathology of AD.
Suggested measures: Patients with orthostatic hypotension should actively seek and remove the causes that lead to the occurrence and deterioration of orthostatic hypotension, such as drug effects, dehydration, infection and autonomic dysfunction. Increase salt and fluid intake, add abdominal belts and compression stockings to help improve blood pressure. If necessary, short-acting blood pressure drugs can be used instead of treatment.
12. Depression
Recommended reason: to maintain a good mental health, and to closely monitor the cognitive function status of patients with depressive symptoms.
Reason analysis: Depression is an independent risk factor for AD. Depression can increase the risk of AD by about 23% by affecting AD pathology, hormones, nerve growth factor, hippocampal volume, etc.
Suggested measures: Learn to self-regulate and talk reasonably to eliminate negative emotions and negative thinking, and establish positive psychological coping methods. Depressed patients should actively seek medical treatment, and try to use mindfulness meditation, aerobic exercise, psychotherapy, etc. combined with antidepressant medications.
13. Atrial Fibrillation
Recommended reason: to maintain the good condition of the cardiovascular system, patients with atrial fibrillation need medication.
Reason analysis: Atrial fibrillation can lead to hypoperfusion of small arteries and hypertension of capillaries, causing insufficient cerebral perfusion, increasing the risk of AD by 63%. Warfarin-based anticoagulation therapy can reduce the risk of dementia by 29%.
Suggestions for measures: Patients with atrial fibrillation should actively use anticoagulant drugs under the guidance of doctors, and the selection of drug effectiveness and safety should be carried out in accordance with the doctor's advice, and new oral anticoagulants can be appropriately selected.
14. Mental stress
Recommended reason: relax and avoid excessive tension.
Reason analysis: Mental stress can cause hormone levels in the body to rise, induce inflammation in the brain, increase Aβ and tau protein deposition, cause damage to the structure and function of the hippocampus, and increase the risk of AD by about 56%.
Suggested measures: Maintain a positive and optimistic attitude. Under the guidance of a doctor, self-adjustment, relaxation training, meditation training, cognitive behavioral therapy, music therapy, physical or drug therapy can be carried out when mental or physical high tension or obvious symptoms of anxiety occur.
15. Education
Reason for recommendation: Get as much education as possible in the early years.
Reason analysis: Receiving a higher school education before the age of 30 can reduce the risk of AD by 51%. For every year of education, the risk of AD is reduced by 7%. Improving the level of education may reduce the risk of dementia by improving personal lifestyle, socioeconomic level, and increasing cognitive reserves.
Suggested measures: It is recommended to receive a higher level of school education (>6-15 years) before the age of 30, and at least receive secondary education to prevent and reduce the occurrence of dementia in later life. Lifelong education has also been proven to prevent dementia.
16. Hyperhomocysteinemia
Reason for recommendation: Regularly check blood homocysteine levels. For patients with hyperhomocysteinemia, use vitamin B and/or folic acid for treatment, and closely monitor their cognitive function status.
Reason analysis: Hyperhomocysteinemia (>13 mmol/L) can mediate vascular damage, cause brain tissue ischemia, and increase the risk of AD by 67% by promoting the deposition of Aβ and tau protein.
Suggested measures: Patients with elevated homocysteine levels can be treated with vitamin B and/or folic acid to control homocysteine within the range of 5-15 mmol/L.
17. Vitamin C
Recommended reason: dietary intake or additional vitamin C supplementation may be helpful.
Reason analysis: Vitamin C, as an antioxidant, can combat AD neurodegenerative changes caused by oxidative stress damage. Additional vitamin C supplementation can significantly reduce the risk of AD by 16%.
Suggested measures: It is recommended that middle-aged and elderly people eat more foods rich in vitamin C, such as vegetables and fruits.
18. Estrogen replacement therapy
Recommended reason: For postmenopausal women, estrogen replacement therapy is not recommended to prevent AD.
Reason analysis: Based on a number of studies, estrogen replacement therapy does not reduce the risk of AD, but may aggravate the progression of AD, especially if the course of treatment exceeds 10 years, so it is not recommended.
19. Acetylcholinesterase inhibitor
Recommendation reason: For patients with cognitive impairment, it is not recommended to use acetylcholinesterase inhibitors to prevent AD.
Reason analysis: Although acetylcholinesterase inhibitors can improve the clinical symptoms of AD, the summary results of 12 clinical studies have found that acetylcholinesterase inhibitors cannot reduce the risk of AD, so they are not recommended.
The expert group also evaluated other risk factors for AD, including social relationships, dietary patterns (such as Mediterranean diet, DASH diet, MIND diet, etc.), fish intake, non-steroidal anti-inflammatory drugs, osteoporosis, Heart failure, myocardial infarction, alcohol, tea, coffee, pesticide exposure, excessive silicon in drinking water, etc. Although the current level of evidence for these factors is not high enough, no recommendations have been made, but in the future, as AD-related risk factors and prevention clinical research continue to progress, the relevant content and level recommended by the guidelines will continue to change.