中国阿尔茨海默病早期预防指南(2024)

阿尔茨海默病是一种病因复杂的严重智力致残疾病,目前尚无有效的治疗方法。我国是世界上老年人口最多、增长最快的国家之一,也是阿尔茨海默病发病率较高的国家。因此,如何早期预防阿尔茨海默病的发生,是现今健康领域最重要的课题之一。我们在国内外相关研究的基础上,通过文献循证、干预研究实践、案例分析、经验总结和专家咨询,结合中国老年健康和社会文化特点,体现中国传统医学、武术、养生以及社区组织优势,制订出具有中国特色的阿尔茨海默病早期预防指南,涵盖了个人、家庭和社会三个层面的预防策略,从积极生活态度、社会活动参与、认知训练、体育锻炼、戒烟限酒、营养、睡眠,血压、血糖、血脂管理,体重和其他慢病管理以及中医开展针对阿尔茨海默病的一级预防。本指南仅供个人、家庭和社会开展阿尔茨海默病预防时参考。

骨肉瘤双硫死亡相关lncRNA预后预测模型的构建与验证

目的:构建双硫死亡相关lncRNA(disulfidptosis-relatedlncRNAs,DRLncs)的预后模型,以预测骨肉瘤(osteosarcoma,OS)的预后,提高患者生存率。方法:差异表达和皮尔逊(Pearson)相关性分析用于鉴定OS相关DRLncs,使用单变量Cox回归分析和最小绝对收缩选择算子(least absolute shrinkage and selection operator,LASSO)回归分析构建DRLncs的风险预后模型。通过生存分析、受试者工作特征(receiver operating characteristic,ROC)曲线、列线图和校准曲线以验证模型的可靠性。此外,探讨预后模型与免疫微环境和药物敏感性之间的关系。选取近10年自广西中医药大学第一附属医院OS患者的肿瘤组织及健康人的正常组织各30例,通过实时荧光定量-PCR(real-time quantitative PCR,qRT-PCR)验证DRLncs在OS组织中的表达。结果:成功构建包含3种DRLncs(RERG-IT1、AL035446.1和AC010894.1)的风险预后模型,该模型在预测OS患者的总体生存率方面表现出良好的性能。DRLncs预后模型与肿瘤微环境、免疫浸润细胞和药物敏感性之间具有显著性相关。qRT-PCR实验结果显示,RERG-IT1在OS组织中表达显著升高,而AL035446.1和AC010894.1则显著降低(P<0.01)。结论:本研究构建的DRLncs预后模型可准确预测OS患者的预后,为OS的个性化治疗提供了新的思路。

Biomarkers for the diagnosis of Alzheimer's disease, dementia Lewy body, frontotemporal dementia and vascular dementia

Background Dementia is a chronic brain disorder classified by four distinct diseases that impact cognition and mental degeneration. Each subgroup exhibits similar brain deficiencies and mutations. This review will focus on four dementia subgroups: Alzheimer's disease, vascular dementia, frontotemporal dementia and dementia Lewy body. Aim The aim of this systematic review is to create a concise overview of unique similarities within dementia used to locate and identify new biomarker methods in diagnosing dementia. Methods 123 300 articles published after 2010 were identified from PubMed, JSTOR, WorldCat Online Computer Library and PALNI (Private Academic Library Network of Indiana) using the following search items (in title or abstract):'Neurodegenerative Diseases' OR 'Biomarkers' OR 'Alzheimer's Disease' OR 'Frontal Temporal Lobe Dementia' OR 'Vascular Dementia, OR 'Dementia Lewy Body' OR 'Cerebral Spinal Fluid' OR 'Mental Cognitive Impairment'. 47 studies were included in the qualitative synthesis. Results Evidence suggested neuroimaging with amyloid positron emission tomography (PET) scanning and newly found PET tracers to be more effective in diagnosing Alzheimer's and amnesiac mental cognitive impairment than carbon-11 Pittsburgh compound-B radioisotope tracer. Newly created methods to make PET scans more accurate and practical in clinical settings signify a major shift in diagnosing dementia and neurodegenerative diseases. Conclusion Vast improvements in neuroimaging techniques have led to newly discovered biomarkers and diagnostics. Neuroimaging with amyloid PET scanning surpasses what had been considered the dominant method of neuroimaging and MRI. Newly created methods to make PET scans more accurate and practical in clinical settings signify a major shift in diagnosing dementia pathology. Continued research and studies must be conducted to improve current findings and streamline methods to further subcategorise neurodegenerative disorders and diagnosis.

Bifurcation and buckling analysis of a unilaterally confined self-rotating cantilever beam

A nonlinear dynamic model of a simple nonholonomic system comprising a self-rotating cantilever beam subjected to a unilateral locked or unlocked constraint is established by employing the general Hamilton＇s Variational Principle. The critical values, at which the trivial equilibrium loses its stability or the unilateral constraint is activated or a saddle-node bifurcation occurs, and the equilibria are investigated by approximately analytical and numerical methods. The results indicate that both the buckled equilibria and the bifurcation mode of the beam are different depending on whether the distance of the clearance of unilateral constraint equals zero or not and whether the unilateral constraint is locked or not. The unidirectional snap-through phenomenon （i.e. catastrophe phenomenon） is destined to occur in the system no matter whether the constraint is lockable or not. The saddle-node bifurcation can occur only on the condition that the unilateral constraint is lockable and its clearance is nonzero. The results obtained by two methods are consistent.

Study of brain morphology change in Alzheimer’s disease and amnestic mild cognitive impairment compared with normal controls

Background With an aggravated social ageing level, the number of patients with Alzheimer's disease (AD) is gradually increasing, and mild cognitive impairment (MCI) is considered to be an early form of Alzheimer's disease. How to distinguish diseases in the early stage for the purposes of early diagnosis and treatment is an important topic. Aims The purpose of our study was to investigate the differences in brain cortical thickness and surface area among elderly patients with AD, elderly patients with amnestic MCI (aMCI) and normal controls (NC). Methods 20 AD patients, 21 aMCIs and 25 NC were recruited in the study. FreeSurfer software was used to calculate cortical thickness and surface area among groups. Results The patients with AD had less cortical thickness both in the left and right hemisphere in 17 of the 36 brain regions examined than the patients with aMCI or NC. The patients with AD also had smaller cerebral surface area both in the left and right hemisphere in 3 of the 36 brain regions examined than the patients with aMCI or NC. Compared with the NC, the patients with aMCI only had slight atrophy in the inferior parietal lobe of the left hemisphere, and no significant difference was found. Conclusion AD, as well as aMCI (to a lesser extent), is associated with reduced cortical thickness and surface area in a few brain regions associated with cognitive impairment. These results suggest that cortical thickness and surface area could be used for early detection of AD.

上海社区老人生活方式与轻度认知功能损害的关系（英文）

背景:轻度认知功能损害(Mild cognitive impairment,MCI)老人发展为阿尔茨海默病(Alzheimer’s disease,AD)的风险比普通人群高10倍。对MCI诊断及早期干预有助于早期诊治AD,从而延缓其发展,改善MCI老人的生活质量。目的:分析上海社区老人生活方式与轻度认知损害的关系,从生活方式中寻找老年轻度认知损害的防治措施。方法:随机抽取1005名上海社区老人,最终确诊的265名MCI和607名正常老人作为研究对象,搜集这些老人的人口学、生活习惯等资料,进行单因素和多因素分析,寻找有统计学意义的指标。结果:单因素分析发现吸烟(χ~2=10.808,p=0.001)、饮茶(χ~2=11.74,p=0.001)、有业余爱好(χ~2=20.815,p<0.001)、读书(χ~2=28.670,p=0.001)、上网(χ~2=12.623,p=0.001)、摄影(χ~2=4.470,p=0.034)为MCI的保护性因素。多因素分析二项分类logistic回归分析发现,吸烟、读书、上网有统计学意义,其OR值分别为0.562(0.358-0.883)、0.428(0.253-0.726)、0.238(0.071-0.797)。即吸烟、读书、上网为MCI的保护性因素。结论:生活方式和MCI的发病相关,良好的生活习惯及行为方式对预防MCI有积极意义。

Association between tea consumption and cognitive function in cognitively healthy older adults and older adults with mild cognitive impairment

Background Prospective studies suggest that tea consumption may decrease the risk for cognitive impairment in late life.However,little research has examined the association between tea consumption and cognitive performance across multiple domains.In addition,no research has examined the benefit of tea consumption on cognitive performance among older adults with existing impairment.Aims The current study examined the association between tea consumption and performance on tasks of global cognitive function,episodic memory and executive function in cognitively healthy(CH)older adults and older adults with mild cognitive impairment(MCI).Methods The analytical sample included 1849 community-dwelling older adults from the Shanghai Brain Aging Study(65.6%female,mean age of 69.50(8.02)years).Following ascertainment of cognitive function,816 were categorised as MCI.In addition to completion of a demographics questionnaire,participants reported their tea consumption and completed a battery of tests to measure global cognitive function,episodic memory and working memory.Results Independent analyses of covariance revealed a significant association between tea consumption and measures of episodic memory;however,these associations were restricted to CH older adults but not older adults with MCI.Tea consumption was not associated with working memory performance.Conclusions The current study suggests that the benefit of tea consumption is restricted to cognitively healthy older adults and does not extend to older adults with MCI.

伴躯体化症状及失眠的老年抑郁症被确诊为多系统萎缩1例（英文）

概述:老年抑郁症患者伴有躯体化症状在临床上非常常见。本病例报告了一例反复住院治疗,伴躯体症状的老年抑郁症患者。虽然在首次住院治疗获得了临床痊愈,但一年后病情复发,经过随访以及神经内科诊治,我们发现这其实是一例多系统萎缩(multiple system atrophy,MSA)。这个病例的诊治过程提示我们对于一些反复治疗、疗效欠佳的老年抑郁症患者,尤其对于"躯体化症状"突出的病例,临床医生需要考虑是否存在躯体疾病,仔细寻找器质性病因。而快速动眼睡眠行为障碍(rapid eye movement sleep behavior disorder,RBD)

Relationship between afternoon napping and cognitive function in the ageing Chinese population

Background Several studies have shown that afternoon napping promotes cognitive function in the elderly;on the other hand,some studies have shown opposite results.This current study further examined the relationship between afternoon napping and cognitive function in the ageing Chinese population.Methods A total of 2214 elderly were included(napping group:n=1534;non-napping group:n=680).They all received cognitive evaluations by the Beijing version of the Montreal Cognitive Assessment,the Mini-Mental State Examination,and the Chinese version of the Neuropsychological Test Battery.Among all the subjects,739 elderly volunteered to take blood lipid tests.Results Significant differences in cognitive function and blood lipids were observed between the napping and the non-napping groups.Afternoon napping was associated with better cognitive function including orientation,language,and memory in the present study.Subjects with the habit of afternoon napping also showed a higher level of triglyceride than the non-napping subjects.Conclusion The results demonstrated that afternoon napping was related to better cognitive function in the Chinese ageing population.

Patient with frontal-variant syndrome in early-onset Alzheimer's disease

The clinical manifestation of frontal-variant Alzheimer’s disease(fvAD)is not typical,and it is difficult yet necessary to differentiate fvAD from frontal-variant frontal temporal dementia(fvFD).We describe a patient with early-onset Alzheimer's disease(AD)who presented with an fvFTD-like syndrome and apolipoprotein E ε3/ε4 genotype.A brain amyloid imaging procedure,11 C-Pittsburgh compound B positron emission tomography(PET),supported the final diagnosis of AD.Our present case highlights the clinical variability that characterises early-onset AD.A multimodal approach is crucial when assessing rare forms of dementia.

ACE gene missense mutation in a case with early-onset, rapid progressing dementia

The population of early-onset Alzheimer's disease(EOAD)accounts for 1%-2%of the total population of Alzheimer's disease,and genetic mutations are more common in EOAD.The first symptom of the patient in the present case report was the decline in memories of recent events,and the disease progressed rapidly in the following 2 years.Genetic testing has revealed the presence of genetic mutations(c.A479G,p.N160S)of ACE,which causes the 160th codon of the ACE protein to change from aspartic acid to serine,and at the same time genotype of apolipoprotein E(APOE)is ε3/ε4.We think that this patient carries the mutation type of the sensitive gene ACE and the risk gene APOE of Alzheimer's disease,and this is the reason why the disease progressed rapidly.Moreover,we discussed ACE genetic mutation's meaning in EOAD progression.

Psychometric properties of the Chinese version of the Arabic Scale of Death Anxiety

背景:死亡焦虑被视为精神病理学症状的风险因素和持续存在的因素。虽然阿拉伯死亡焦虑量表(ASDA)是一种简单而常用的评估工具,但是在国内临床实践中缺少这样的工具。目标:本研究旨在采用多级回译法开发ASDA中文版,即ASDA(C),并研究该量表的心理测量学特性。方法:从国内三个地区的医院和大学共招募了1372名参试者。为了计算出ASDA(C)的效标相关效度与有关死亡和死亡清单的多维度取向表格中文版(MODDI-F/chin)相比较,随机指定49名大学生完成这两份调查问卷。在所有参试者中随机指定56名再做一次ASDA(C)问卷调查,来评估ASDA(C)的一周后重测信度。结果:量表总的Cronbach’sα值为0.91。一周后的重测信度为0.96。探索性因子分析(EFA)显示三个因素,"对死人和坟墓的恐惧,"对致命疾病的恐惧"和"对死亡事件的恐惧",占总方差的57.09%。因而构建三因素模型。量表ASDA(C)总分与MODDI-F/chin的相关系数是0.54,表示信度都可以接受。结论:ASDA(C)有较好的心理测量学特性,说明这是一个可靠有效的量表。该量表能用于讲普通话的中国人群,来评估死亡焦虑。

Efficacy of comprehensive cognitive health management for Shanghai community older adults with mild cognitive impairment

Background The management of modifiable risk factors and comorbidities may impact the future trajectory of cognitive impairment,but easy-to-implement management methods are lacking.Aims This study investigated the effects of simple but comprehensive cognitive health management practices on the cognitive function of older adults in the community with normal cognition(NC)and mild cognitive impairment(MCI).Methods The comprehensive cognitive health management programme included a psychiatric assessment of the cognitive risk factors for those in the intervention groups and individualised recommendations for reducing the risks through self-management supported by regular medical professional follow-up.The intervention groups for this study included 84 elderly participants with NC and 43 elderly participants with MCI who received comprehensive cognitive health management.The control groups included 84 elderly participants with NC and 43 elderly participants with MCI who matched the intervention group’s general characteristics and scale scores using the propensity matching score analysis.The Montreal Cognitive Assessment(MoCA)scale and Geriatric Depression Scale(GDS)scores were compared after a 1-year follow-up.Results For older adults with MCI in the intervention group,MoCA scores were higher at the 1-year followup than at baseline(24.07(3.674)vs 22.21(3.052),p=0.002).For the MoCA subscales,the intervention group’s abstract and delayed memory scores had significantly increased during the 1-year follow-up.Furthermore,in a generalised linear mixed model analysis,the interaction effect of group×follow-up was statistically significant for the MCI group(F=6.61,p=0.011;coefficients=5.83).Conclusions After the comprehensive cognitive health management intervention,the older adults with MCI in the community showed improvement at the 1-year follow-up.This preliminary study was the first to demonstrate an easy-to-implement strategy for modifying the cognitive risk factors of elderly individuals with MCI in the community,providing new insight into early-stage intervention for dementia.

Case of early-onset Alzheimer’s disease with atypical manifestation

Short-term memory decline is the typical clinical manifestation of Alzheimer’s disease(AD).However,early-onset AD usually has atypical symptoms and may get misdiagnosed.In the present case study,we reported a patient who experienced symptoms of memory loss with progressive non-fluent aphasia accompanied by gradual social withdrawal.He did not meet the diagnostic criteria of AD based on the clinical manifestation and brain MRI.However,his cerebrospinal fluid examination showed a decreased level of beta-amyloid 42,and increased total tau and phosphorylated tau.Massive amyloid β-protein deposition by 11C-Pittsburgh positron emission tomography confirmed the diagnosis of frontal variant AD.This case indicated that early-onset AD may have progressive non-fluent aphasia as the core manifestation.The combination of individual and precision diagnosis would be beneficial for similar cases.