重视阿尔茨海默病认知储备的跨学科研究

Strengthening multidisciplinary research on cognitive reserve in Alzheimer's disease

阿尔茨海默病(Alzheimer's disease,AD)是老年期痴呆最常见的一种类型(约占全部痴呆症的75%),严重威胁着老年人的健康和生存质量,给社会以及经济可持续发展带来沉重负担,因而成为了全球优先应对的重大公共健康问题。神经病理和分子影像学研究揭示,老年人脑组织AD病理负荷和认知障碍临床症状之间常有不一致的情形,有学者提出了"认知储备"假说来解释这种现象,即某些智力刺激因素能增加认知储备的容量,从而有助于维持认知功能,降低AD发病风险,延迟临床发病时间。这些因素包括青少年期文化教育、成年期工作复杂程度以及中晚年业余时间参加社交、认知或智力刺激活动以及体力锻炼活动等。近年来国际上神经影像和分子影像研究亦支持"认知储备"假说,但其神经病理和神经生物学机制目前尚不清楚。"认知储备"理论为AD的人群干预提供了重要理论基础,应重视从多学科角度探讨认知储备相关因素及其在AD临床发病中的作用和相关机制,为制定适合我国老龄人群和文化特征的人群干预策略和方案提供依据。

Alzheimer's disease (AD) as the most common form of dementia has been recognized as a global public health priority owing to its huge negative impact on sustainable social and economic development. Neuropathological and moleclar neuroimaging studies revealed the disparities between the load of Alzheimer pathology in the brain and the severity of cognitive symptoms, in which cognitive reserve hypothesis has been proposed to interpret this phenomenon. Indeed, epidemiological research has shown that certain intellectual factors such as early-life high education, midlife great work complexity, and leisure-time social, mental, and physical activities are frequently associated with a reduced risk of AD or dementia, possibly by increasing the cognitive reserve capacity, thus delaying the clinical onset of AD or dementia syndrome. The cognitive reserve hypothesis has been supported by neuropathological and moleclar neuroimaging studies, although its neuropathological and neurobiological mechanisms remain largely unknown. The cognitive reserve hypothesis has significant implications for interventions to delay the clinical onset of dementia or AD. Thus, we call for action in China to strengthen multidisciplinary research on cognitive reserve in AD as well as its neurobiological mechanisms. This will help develop intervention programs that are sensitive to Chinese society and clture to delay the clinical onset of AD and dementia.