world alzheimer's day | alzheimer's disease has doubled in 20 years, with 15 million patients in my country alone
2024-09-21
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introduction
there are more than 15 million people with alzheimer's disease in my country. as the population ages, the number of people suffering from neurodegenerative diseases is also increasing rapidly.
previously, we had the honor to talk with professor jintai yu about the current understanding of alzheimer's disease and future hopes. professor yu is the chief physician and professor of the department of neurology at huashan hospital affiliated to fudan university, and the executive deputy director of the institute of neurology at fudan university. he has done in-depth research on alzheimer's disease.
professor yu introduced thatalzheimer's disease is closely related to vascular risk factors, emotions, education level, and social activities."regular exercise, keeping the brain active, and ensuring good sleep are essential to preventing alzheimer's disease."
yu jintai (chief physician and professor of neurology, huashan hospital affiliated to fudan university) | guestwhat are neurodegenerative diseases?
q: what are the common neurodegenerative diseases?yujintai:neurodegenerative diseases, also known as neurodegenerative diseases or neurodegenerative diseases, are neurological diseases that are closely related to aging. among them, the most common is alzheimer's disease. in addition to alzheimer's disease, there is parkinson's disease, which is the second most common neurodegenerative disease.generally speaking, we divide neurodegenerative diseases into two categories: one is related to cognitive impairment, and the other is related to movement disorders, including parkinson's disease, multiple system atrophy, etc. these diseases are collectively referred to as neurodegenerative diseases.q: what are the characteristics of this type of disease compared to other diseases in the body?yujintai:a notable feature of neurodegenerative diseases is that they are closely related to age. the incidence of these diseases gradually increases with age.alzheimer's diseasefor example,the prevalence rate in people over 60 is about 5%, but it may rise to nearly 20% in people over 70, and may reach 30% to 40% in people over 90.in addition, the main characteristics of this type of neurodegenerative disease are brain atrophy, neuronal degeneration and damage, which lead to loss of function and are generally irreversible. currently, we cannot completely reverse its onset and development process, which is also one of the important challenges in research and treatment in this field.q: what are the current difficulties and challenges in researching and treating this type of disease?yujintai:these neurodegenerative diseases are age-related.it has the characteristics of insidious onset and gradual progression.the disease often develops gradually without notice, which makes early diagnosis very difficult.on the other hand,these diseases mainly cause brain degeneration and atrophy, neuronal loss,therefore, when clinical symptoms become apparent, the structure of the brain has already been severely damaged, such as atrophy, degeneration, or neuronal loss. currently, there is no drug that can effectively reverse the pathological process of these diseases, so early diagnosis and better prevention strategies are crucial, but this is also a huge challenge.what are the main symptoms of alzheimer's disease?
q: next, we would like to learn about a typical neurodegenerative disease, alzheimer's disease. can you tell us what kind of brain disease it is and what are its typical characteristics?yujintai:alzheimer's disease, commonly known as senile dementia, is the most common neurodegenerative disease and the most common cause of dementia. about two-thirds of dementia cases are related to the degeneration of aβ protein. like other neurodegenerative diseases, it is characterized by a process that first causes the disease and then gradually progresses. its incidence rate increases year by year with age.the most typical clinical manifestation of alzheimer's disease isepisodic memory impairment: patients often forget recent events but can remember things from earlier years. as the disease progresses,in addition to memory problems, other cognitive dysfunctions such as language disorders, visual-spatial disorders, and calculation disorders may also occur.in the late stages of the disease,patients may also experience psychiatric problems and abnormal behavior.the quality of life of patients with alzheimer's disease is seriously affected. another major pathological feature of alzheimer's disease is the deposition of amyloid protein in the brain and the neuronal tangles caused by abnormal phosphorylation, which constitute the two core pathologies of the disease.the two core pathologies provide the "gold standard" for the pathological diagnosis of alzheimer's disease. currently, the biological diagnosis and treatment of alzheimer's disease mainly focus on the study of these two core pathologies, and a series of exploratory work has been carried out.q: what is the current trend in the prevalence of alzheimer’s disease?yujintai:in fact, not only in china, but also around the world, alzheimer's disease is showing a growth trend of doubling every 20 years.this is mainly due to two main factors: on the one hand, as mentioned above, this type of disease is closely related to age, and the current society is experiencing an aging process, so the incidence of alzheimer's disease is gradually increasing. on the other hand, the more important reason is the improvement of the quality of life and the gradual extension of human life span, which also leads to an increased risk of alzheimer's disease.in addition, there are other risk factors to consider, includingcardiovascular and cerebrovascular diseasesand related vascular metabolic diseases. the continuous increase of these factors has also indirectly led to the increasing incidence of alzheimer's disease year by year.several hypotheses on the causes of alzheimer's disease
q: alzheimer's disease is a very complex disease. what are the current hypotheses about the cause of alzheimer's disease?yujintai:regarding alzheimer's disease, its pathogenesis is actually very complex, and the cause has not yet been fully clarified. of course, there are many different hypotheses, including the amyloid protein cascade hypothesis, the abnormal tau phosphorylation hypothesis, and hypotheses involving infection, inflammation, calcium homeostasis disorders, cholinesterase, etc. in general,the most widely accepted hypothesis at present is the amyloid cascade hypothesis.the hypothesis holds that amyloid proteins, especially aβ proteins, abnormally increase and misfold in the brain, forming senile plaques in the brain. this phenomenon triggers a series of downstream amyloid protein cascade reactions, leading to abnormal tau phosphorylation, which in turn leads to neuronal degeneration, damage and apoptosis, and ultimately brain atrophy. when it reaches a certain level, it affects various brain functions, especially memory function, resulting in clinical symptoms of the disease.q: what other hypotheses are there about the cause of alzheimer's disease? can you introduce them?yujintai:the most important research hypothesis remains the amyloid cascade hypothesis, in addition, the abnormal phosphorylation hypothesis of tau is becoming more and more common.it is particularly noteworthy that the amyloid cascade hypothesis currently dominates the field of alzheimer's disease-related drug development, and many drug studies are based on this.this hypothesis is mainly proposed for some special familial alzheimer's disease, which will cause mutations in the gene that produces related amyloid proteins. this abnormality leads to excessive accumulation of amyloid proteins in the brain, and eventually leads to the onset of alzheimer's disease after a certain age. therefore, the amyloid cascade hypothesis is currently recognized.how to diagnose alzheimer's disease early
q: how is alzheimer's disease diagnosed currently?yujintai:there are now a growing number of options for diagnostic methods and tools for alzheimer's disease.first, we have diagnostic criteria, which are constantly evolving.it is usually viewed as a clinical syndrome.we usually check it through the following steps: first, determine whether the patient has symptoms of dementia, then observe whether it meets the typical characteristics of alzheimer's disease, and finally rule out other potential causes of dementia. these steps can be used to diagnose alzheimer's disease.however, there are some problems. on the one hand, it is difficult to achieve early diagnosis.because a diagnosis can usually only be made when the disease progresses to the dementia stage, by which time the best time for intervention has often been missed.on the other hand, the accuracy of clinical diagnosis is not very high.of course, the gold standard for alzheimer's disease is to make a pathological diagnosis by autopsy pathological observation to determine whether there is amyloid deposition and abnormal phosphorylation of tau protein to form neurofibrillary tangles. in contrast, the accuracy of clinical diagnosis is only 70% to 80%.in view of the above shortcomings and challenges, the diagnostic criteria for alzheimer's disease are constantly evolving and being revised. these evolutions and revisions are mainly based on the research progress of specific biomarkers related to alzheimer's disease. in particular, we can now diagnose by detecting biomarkers of amyloid problems and abnormal tau phosphorylation in cerebrospinal fluid.in addition, molecular imaging techniques, such as amyloid pet and tau pet, allow us to more accurately detect amyloid in the brain. therefore, the current diagnostic criteria have expanded the positioning of alzheimer's disease from the previous clinical syndrome to the clinical and biological level. this means that we can consider a series of clinical manifestations as well as some biological indicators to make a more accurate diagnosis.we can diagnose alzheimer's disease intothere are three different stages: preclinical, cognitive impairment, and dementia.recently, the latest version of the diagnostic criteria was released at the alzheimer's disease international conference. this latest version completely defines alzheimer's disease as a biological entity, and as long as an individual detects signs of amyloid deposition and abnormal tau phosphorylation in the brain, he or she is considered to have alzheimer's disease.what are the factors that cause alzheimer's disease?
question: what factors are currently known to be closely related to alzheimer's disease? how much influence do genetic and environmental factors have on alzheimer's disease?yujintai:when it comes to alzheimer's disease, we actually divide it into two major categories.one type is called familial alzheimer's disease, which has a relatively low incidence rate of about 1% to 5% and is usually related to specific genetic gene mutations. these gene carriers will develop the disease when they reach a certain age;one is sporadic alzheimer's disease, which accounts for about 95% of alzheimer's disease cases. its onset is the result of the interaction between genes and environmental factors. studies have shown that genetic factors account for about 40% of the risk of disease, while environmental factors may account for about 60%.q: can you briefly introduce the environmental factors that are currently known to be closely related to alzheimer's disease, such as lifestyle habits, eating habits, etc.?yujintai:the more obvious factorsincluding lifestyle habits such as exercise, sleep, cognitive activity, and social interaction,these factors play a very important role in improving cognitive function and preventing dementia.also,vascular risk factors are also critical.including diabetes, hypertension, cardiovascular and cerebrovascular diseases, and even hypotension can significantly increase the risk of alzheimer's disease.other factorsincluding emotional issues,like depression, it can also significantly increase the risk of alzheimer's disease. in addition, abnormalities in homocysteine levels and other metabolic markers are also associated with increased disease risk.education level is also a very important factor, studies have shown thatthe higher the level of education, the lower the risk of developing the disease in the future.is there a cure for alzheimer's?
q: in recent years, there have been remarkable advances in alzheimer’s research and drug development. can you briefly analyze the breakthroughs made in the past few years?yujintai:one of the most notable breakthroughs involves drug development based on the amyloid cascade hypothesis, which holds that abnormal production and deposition of amyloid plays a key role in the pathogenesis of alzheimer's disease. given the importance of amyloid in the pathological process, researchers have developed a series of selective antibodies that can selectively clear amyloid from the brain, with promising results.first, the results of the phase iii clinical trial of the monoclonal antibody last year were very impressive, and it received unconditional approval for marketing in the united states in july this year.in addition, another similar product has also achieved very good results in the phase iii trial. if all goes well, it is expected to be approved for marketing in the second half of this year.so this class of drugs is different from the drugs of the past, which were mainly related to neurotransmitters, but now we have monoclonal antibodies that can clear toxic amyloid in the brain, and combined with neurotransmitter drugs, it may have a positive effect on reducing the occurrence of this disease.question: will there be new directions in the treatment of alzheimer's disease in the future?yujintai:regarding the future treatment of alzheimer's disease, i just mentioned the major breakthroughs made in the past few years.the research focuses on the amyloid cascade hypothesis. another major core pathology is the abnormal phosphorylation of tau protein, which leads to the formation of neuronal tangles.this is also a very important pathological process. therefore, many new drugs have been developed in this field and have made breakthrough progress. these drugs can inhibit the abnormal phosphorylation of tau protein, thereby delaying the course and progression of the disease. for pathological research around tau protein, we have reason to believe that major breakthroughs will be made in the future.of course, for alzheimer's disease, the two core pathologies mentioned above are both crucial. in the future, whether we can combine the treatment of clearing amyloid protein in the brain and inhibiting related tau protein problems to clear abnormal tau protein tangles in the brain may play a more important role in delaying and developing the disease.how to prevent alzheimer's disease for the general public
q: how should the general public prevent alzheimer's disease?yujintai:this problem is also the most prominent feature of our team and our greatest contribution to alzheimer's research. first, we conducted a study on the adjustable risk factors for alzheimer's disease and identified multiple adjustable risk factors related to alzheimer's disease.subsequently, we worked with international experts to develop an evidence-based prevention guideline for alzheimer's disease, aiming to reduce the occurrence and progression of the disease. so how do we prevent it? in this study, we made 21 recommendations, 19 of which were considered worthy of recommendation, while two were not recommended.one of the main recommendations is to focus on lifestyle.factors including regular physical activity, keeping the brain active, ensuring good sleep and emotional health are important in preventing alzheimer's disease. in addition, lifelong learning and active social interaction are also believed to help reduce the risk.in addition to lifestyle,controlling blood pressure and blood sugar is also considered vital, as is avoiding brain injury and trauma. preventing stroke is also an important aspect of dementia risk management.other relevant factors include heart health, especially atrial fibrillation, as they are closely related to the development and progression of alzheimer's disease.depression is also considered an important risk factor, so maintaining a good emotional state is also very important to prevent the occurrence of alzheimer's disease. in addition, the control of homocysteine levels is also recommended, and some trace elements such as vitamin c can be appropriately supplemented.apart from this, there are two suggestions that are not recommended.one is the use of estrogen replacement therapy to prevent alzheimer's disease.all relevant clinical trials have failed. clinical trials have shown that this method not only cannot prevent, but will increase the risk of alzheimer's disease. we also clearly do not recommend the use of cholinesterase inhibitors to prevent the disease, because these drugs can only improve symptoms but cannot prevent it.at last,weight management is also important.being too fat or too thin is bad for your health.team/author: deep sciencereviewer: chen hai (deputy director of pla general hospital (301 hospital), postgraduate instructor)producer: china science and technology press co., ltd., beijing zhongke xinghe culture media co., ltd.
