"My physical examination and memory test results are normal" \(^o^)/YES! Ms. Li, 58 years old, is always worried that she might inherit Alzheimer's disease from her mother, who suffers from it
However, blood tests revealed a significant increase in her p-tau217 levels, indicating specific pathological changes in the brain consistent with Alzheimer's disease. Although her ability to live and work has not yet been affected, she is already in the preclinical phase.
This is the golden window for intervention, and tens of millions of people worldwide are currently in this "silent period". Remember: Alzheimer's disease does not start with memory loss.
I. Disease is a "continuum", which starts 10-20 years before symptoms appear
In medicine, the progression of Alzheimer's disease is viewed as a continuous spectrum. According to the latest international staging criteria in 2024:
Stage 0: Only risk genes are present, without any pathology or symptoms
Stage 1: Pathology has been initiated (such as Aβ deposition), but there are no subjective symptoms, and it can only be detected through biomarker tests (such as blood p-tau217/cerebrospinal fluid/Aβ PET)
Stage 2: Subjective cognitive decline emerges - individuals feel their memory is deteriorating and are concerned about it, yet objective tests still indicate normal results
The first three stages (stages 0-2) are collectively referred to as the preclinical phase, which may last for 10-20 years. During this lengthy window, the brain is engaged in a silent "battle of compensation":
Cognitive reserve comes into play: a good educational background and complex professional experience are like laying more "backup networks" for the brain, which can effectively compensate for early damage.
Neuroplasticity compensates fully: healthy brain regions attempt to take over the functions of damaged areas by enhancing connectivity.
Ms. Li's "hazy feeling" is a signal that cognitive reserve is still functioning, but the compensatory mechanism has begun to be stressed. This is the earliest warning signal from the brain.
II. don't ignore "subjective cognitive decline (SCD)", which is a critical signal
When you or your family members consistently feel that "your memory is not as good as it used to be" and are genuinely concerned about it, it is medically referred to as subjective cognitive decline (SCD).
This is not just "overthinking". Recent neuroscience research has found that the brain in the SCD stage has undergone observable changes:
Decreased efficiency of default network connectivity: This network is responsible for autobiographical memory and future planning, and subtle changes in it may lead to reduced fluency of thought.
Decreased metabolic activity in the posterior cingulate gyrus: This early change in the brain's "information hub" is closely related to the pathological deposition of Alzheimer's disease.
Elevated blood p-tau217 levels: The 2024 international new standard confirms that a positive result of this blood biomarker alone can be used to make a biological diagnosis of Alzheimer's disease, which precedes the appearance of any clinical symptoms.
SCD characteristics that require attention:
Continuity: It is not occasional forgetting, but a stable perception that persists for more than half a year
Progressivity: It feels like this change is slowly worsening
Accompanied by emotional concern: experiencing genuine worry and anxiety for this reason
Family history: having immediate family members with Alzheimer's disease
Key insight: SCD serves as a critical signal indicating the brain's transition from the "asymptomatic pathological phase" to the "pre-symptomatic phase". By paying attention to this signal, we can gain valuable intervention time.
III. Experiencing persistent cognitive concerns? Follow these 4 professional diagnostic steps
When you or your family members experience persistent cognitive concerns, the professional diagnostic approach should be as follows:
1. Subjective evaluation
Doctor interview: Inquire in detail about the medical history and specific instances of difficulties.
Interview with insiders: Family members provide objective observation information.
2. Objective cognitive assessment
Comprehensive screening: Complete scales such as MoCA.
Domain-specific assessment: If abnormalities are detected during screening, conduct comprehensive tests in specific domains such as memory, executive function, and language.
3. Functional status assessment
IADL assessment: Through family interviews and questionnaires, rigorously assess the level of independence in daily functioning.
4. Etiological examination
Blood p-tau217 detection: This is a game-changing technology. By simply drawing blood, it is possible to detect Alzheimer's disease-specific pathological changes with high precision, achieving an accuracy rate of around 90% in consistency with AβPET.
Amyloid PET imaging: It visually displays the distribution and burden of Aβ plaque deposition in the brain, transforming invisible pathology into visible images.
Cerebrospinal fluid (CSF) testing: It remains the "gold standard" for diagnosis, allowing for the simultaneous detection of multiple key biomarkers.
Integrated diagnosis: Doctors will comprehensively analyze all information and perform biological classification according to the "Revised Diagnostic and Staging Criteria for Alzheimer's Disease", to determine the stage of the disease and lay the foundation for precise intervention.
IV. Treatment Ushers in a Watershed: The Revolution from "Symptomatic Treatment" to "Etiological Treatment"
2024 marks a watershed moment for Alzheimer's disease treatment in China. With the introduction of disease-modifying therapies, we are now able to target the core pathology of the disease for treatment for the first time.
Traditional drug therapy:
Cholinesterase inhibitors (such as donepezil) and NMDA receptor antagonists (such as memantine) are still important basic treatments, as they can improve symptoms and enhance quality of life by regulating neurotransmitters.
The Revolution of Disease-Modifying Therapies (DMT):
Monoclonal antibody drugs, represented by lenvatinib, can precisely eliminate Aβ plaques in the brain. The key point is that these drugs are primarily suitable for patients with early-stage Alzheimer's disease (from MCI stage to mild dementia), and require biomarker confirmation of Aβ positivity. The earlier they are used, the greater the potential benefits may be.
A fundamental shift in treatment philosophy: We are transitioning from passive symptom management to active intervention in the disease process. Intervening at the preclinical or MCI stage may maximize the protection of cognitive function and delay disease progression.
Regarding nutritional supplements:
Based on lifestyle intervention, some individuals may consider utilizing nutritional supplements, such as krill oil. This supplement contains Omega-3, particularly in phospholipid form, which has demonstrated potential in regulating blood lipids and exhibiting antioxidant properties in research. However, it is important to note the following when purchasing and using such supplements:
Pay attention to the core ingredients and dosage, focusing on the first item on the ingredient list and the total content of Omega-3 in the product.
We should prioritize purity and safety, opt for reputable brands, and ensure that products have been tested and certified by authoritative third-party institutions.
At the same time, it is important to manage expectations and have a clear positioning. Supplements cannot replace any prescription medications. If blood lipids have been confirmed to be elevated, the primary task is to follow the doctor's advice and take medication.
Before taking this medicine, especially if you are currently using anticoagulant drugs or have a history of seafood allergy, it is essential to consult a doctor or clinical pharmacist.
V. Protect the brain's 5 major life pillars to scientifically slow down the progression
Besides medications, lifestyle adjustments are the cornerstone of cognitive protection. Studies have shown that comprehensive interventions can significantly reduce risks or delay the onset of the disease for several years.
First Pillar: Cognitive stimulation and reserve building
Continuously learning new skills (such as playing musical instruments or learning languages), engaging in deep reading, and playing strategic games (such as bridge or Go) can promote the formation of new synapses and enhance neural network connectivity.
Second pillar: vascular risk management
Strictly control blood pressure (<130/80mmHg), blood sugar, and blood lipids. Cerebrovascular health directly affects brain cognitive function, so protecting blood vessels is equivalent to protecting the brain.
Third pillar: MIND diet pattern
Combining the advantages of the Mediterranean and DASH diets, include at least one serving of green leafy vegetables daily, consume berries twice a week, and eat five servings of nuts per week, with a preference for olive oil, fish, and poultry.
Fourth pillar: sleep optimization
During deep sleep, the brain's "glymphatic system" actively clears metabolic waste, including Aβ protein. Ensure 6.5-7.4 hours of high-quality sleep, and if snoring occurs, screen for sleep apnea.
Fifth Pillar: Psychosomatic Integration and Stress Management
Regular aerobic exercise (150 minutes per week), Tai Chi, mindfulness meditation, etc., can not only improve cognition but also reduce the damage to the hippocampus caused by the stress hormone cortisol.
When Ms. Li had a follow-up examination six months later, her blood markers remained stable. She said, "Knowing what the problem is, I feel relieved. Now I exercise every day and learn new recipes, and I feel more energetic than I did a year ago."
Protecting memory begins with understanding the early signals of the brain. Early identification, early diagnosis, and early intervention mean that we are no longer helpless in the face of Alzheimer's disease.
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, doctoral 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 cells and gene programming, as well as new technologies like insulin pumps and diabetes reversal
VI. High-intensity focused ultrasound (HIFU) therapy for 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