The world has a dementia patient every 3 seconds, and new guidance is urgently needed on how to prevent and treat elderly dementia represented by Alzheimer's disease. On December 24, 2021, the Guidelines for the Prevention and Treatment of Dementia in The Elderly in China (2021 Edition) (hereinafter referred to as the "Guidelines"), organized by the Psychiatric Branch of the Chinese Medical Association and edited by Professor Yu Enyan, were officially released. The guidelines, which have been updated after a lapse of 14 years, focus on disease prevention, emphasize the management of the whole course of illness, encourage multidisciplinary participation, and highlight the three major priorities of prevention, early intervention, home management and rehabilitation.
Guidelines for the Prevention and Treatment of Dementia in Old Age in China, 2021 Edition
The time is ripe for a re-update of the guide
Dementia refers to an acquired brain syndrome caused by neurodegenerative changes, cerebrovascular lesions, infections, trauma, tumors, nutritional metabolic disorders and other causes, which is characterized by cognitive function in two or more areas (such as memory, executive function, attention, language, social cognition and judgment, etc.) impaired, and can be accompanied by personality changes, psychobehavioral symptoms, etc., can not be attributed to normal aging. There are many diseases that cause dementia, and the causes are mixed, and Alzheimer's disease is its main representative. At present, dementia in the elderly (age more than 65 years old) has become a multi-morbid and common disease, and the attention of the state and the whole society has been continuously increased.
"Over the past ten years, the research and clinical treatment of diseases with cognitive impairment in the elderly represented by Alzheimer's disease have made great progress. The prevention, intervention, drugs, concepts, etc. of dementia have been greatly developed, there have been many new achievements and new experiences, and great changes have taken place from diagnostic classification, clinical diagnosis and treatment to prevention strategies. Therefore, the time is ripe for the re-publication and updating of the Guide, and it is both necessary and urgent. Professor Yu Enyan, editor-in-chief of the guidelines and the Department of Clinical Psychology of the Affiliated Cancer Hospital of the University of Chinese Academy of Sciences, introduced, "The new version of the guidelines mainly includes 7 main sections such as overview, prevention and intervention, assessment and diagnosis, treatment and rehabilitation, home and institutional care, caregiver support, promotion and implementation, etc., with comprehensive content; in addition, 8 aspects of controllable risk factors, biomarkers, ethics, and hospice care have been added, enriching the content of assessment, multidisciplinary collaboration, and non-drug treatment. On the basis of emphasizing scientificity, advancedness, applicability, operability and emphasis on diagnosis and treatment, the new version of the Guidelines highlights the three characteristics of prevention, early intervention, home management and rehabilitation, and emphasizes the concept of whole-course management. ”
Three characteristics guide the new direction of disease management
With the development of medical technology, some diseases can achieve accurate diagnosis in the asymptomatic period, making early prevention and early recognition possible. Professor Xiao Shifu of Shanghai Mental Health Center analyzed: "Elderly dementia is a group of diseases, the most common is Alzheimer's disease, accounting for about 60%, and other Parkinson's dementia, vascular dementia, vitamin B12 deficiency dementia and so on. In the diagnosis of diseases, especially for Alzheimer's disease, accurate diagnosis has been achieved, and the standard of diagnosis is constantly improving. "In particular, it should be emphasized that although current treatment is still difficult to reverse the progression of the disease, it can slow down the progression of the disease, and the earlier the treatment, the better the effect, so aggressive treatment is the right choice."
However, because there is currently no effective treatment for Alzheimer's disease that can reverse or stop disease progression, it is particularly important to prevent the occurrence of dementia in old age. Professor Xiao Shifu introduced that cognitive function damage is a slow and gradual process, and the state before entering dementia is the time to intervene, while subjective cognitive function loss and mild cognitive dysfunction are the key periods of intervention, and the role of early intervention should be highlighted. Practice has proved that lifestyle changes can prevent dementia and can be implemented, such as using more brains, healthy diet, smoking cessation and alcohol restriction, controlling the "three highs", and exercising more. For high-risk groups with risk factors, as well as people with subjective cognitive decline and mild cognitive impairment, early intervention is required to delay disease progression.
Professor Chen Wei of the Department of Mental Health of Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine mentioned that the auxiliary examination of dementia in the elderly can reveal the cause of dementia, find potential risk factors, find concomitant diseases or treatment, provide objective evidence for the diagnosis of dementia, and help detect early changes. At present, the most important is MRI, which can help to understand whether there are vascular changes, cerebral atrophy, hydrocephalus, tumors and other mass lesions, on the one hand, it is helpful for differential diagnosis, and on the other hand, it can also help determine the severity of the disease. At the same time, it is recommended that cerebrospinal fluid biomarker examination, PET examination of Aβ and tau should be carried out if conditions permit, which is very important for the diagnosis of Alzheimer's disease.
In addition, once the patient enters a state of dementia, it enters a long period of rehabilitation, during which although the necessary treatment is still being carried out, life care and rehabilitation are the main contents. The quality of care determines the quality of life of patients, and the mental state of caregivers affects the survival status of dementia patients, so scientific care and rehabilitation that meets the patient's personality characteristics and family conditions are crucial. Professor Wang Huali of the Department of Psychiatry of Peking University Sixth Hospital said: "Dementia home care emphasizes individualization, there is no amorphous formula, and the care techniques and interventions must be adjusted at any time according to the characteristics of each patient and family. "This also means that clinical frontline workers still need to work with patients and their families for long-term disease management." Professor Wang Huali said: "We should put forward suggestions for caregivers on the goals, measures, care contents, environmental arrangements, etc., and make suggestions for the end-of-life palliative care of dementia in the elderly, and also analyze the influencing factors of the burden on caregivers, focus on empowering caregivers and provide more support as much as possible." ”
Multidisciplinary participation is encouraged and emphasis is placed on the management of the whole course of the disease
At present, senile dementia has become an interdisciplinary disease in psychiatry, neurology and geriatrics, and rehabilitation, nutrition, general practitioners and community workers are increasingly actively involved in prevention and treatment. Treatment goals for elderly dementia include improving or maintaining the patient's cognitive function, or delaying cognitive decline, controlling the patient's BPSD, reducing the occurrence of symptoms, reducing the distress and harm caused by the disease to the patient and caregiver, maintaining the patient's social functioning, improving the patient's quality of life, and reducing the burden on the caregiver.
The Guidelines, which specifically recommend multidisciplinary collaboration in the treatment of elderly dementia, point out that elderly dementia patients often have comorbidities with other somatic diseases, such as cerebrovascular diseases, hypertension, diabetes, etc. In elderly patients with comorbid physical disease, a comprehensive history is required, and physical examination, laboratory tests, and related special tests are systematically performed. Professor Yu Enyan said that on this basis, the diagnosis should be clarified as soon as possible, and multidisciplinary consultation and collaboration should be actively carried out, and the risk assessment of comorbidities should be carried out, the treatment plan should be optimized, and the complications should be actively prevented and controlled to help improve the cognitive function of patients and prolong the survival time. At the same time, focusing on prevention, emphasizing the management of the whole course of the disease, and encouraging multidisciplinary participation are the concepts followed by the guidelines, which aim to provide reference for psychiatry, neurology, geriatrics and related clinicians, clinical psychologists, community workers, patients and caregivers; and contribute to the all-round full-cycle protection of people's health and the construction of a healthy China.
[Reporter] Yan Huifang
【Author】 Yan Huifang
Healthy living circle
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