Abbreviation (ISO4): Chinese Journal of Alzheimer's Disease and Related Disorders
Editor in chief: Jun WANG
To better address the severe challenges of Alzheimer's disease (AD) prevention and control in China, the national government has published the National Action Plan for Addressing the elderly people with dementia. In order to accelerate the achievement of its core objectives, the Chinese Expert Consensus on Multidisciplinary Rehabilitation Interventions for Alzheimer's Disease has been formulated by integrating multidisciplinary expert opinions and evidence-based findings, using the Delphi method combined with GRADE evidence grading. This consensus advocates a “hospital-community-family” tripartite collaborative management model to standardize systematic and multidimensional approaches for the prevention, treatment, rehabilitation, and care of AD.This consensus deliver evidence-based guidance for tripartite stakeholders (healthcare providers, community networks, and family care systems) to operationalize healthy aging strategies through standardized AD management protocols.. For preventive strategies, AD risk factors are categorized into low-, medium-, and high-risk tiers to guide the formulation of personalized prevention and intervention strategies. For therapeutic management, treatment regimens are stratified by AD clinical stages (mild/moderate/severe), incorporating Western pharmacotherapy, traditional Chinese medicine and neuromodulation techniques. Rehabilitation requires individualized protocols based on multidimensional assessments encompassing functional disability evaluations, personal preferences, and familial support systems, with active rehabilitation prioritized during early/mid-stages and passive interventions dominating advanced AD care. Rehabilitation measures include cognitive therapies (including cognitive training, cognitive stimulation, and cognitive rehabilitation), lifestyle modifications (featuring nutritional guidance and exercise regimens that combine aerobic, strength, and mind-body training), humanistic approaches (such as reminiscence and immersive technologies), art-based therapies (applying music, dance, and visual arts), nature-assisted therapies (through horticultural and animal-assisted interaction), as well as sensory modulation techniques (utilizing light therapy and aromatherapy). For moderate-to-advanced stage AD patients presenting with behavioral and psychological symptoms of dementia or profound cognitive-functional decline, care strategies should implement person-centered care frameworks to preserve self-identity, deliver integrated palliative support, and manage comorbidities through multidisciplinary coordination.
Objective: We aimed to explore the association of liver fibrosis markers with cognitive decline. Methods: In this cross-sectional study, there were 8669 participants over 60 years old from 51 Community Health Centers in the Luohu District of Shenzhen from 2017 to 2018. All participants were divided into a cognitive low-risk group (n=8202) and a cognitive high-risk group (n=467) according to their scores of mini-mental state examination and education status. Blood routine examination and liver function markers were tested from fasting blood samples. The liver fibrosis markers FIB-4 and APRI were calculated with parameters such as ALT, AST, and PLT using specific formulas. We used the t-test, Mann-Whitney test, and Chi-square test to analyze the differences in general statistical characteristics and live fibrosis markers between the two groups, and binary Logistic regression analysis was used to analyze each parameter. The association between the liver fibrosis markers and alcohol drinking habits was tested by Spearman rank correlation. Results: FIB-4 was significantly higher in the cognitive high-risk group than the cognitive low-risk group [1.40 (1.13,1.78) vs. 1.49 (1.21,1.88), Z=3.595, P<0.001] but FIB-4 was not an independent risk factor of cognitive decline [OR (95%CI): 0.718 (0.444~1.159), P=0.175]. For alcohol drinkers, FIB-4 was significantly positively correlated with the age of starting drinking (rs=0.089, P=0.005) and frequency of drinking (rs=0.149, P<0.001). There was a positive correlation between APRI and frequency of drinking (rs=0.078, P=0.013) as well. For people abstaining from alcohol, FIB-4 exhibited a positive correlation with the age of abstinence (rs=0.172, P=0.014). Conclusion: FIB-4 was elevated in people with cognitive decline, and increased frequency of drinking was correlated with raised FIB-4 and APRI, and giving up drinking as soon as possible might be beneficial to prevent the cognitive decline by liver health.
Objective: To explore the relationship between apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB) and executive function in people with early cognitive impairment (EMCI), late mild cognitive impairment (LMCI), and early Alzheimer's disease (AD) patients, and to establish a group of Normal Control (NC) as a control group, in order to provide help for clinical intervention in the AD patients. Methods: A total of 142 people aged 50-80 years were recruited from Chengdu Fourth People's Hospital, including 35 cases of EMCI, 17 cases of LMCI, 26 cases of AD and 64 cases of NC. Each patient collected the following scales for executive function assessments using The Shape Trail Test part A (STT-A), The Shape Trail Test part B (STT-B), The Animal Fluency Test (AFT), The Symbol Digit Modalities Test (SDMT), Digit Span Test (DST) at baseline. The laboratory collected morning fasting blood to detect ApoA1 and ApoB levels. Spearman correlation test was used to analyze the correlation between ApoA1, ApoB and executive function, and linear regression analysis of the influencing factors of ApoA1 and ApoB on executive function. Results: The years of education in AD group were significantly lower than that in the NC group (P<0.05); In the NC group，the time spent on STT-A and STT-B were significantly lower than that in the EMCI group, LMCI group and AD group(P<0.05); in the EMCI group, the time spent on STT-A was significantly lower than that in the AD group(P<0.05), and the AFT and SDMT scores were significantly lower than those in the NC group(P<0.05) ; in the AD group, the AFT score was significantly lower than that in the NC group and LMCI group(P<0.05) ; the SDMT and DST score was significantly lower than that in the NC group (P<0.05) ; the ApoA1 level in the AD group was significantly lower than that in the NC group and EMCI group(P<0.05) ; there was no statistically significant difference in the ApoB levels among the four groups. ApoA1 levels were positively correlated with AFT, SDMT, and DST (P<0.05), and negatively correlated with STT-A and STT-B (P<0.05) ; ApoB levels had no correlation with executive functions; after adjusting for confounding factors, the multiple linear regression results of ApoA1 and executive function showed that ApoA1 significantly positively affected SDMT (P<0.05). After diagnosis stratification, the results of linear regression between ApoA1 and SDMT showed that ApoA1 could significantly positively affect SDMT in the NC group, LMCI group, and AD group (P<0.05). Conclusion: The connection between ApoB and executive function has not been found;. ApoA1 is mainly significantly related to information processing speed in the NC group, LMCI group, and AD group, indicating that the combination of ApoA1 and information processing speed can become an important tool for exploring cognitive impairment..
Objective: Investigate the diagnostic value of cerebrospinal fluid (CSF) growth-associated protein 43 (GAP-43) in AD and the predictive value of AD transition from mild cognitive impairment (MCI) to dementia through a cross-sectional and longitudinal observational study. Methods: 787 subjects with CSF GAP-43 data were divided into normal group (n=247), MCI group (n=413) and dementia group (n=127) based on cognitive status. Kruskal-Wallis test was used to compare the differences of CSF GAP-43 between groups. Multiple logistic model was used to test the correlation between CSF GAP-43 and different cognitive states. The diagnostic efficacy of CSF GAP-43 level for AD was evaluated by receiver-operating curves (ROC) and the area under curves (AUC). The diagnostic efficacy of AD was compared with that of CSF core markers (Aβ, t-tau, p-tau). Patients with MCI were divided into stable MCI (sMCI) and progressive MCI (pMCI) according to whether they progressed to dementia within 5 years. Mann-Whitney u test was used to compare CSF GAP-43 between groups. Cox regression model was used to test the correlation between CSF GAP-43 and the progression of MCI to dementia. The predictive value of CSF GAP-43 levels in predicting MCI progression to dementia was evaluated by ROC curve. The association of CSF GAP-43 level with the risk of progression to dementia was evaluated using Kaplan-Meier survival curves. Results: The results of cross-sectional study showed that the level of CSF GAP-43 was significantly higher in the dementia group than in the normal group and the MCI group (P<0.0001). CSF GAP-43 was an independent risk factor for the onset of AD dementia (P=0.002). The AUC of CSF GAP-43, Aβ, p-tau and t-tau for the diagnosis of AD were 0.64, 0.68, 0.64 and 0.63. Follow-up analysis showed that the level of CSF GAP-43 in pMCI patients was significantly higher than that in sMCI patients (P<0.0001), and CSF GAP-43 was an independent risk factor for the progression of MCI to dementia (P=0.012). The AUC for CSF GAP-43 predicting MCI progression to dementia was 0.75 (P<0.0001, 95%CI: 0.69~0.80). The risk of progression to dementia was 3.45 times greater in MCI patients with high CSF GAP-43 levels than in MCI patients with low CSF GAP-43 levels (P<0.0001, 95%CI: 2.17~5.43).Conclusion: CSF GAP-43 level can be used in the diagnosis of AD dementia, and its diagnostic efficacy is comparable to that of CSF core biomarkers (Aβ, t-tau, p-tau). CSF GAP-43 can predict the progression of MCI to dementia and is an independent risk factor for the progression of MCI to dementia.
Objective: To investigate the effect of Guide Care management model on self-management of Parkinson's disease patients.Methods: A total of 90 patients with Parkinson's disease who were hospitalized in the Department of Geriatric Neurology of our hospital from November 2021 to December 2022 were selected as the research objects. According to the random principle, they were divided into an experimental group and a control group, with 45 cases in each group. The control group was given routine nursing intervention, while the experimental group was given Guided Care management model intervention. The self-management ability, quality of life, disease progression, anxiety and depression of the two groups were evaluated. The intervention lasted for 6 weeks. Results: After intervention, the scores of three dimensions of self-management (daily behavior management, management cognition and disease management) in the experimental group were higher than those in the control group. The total scores of self-management and daily behavior management in the experimental group were higher than those in the control group (P< 0.001). The scores of UPDRS in both groups decreased before treatment, and the scores of motor examination, activities of daily living, mental behavior and emotion in the experimental group were significantly lower than those in the control group (P< 0.001). After intervention, the PDQ-39 scores of the two groups were significantly decreased, and the score of the experimental group was significantly lower than that of the control group (P< 0.05). After intervention, the SAS and SDS scores of the experimental group were significantly lower than those of the control group (P< 0.05). Conclusion: The Guide Care management model can improve the self-management ability of patients with Parkinson's disease and improve the clinical prognosis..
Alzheimer's disease (AD) is the most common neurodegenerative disease worldwide and a leading cause of dementia. Currently, there are no highly effective treatments for this condition. The imbalance between the production and clearance of Aβ(amyloid-beta) protein is considered a primary pathogenic mechanism of AD. Enhancing the clearance of Aβ in the brain during the early stages can delay the onset and progression of AD. In recent years, with the introduction of the concept of the glymphatic system and the discovery of meningeal lymphatic vessels, the directional transport of fluids within the central nervous system has become a research hotspot. The glymphatic system plays a crucial role in clearing amyloid-beta protein and holds promise as a novel approach to combat neurodegenerative diseases. This review aims to summarize the current research progress on the role of the brain's glymphatic system in AD treatment and explore its potential applications in disease management.
The meningeal lymphatic vessels (mLVs) play a crucial role in the complex circulation and exchange of soluble contents between the cerebrospinal fluid (CSF) and the interstitial fluid (ISF). It has been confirmed that mLVs can drain intracranial CSF and immune cells to extracranial deep cervical lymph nodes (dCLNs), thereby establishing a direct link between the central nervous system (CNS) and the peripheral immune system. Given the limited therapeutic options for Alzheimer's disease (AD), enhancing brain lymphatic flow to improve the clearance of toxic waste has emerged as a new approach to alleviating cognitive impairment. This article briefly introduces the discovery process, structure, and location of mLVs, and thoroughly discusses their physiological functions. It focuses on the relationship between mLVs and the pathogenesis of AD, aiming to provide reference for emerging therapeutic mechanisms of AD.
Cognitive impairment is the primary symptom of Alzheimer's disease (AD), manifesting as memory loss and changes in other cognitive functions. Currently, cognitive tools such as the mini-mental state examination (MMSE) and the montreal cognitive assessment (MoCA) are widely used to evaluate overall cognitive function in patients. However, these scales are time-consuming and require experienced clinicians to conduct face-to-face testing. This review aims to introduce MemTrax, a computerized continuous recognition task, and its application in cognitive assessment. In this test, subjects are required to complete a picture recognition task within approximately 90 seconds to assess their cognitive functions, mainly episodic memory, including memory processing, storage, retrieval, and reaction time.Previous studies have confirmed that its efficacy in identifying normal individuals, mild cognitive impairment (MCI), and AD patients is superior to MoCA. Moreover, combining with other biomarkers can further enhance its diagnostic efficacy, and it is also potential for assessment of treatment efficacy. Here we also introduce the application of MemTrax in various types of cognitive disorder diseases. Finally, this article proposes that MemTrax can be used as a digital tool to establish a systematic neuroscience database in the future, combining machine learning and other biomarkers to predict early dementia, as well as for large-scale cognitive screening and continuous cognitive monitoring.
Objective: This study aims to explore the application of toys and games in non-pharmacological interventions of Alzheimer's disease, and analyze the current research status, in order to provide guidance for future studies. Methods: This paper adopts literature review and thematic analysis methods. Literature searches were conducted on CNKI, Wanfang, Google Scholar, SCOPUS, Pubmed, and Science Direct using keywords such as "Alzheimer's disease," "dementia," "non-pharmacological intervention," "toys," and "games." Relevant literature from 2020 to 2024 was collected and subjected to thematic analysis. Results: The research indicates that non-pharmacological interventions for Alzheimer's disease are continuously emerging, among which a significant form of treatment is to use toys and games to enhance patients' quality of life. These toys and games stimulate cognitive and sensory functions, improve patients' social interaction abilities, promote physical activity, and alleviate negative emotions such as depression and anxiety. Conclusion: Currently, the toys used in occupational therapy for Alzheimer's disease patients mostly come from existing children's toys on the market or are simple toys developed by researchers in psychology and medicine, lacking research on how to design more tools for occupational therapy for Alzheimer's disease patients from a design perspective. Future research can start from the field of design to explore its principles and methods, in order to provide more beneficial insights and guidance for non-pharmacological interaction of Alzheimer's disease patients.
ISSN 2096-5516 (Print)
Started from 2018
Published by: China Association for Alzheimer’s Disease
