By Yin Jianhua
September 21 marks the 28th World Alzheimer's Day, with the theme of "Knowing Yourself and Alzheimer in Early Diagnosis". According to the Personalized and Accurate Diagnosis Office for Geriatric Diseases of Jiangwan Hospital affiliated to Hongkou District Staff Innovation Office, it is conducting clinical research on precise detection of Alzheimer Disease (AD) for diagnosis and treatment as early as possible through innovative detect techniques.
Seizing Opportunity of Diagnosis and Treatment in Preliminary Stage
"My mum has recently been forgetting to turn off stoves and what I told her." Miss. Chen is facing such an agony. Is it normal forgetfulness of old people or an omen of AD? Does it require hospital check? As we all known, AD has already become ubiquitous in the aging society. Besides the trend of quickening aging, another important reason is that many people take forgetfulness for granted among the elderly. Some others think that AD is incurable, which eventually results in heavy burden for patients and their families.
Xie Fandi, Head of the Office and Executive Deputy Chair of the Special Committee on Inspection and Health of the Shanghai Association of Rehabilitation Medicine, says that although AD is a world-level challenge as no completely effective treatment has been found yet, timely diagnosis and active prevention and intervention can defer the occurrence and development of AD. At present, the methods of clinical auxiliary diagnosis include biomarkers, gene detection and brain PET scanning, and diagnosis can be made by judging protein deposition. However, the clinical values in different methods greatly vary and cost much time and money. As a result, few patients were willing to "pay the bill". To make accurate diagnosis, the office worked in strategic cooperation with such teams led by professor Guan Ming from Huashan Hospital Affiliated to Fudan University and by professor Dai Yong from Shenzhen First People's Hospital this year, which focused on research on clinical transforming application between AD and senile anti-aging mechanism, basic research on cell tumor, stem cells and treatment and intestinal brain axis. The office has conducted T-tau, P-tau181 and Aβ 1-42 inspections for potential patients and also carried out 14-3-3 protein, autoimmune encephalitis antibody and paraneoplastic related antibody in various body fluids on quickly developing dementia patients. The AD patients can be sieved as early as possible by low-cost test. Early interventional therapy can delay the course of disease, improve the life quality of old patients, and reduce the burden of families.
Establishing A Cognitive Impairment Rehabilitation Team
Memory loss is a typical symptom of AD and the earliest clinical manifestation. It often happens to patients with dementia caused by other causes, which can not be clearly recognized by ordinary patients. Jiangwan Hospital has set up a special clinic of cognitive rehabilitation, which mainly concentrates on individualized diagnosis and treatment, cognitive rehabilitation evaluation and corresponding cognitive rehabilitation training for patients with memory impairment, executive dysfunction and sleep disorder.
In the interview, Ma Huizhi, head of the clinic, introduces two following cases. In the past year, 80-year-old grandpa Chen was always forgetful, accompanied by abnormal mental behaviors. His family was very anxious, so that they took him to the cognitive rehabilitation clinic of Jiangwan Hospital. Through inspection and evaluation, the old man was diagnosed with sequelae of cerebral infarction and vascular dementia, which was a bolt from the blue for the family. Fortunately, through the secondary prevention of brain stroke, the control of mental symptoms, drugs of improving cognitive function, rehabilitation guidance and training and other treatment methods, grandpa Chen's hallucinations, paranoia and behavior disorders have gradually eased, his sleep is sound, the memory has also improved, and the family order has steadily returned to normal. Another 65-year-old aunt pitifully missed the opportunity of early diagnosis and intervention. Because her husband died early and her child does not live with her all year round, her child found that she had a bad memory and poor mood during the video call. At first, her child thought she just had a bad mood. Later, she went out and lost. Fortunately, she was found and was taken to hospital for examination. She was diagnosed as advanced Alzheimer's disease. The cognitive impairment rehabilitation team of the hospital consisted of neurophysicians, rehabilitation doctors, rehabilitation therapists and nurses. They cooperated with the hospital inspection team and the imaging team to practice personalized diagnosis, treatment and rehabilitation in integrated model of “outpatient - evaluation room - treatment room – ward” and by means of drug treatment, active control of high-risk factors, treatment of comorbidity and lifestyle intervention for patients with cognitive impairment caused by a multiplicity of causes, which achieved great effects.
Xie Fandi says that AD is a gradual process. In daily life, if the elderly at home have abnormal behaviors such as forgetfulness, large changes in temperament and difficulty in speaking and doing things, their families need to take him or her to the cognitive rehabilitation clinic for professional evaluation as soon as possible, so as to judge whether there are early symptoms of AD, which can effectively delay the disease’s occurrence and development through active prevention and intervention.