"Dad, who am I?" "You... youre..." This heartbreaking scene, both cruel and all too real, is playing out in 17 million households across China. More merciless than cancer, Alzheimers disease (commonly known as senile dementia) turns loved ones into "the most familiar strangers"...
Against the backdrop of a rapidly aging population, the prevention and treatment of age-related diseases have become a major social concern. Alzheimers disease (AD), a neurodegenerative disorder, is spreading globally at an alarming rate. Clinically characterized by memory impairment, aphasia, apraxia, agnosia, executive dysfunction, as well as personality and behavioral changes, this comprehensive dementia syndrome severely impacts cognitive abilities and quality of life for the elderly.
According to World Health Organization estimates, there are at least 50 million Alzheimers patients worldwide, with nearly 17 million elderly in China battling the disease – and women are twice as likely to be affected as men!
"While Alzheimers symptoms manifest in old age, the disease actually begins developing decades earlier," explained Professor Han Ying, Chair of the China Preclinical Alzheimers Disease Alliance and Chief Neurologist at Xuanwu Hospital, Capital Medical University. She emphasized that precisely understanding ADs progression is the cornerstone for effective intervention and treatment.
New Understanding of AD Symptom Staging
The 2024 Revised Diagnostic and Staging Criteria for AD classifies the disease into seven distinct clinical stages, ranging from Stage 0 to Stage 6.
Stage 0: No core biomarkers or clinical symptoms, but carrying pathogenic genes for familial Alzheimers disease (FAD).
Stage 1: Asymptomatic stage with positive detection of ≥1 core AD biomarker(s);
Stage 2: Based on Stage 1, now presenting with subjective cognitive decline (SCD) or mild objective cognitive impairment;
Stage 3: Mild Cognitive Impairment (MCI for short) is present on objective examination; the individual is unable to take care of himself/herself, entering the dementia stage;
Stage 4: Mild AD dementia, temporal disorientation, not knowing time;
Stage 5: Moderate AD dementia, location disorientation, wandering away once leaving home;
Stage 6: Severe AD dementia, character disorientation, not even recognizing loved ones.
The Critical Role of AD Screening in Physical Exam
Early detection and intervention: Early symptoms of AD are hidden, and physical examination and screening can detect potential problems in advance. Early detection through lifestyle adjustment, cognitive training, and rational drug treatment can slow down the progression of the disease, improve the quality of the patients life, and reduce the burden on families and society.
Accurate diagnosis and identification:
With the help of professional cognitive function tests, biomarker tests and neuroimaging, combined with history and symptoms, AD can be accurately diagnosed and identified from other cognitive disorders, providing a basis for subsequent treatment and care.
Understanding the risk of disease: For people with a family history of AD or high risk factors, medical screening can help them understand their risk of developing the disease. Regular screening can detect cognitive changes in time and reduce or delay the onset of the disease by controlling cardiovascular risk factors, exercising, and eating a healthy diet.
Prepare for home care: Early screening and diagnosis gives patients and their families sufficient time to understand the disease, prepare psychologically and practically for medical decision-making, financial planning, and long-term care arrangements, and better cope with the challenges of the disease.
What physical screening tests can be done for Alzheimers disease?
1. Biomarker testing
Among various tau protein biomarkers, p-tau217 detection holds unique and critical significance. Research demonstrates that blood p-tau217 levels rise significantly during the early stages of AD. Through p-tau217 testing, individuals at risk can be accurately identified in the preclinical phase—even before symptom onset.
2、Neuroimaging examination
In addition to biomarker testing, neuroimaging plays an irreplaceable role in the early diagnosis of AD, with Aβ PET and tau PET being particularly important.
Aβ PET and tau PET complement each other in the diagnosis and staging of AD. Aβ PET qualitatively diagnoses AD and clarifies the presence of the disease, while tau PET determines the biological stage of the disease. The combination of the two is like a pair of “perspective eyes” for doctors, providing a comprehensive and multi-level understanding of AD-related pathological changes in the brain.
3. APOE genetic testing
The genetic risk of an individual for AD can be accurately assessed by testing for the APOE gene during a medical examination. Preventive measures can be tailored to those who are found to be at high risk of carrying the APOE ε4 gene.
AD screening in physical examination is the first line of defense in guarding the cognitive health of the elderly. It not only concerns the quality of life of every elderly person in their twilight years, but also influences the happiness of countless families and the sustainable development of society. Let us guard every precious memory with love through scientific prevention and timely intervention, so that love will not be forgotten.
Photo & Text | Huang Fei