When a PET report or blood test shows "positive for Alzheimer's disease biomarkers", many families will instantly fall into a state of fear and helplessness.
But is this paper report an irrevocable "judgment" or a crucial "health warning"?
An international consensus issued by a group of top experts globally is refreshing our cognition.
Don't mistake "risk" for "judgment"
Brain pathology does not necessarily equate to dementia
Dilemma: Cognitive fog brought by technological progress
Advanced biomarker testing (such as amyloid PET and blood p-tau217) allows us to detect pathological traces of Alzheimer's disease in the brain 10 or even 20 years before symptoms appear.
However, a crucial fact has been overlooked: scientific research has confirmed that a significant proportion of individuals carrying these "pathological seeds" will never develop dementia symptoms throughout their lives.
This presents a significant clinical and ethical dilemma: if we label cognitively normal individuals as "Alzheimer's disease" solely based on positive biomarker results, it will prematurely plunge millions of people into the anxiety of being labeled as "patients", enduring unnecessary psychological, social, and insurance pressures. Currently, we do not have a specific drug that can "cure" this pathology.
Faced with this dilemma, should we continue to create a large number of "patients in waiting" or seek a more scientific and responsible path? The experts of the International Working Group (IWG) firmly chose the latter. The "risk stratification" model they proposed is precisely the light that pierces through the fog.
Breaking the mold: From "black and white" to "risk stratification"
The core idea of IWG is to undergo a fundamental conceptual shift: to view biomarkers as risk factors akin to "high cholesterol," rather than the diseases themselves.
High cholesterol ≠ immediate myocardial infarction → It warns you that you must start managing your diet and increasing your exercise.
Positive brain biomarker ≠ immediate dementia → It reminds you that you must start paying attention to brain health and managing controllable risks.
Based on this, the IWG precisely divided the population with normal cognition but positive biomarkers into two categories:
"Asymptomatic, but at risk" - this is the situation of the vast majority of people
Identifying features: Cognitively normal, but with detection of amyloid deposition or tau abnormalities limited to the medial temporal lobe.
Risk Nature: Probabilistic, not predetermined. Your future is not a fixed number, but a probability influenced by various factors such as age, gender, APOE genotype, lifestyle, and brain resilience. Data shows that for individuals with normal cognition but positive biomarkers, their lifetime risk varies greatly, ranging from as low as 5.4% to as high as 77% depending on whether they are accompanied by neurodegenerative diseases or not. This precisely illustrates that the future is in the hands of multiple factors, rather than being predetermined by a single indicator.
"Pre-symptomatic" - applicable to a very small number of specific individuals
Identifying characteristics: Primarily refers to individuals who are carriers of specific familial genetic mutations (such as PSEN1) and those with Down's syndrome. For these individuals, the likelihood of the disease developing during their lifetime is extremely high (>95%).
Emphasis: Such cases only account for about 15% of all individuals with normal cognition but positive biomarkers. This means that among every 100 people with abnormal test indicators but good memory, only about 15 belong to this 'nearly inevitable' high-risk situation. For ordinary families without a clear family history, there is no need to panic excessively.
Distinguishing between "risk" and "early stage" is not to create new anxiety, but to guide distinctly different actions. So, for the vast majority of "risky" families, what can we do now to change that "probability"?
Action: A scientific response checklist for families of "risk takers"
The ultimate goal of the IWG framework is to lead to proactive management and intervention
Seek professional evaluation, not self-diagnosis
It is strongly recommended to visit a hospital equipped with a 'memory clinic' or a more specialized 'brain health service center' for evaluation. There, doctors will comprehensively assess your biomarker results, genetic background, lifestyle, and comorbidities, providing you with a comprehensive risk interpretation and personalized management plan.
Focus on "changeable factors" to build a disease-resistant brain
This is the most promising part! The literature clearly indicates that up to 45% of the attributable risk of dementia stems from modifiable factors.
Your "family action prescription" should include:
1. Cardiovascular health is brain health: manage blood pressure, blood sugar, and blood lipids well.
2. Regular exercise: 150 minutes of moderate-intensity exercise (such as brisk walking, swimming) per week.
3. Brain-boosting diet: The Mediterranean diet (rich in fruits and vegetables, fish, nuts, and olive oil) is recommended.
4. Lifelong learning and social connection: Encourage elders to maintain social interactions, cultivate hobbies, and engage in cognitive stimulation activities (reading, playing chess, etc.).
5. Stay away from risks: quit smoking, limit alcohol consumption, manage hearing loss, and prevent head trauma.
Understand the significance of research and view the future rationally
The research on the "pre-symptomatic" population aims to enable the precise blockade of clinical expression of diseases through medication, similar to the management of hypertension in the future. Those who meet the criteria are encouraged to pay attention to relevant clinical trials.
This new framework, which is full of humanity and hope, is different from some voices we have heard in the past. Understanding the focus of this scientific debate can help us become wiser decision-makers.
Hainan Chengmei Hospital's Memory Clinic integrates professional resources from multiple fields to provide patients with comprehensive, precise, and personalized diagnosis and treatment services.
Expert Introduction
Dai Wenxin, Chief Physician
Executive Director of the Multidisciplinary Geriatrics Diagnosis and Treatment Center
Professor, PhD candidate
Postdoctoral researcher, master's supervisor
Medical expertise:
I. Diagnosis and treatment of Alzheimer's disease and other geriatric diseases
II. Diagnosis and treatment of diseases across multiple disciplines, including respiratory system, cardiovascular system, nervous system, and geriatric diseases
III. Genetic diagnosis, chemotherapy, targeted therapy, immunotherapy, microenvironment analysis, and integrated precision treatment of tumors
IV. Genetic diagnosis and precision treatment of hypertension, hyperlipidemia, hyperuricemia, and hyperglycemia
V. New biomedical technologies such as stem cell and gene programming, as well as new technologies like insulin pumps and diabetes reversal
VI. High-intensity focused ultrasound (HIFU) for treating benign and malignant tumors
VII. Microbial therapy of intestinal flora for chronic diseases and mental and psychological disorders
VIII. Diagnostic and therapeutic techniques under medical endoscopes such as bronchoscope, mediastinoscope, and thoracoscope
IX. Sleep medicine
X. Chronic disease management
Clinic Hours: Monday and Wednesday morning
Source | WeChat official account of Professor Han Ying's team at Xuanwu Hospital