China Brain Health Day | Pay attention to the brain health of the elderly to prevent Alzheimer's disease

Since 2000, September of each year is China Brain Health Month, and September 16 is "China Brain Health Day", which aims to awaken the public's attention to brain health and enhance people's awareness and understanding of brain health. September 16, 2023, is the 23rd "China Brain Health Day". Let us pay attention to the brain health of the elderly and prevent and treat various brain diseases such as Alzheimer's disease. Tang Yamei, deputy director of Sun Yat-sen Memorial Hospital of Sun Yat-sen University, pointed out that some of the various brain diseases can be effectively prevented and controlled through early detection, early intervention and early treatment.

There are seven types of brain diseases

"If you often experience dizziness and headaches, long-term memory loss, hemiplegia of hands and feet, vision changes, insomnia, convulsions and other symptoms, it may be that there is a problem with the brain and it is unhealthy. You should seek medical treatment as soon as possible." Tang Yamei introduced that encephalopathy is mainly divided into seven categories. The first category is the more common neurodegenerative diseases in neurology, including Alzheimer's disease and Parkinson's disease. The second category is cerebrovascular disease, such as cerebral apoplexy, commonly known as stroke, the most common clinical manifestation is sudden hemiplegia and hemiplegia. The third category is epilepsy, commonly known as epilepsy, the most common manifestation is paroxysmal convulsions. The fourth category is autoimmune diseases and infectious diseases. Autoimmune diseases are diseases caused by disorders of some immune systems in the human body, such as multiple sclerosis or neuromyelitis optica. Intracranial infectious diseases are caused by pathogens such as bacteria, viruses or fungi invading the brain, such as viral encephalitis. The fifth category is brain tumors and brain trauma. The sixth category is nutritional metabolic diseases, such as vitamin deficiency, diabetes, excessive drinking, etc., which can all cause encephalopathy. The seventh category is mental and psychological problems, such as depression. "When mental and psychological problems such as depression and anxiety symptoms appear, you can go to the neurology department or a specialized mental and psychological specialist for treatment." Tang Yamei reminded that among various brain diseases, the most easily overlooked is Alzheimer's disease, especially the most common one - Alzheimer's disease. It has a slow onset and the early symptoms are not serious, which is mistaken for normal aging.

What is Alzheimer's disease?

It is reported that one person in the world develops Alzheimer's disease every 3 seconds. With the aging of my country's population, the prevalence of dementia in people aged 60 and above has gradually increased, but the awareness rate, consultation rate and treatment rate are very low. So what is Alzheimer's disease? Tang Yamei explained that Alzheimer's disease (AD) is the most common type of senile dementia. It is a degenerative change of the central nervous system (brain) characterized by progressive acquired cognitive dysfunction and behavioral impairment, and is an important cause of disability in the elderly.

Epidemiological studies show that there are more than 9 million Alzheimer's patients in my country, accounting for about 1/4 of the world's total number of cases, with an average of 300,000 new cases each year, and the prevalence rate shows a significant increase with age. It is estimated that by 2050, the number of patients over 60 years old in my country will reach 30 million, and the economic burden caused by related expenses is expected to reach 12 trillion yuan. Early diagnosis and prevention of Alzheimer's disease has become a major scientific and social issue.

"I have also felt that my memory has declined in the past two years. Is this a precursor to Alzheimer's disease?" In response to the reporter's question, Tang Yamei smiled and said, "Alzheimer's disease generally begins to develop in people over 60 years old. Memory loss is not necessarily a precursor to Alzheimer's disease, but the most common precursor to Alzheimer's disease is memory loss. Memory loss in young people is a benign memory disorder. The brain will not atrophy, and there are no abnormalities in the relevant markers of blood dementia." It turns out that Alzheimer's disease can be divided into early-onset and late-onset. Early-onset Alzheimer's disease usually shows obvious symptoms at the age of 40-50, develops rapidly, and is usually closely related to genetic mutations. If there are similar dementia patients in the family, the possibility of early-onset Alzheimer's disease will be greater. Late-onset Alzheimer's disease usually appears after the age of 60, which is commonly known as "senile dementia", and the course of the disease can be up to 10-20 years.

Ten early warning signs of Alzheimer's disease

Tang Yamei suggested that middle-aged and elderly people can learn about their chances of developing Alzheimer's disease in the future through screening of some risk factors, and take preventive measures in advance. Because some high-risk factors for this disease are controllable, such as vascular risk factors: hypertension, diabetes, dyslipidemia, overweight or obesity, smoking and harmful drinking, the combined effects of multiple vascular factors, cardiovascular and cerebrovascular diseases, etc.; social and psychological factors: low education level, depression, sleep disorders, etc.; other factors: hearing abnormalities, smell abnormalities, visual abnormalities, brain trauma, etc. However, high-risk factors such as age, gender (female), family history and carriers of apolipoprotein E (APOE4) alleles are uncontrollable, and can only be detected early, intervened early, and treated early.

Tang Yamei said that the latest research conducted by her team found that premature menopause is associated with an increased risk of all-cause dementia, and that postmenopausal complications including sleep disorders, mental disorders, weakness, chronic pain, and metabolic syndrome may be mediating factors that lead to an increased risk of dementia due to premature menopause. In addition, they also found that shift work increases the risk of all-cause dementia by 30% compared with non-shift work, and this relationship is not changed by genetic susceptibility.

As a child, how can you identify whether your elderly have Alzheimer's disease at an early stage? She said that when the elderly at home show 10 kinds of "old and confused" behaviors, it is likely to be an early manifestation of Alzheimer's dementia!

The first is memory loss. This is especially true for recent memory loss, such as forgetting to bring your keys when you go out, or forgetting to buy groceries, or not being able to remember important things you did in the past week. If you can’t remember many times, family members should accompany the elderly to see a doctor in time.

The second is a decline in the ability to plan things. For example, in the past, children could independently complete activities such as wrapping red envelopes during festivals, but this year they need help from others. The ability to handle complex things has declined, and the loss of the ability to plan things is also an important early manifestation.

The third type is difficulty in completing familiar tasks. For example, in the past, many dishes would be prepared for the New Year's Eve dinner, but this year some dishes need to be made by looking at recipes, and this familiar operation will cause certain problems.

The fourth type is confusion about time or place. They cannot remember the exact time or often get lost.

The fifth type is language expression problems. During speech, the child cannot say familiar words and uses other sentences to explain them. The words do not express the meaning or the child has difficulty finding the words. For example, "brush teeth" is said as "toothbrush".

The sixth type is often putting things in the wrong place, such as putting an electric kettle on a gas stove.

The seventh is a decline in judgment, such as not being able to distinguish between positive and negative characters when watching TV.

The eighth type is a problem with visual space. For example, when you are looking for a cup, the cup is right in front of you but you just can’t see it, or you can’t react and realize that it is a cup.

The ninth type is loss of initiative. You are unwilling to participate in social activities, do not want to do your previous job, and are no longer interested in activities you used to enjoy.

Tenth, changes in mood or behavior. There will be rapid changes in mood without any reasonable reason. You may go from joy to tears a few minutes ago, then get angry, and finally calm down. You may also show joy when you should be sad. Some people will also have fragmentary hallucinations and delusions, mostly about being stolen and jealousy.

How to prevent Alzheimer's disease?

Tang Yamei pointed out that in order to prevent Alzheimer's disease, in daily life, we must manage blood pressure, blood sugar, and blood lipids; quit smoking and limit alcohol, exercise more, participate in more entertainment and social activities; read more, use your brain more, and play brain-stimulating games, cards, mahjong, etc. with friends; eat a low-fat, low-salt and Mediterranean diet (cereals, whole grains, fish, nuts, olive oil, etc.); maintain an optimistic attitude, stable emotions and adequate sleep; deal with hearing, vision and smell problems in a timely manner; if there is brain trauma, conduct rehabilitation training in a timely manner.

How is Alzheimer's disease diagnosed? She told reporters that generally after patients come to the hospital, doctors will assess whether cognitive function is normal based on the patient's symptoms and scale screening. If cognitive function is found to have declined, it is necessary to further clarify whether it is dementia. Cognitive function includes memory, language, visual space, execution, calculation, and understanding and judgment. If there are problems in 2 or more cognitive domains and it affects the patient's daily or social abilities, it is considered dementia. Furthermore, the doctor will determine what type of dementia the patient belongs to based on the results of further examinations, whether it is early, middle or late. At this time, it is usually necessary to further clarify the diagnosis through cranial MR, PET-CT examinations, as well as blood tests and cerebrospinal fluid examinations of Aβ, tau protein and other indicators. "There is currently no specific drug to cure Alzheimer's disease, but early diagnosis and timely treatment can alleviate patients' symptoms, delay progression, and long-term treatment should be adhered to as much as possible." Tang Yamei emphasized.

Produced by Guangdong Science and Technology Newspaper Media Center

Gatekeeper: Tang Yamei, Vice President of Sun Yat-sen Memorial Hospital, Sun Yat-sen University

Reporter: Mai Bo

Correspondent: Huang Ruipeng Sudan