The trend of senile dementia is getting younger?

RECENTLY, PROFESSOR JIA JIANPING, DIRECTOR OF THE NEUROLOGICAL DISEASE HIGH-INNOVATION CENTER OF XUANWU HOSPITAL OF CAPITAL MEDICAL UNIVERSITY AND DIRECTOR OF THE NEUROLOGY DEPARTMENT OF CAPITAL MEDICAL UNIVERSITY, REPORTED ONLINE IN THE JOURNAL OF ALZHEIMERS DISEASE A 19-YEAR-OLD BOY DIAGNOSED WITH ALZHEIMER’S DISEASE (AD).

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It is reported that the case is the youngest AD patient in the world to date. As soon as this news came out, it quickly set off a heated discussion on social media platforms. Is this an accident, or is it a harbinger of AD getting younger? Many young people with similar symptoms expressed concern about their situation.

Subverting perceptions: AD is not exclusive to older adults

AD is an insidious neurodegenerative disease with progressive development, in which age is an important risk factor for AD. In 1906, the first case of AD was reported worldwide.

In 2020, a census conducted by Jia Jianping’s team for the elderly aged 60 and above across the country showed that there are more than 50 million people with cognitive impairment in China, including 10 million AD patients. Since AD is widely believed to occur mainly in older people, AD is also commonly known as senile dementia.

“Xiao Cheng (pseudonym) was only 19 years old, and we were shocked when he was diagnosed with AD.” Jia Jianping recalls that Xiao Cheng began to have symptoms of difficulty concentrating at the age of 17, and after a year, short-term memory loss was obvious, such as often losing personal belongings, forgetting whether to eat that day, and difficulty reading, slow response, and inability to complete prescribed academic tasks. Eventually, due to severe memory loss, the patient’s academic performance slipped from the upper middle of the class to the bottom of the class, and had to drop out of high school.

During the diagnosis and treatment, Jia Jianping’s team found that the main manifestation of the patients was memory loss, especially episodic memory, which was supported by the Wechsler Memory Scale and the auditory word learning test assessment. In addition, cerebrospinal fluid biomarkers in patients showed a decrease in the Aβ1-42/1-40 ratio and an increase in p-tau; MRI scans of the head show bilateral hippocampus atrophy disproportionately attributable to juveniles. But whole-genome sequencing did not find that the patient carried any risk or disease-causing gene mutations.

“All of the patient’s symptoms meet internationally accepted diagnostic criteria for AD.” “But in finding the cause, we ruled out the possibility of cognitive impairment caused by genetic, infectious and systemic diseases,” Jia said. ”

Speaking about reporting the rare case, Jia called it “the hardest article to publish in his career.” “A lot of people don’t believe that such a young person can get AD, so our entire submission process took a year and a half, but in the end, a series of scientific evidence proved the correctness of our diagnosis.”

AD is a multifaceted disease that is rarely recognized in young people, let alone AD. The results of Jia Jianping’s team subvert the inherent cognition that “AD is exclusive to the elderly”, rewrite the previous understanding of the age of AD in the history of AD research in the world, and for the first time propose the possibility of non-hereditary AD in young people.

After the publication, George Perry, editor-in-chief of the journal of alzheimers DISEASE, published a paper titled “Alzheimer’s Disease: Not Just for the Aged?” and commented on the significance of this research to raise the imperative of paying attention to the trend of AD rejuvenation, and exploring the mystery of AD in young people may become one of the most challenging scientific questions in the future.

Clear diagnosis: forgetfulness does not equal Alzheimer’s

“Forgetting to clock in with your phone at work, forgetting to bring your keys home after work, is this an early manifestation of Alzheimer’s?”

“What I saw one second, what I said, I don’t remember the next second, do I also have Alzheimer’s?”

In the news comments of 19-year-old AD patients, such messages can often be seen. In this regard, Jia Jianping particularly emphasized that young people do not need to panic excessively, and middle-aged and elderly people should also distinguish rationally. “Forgetfulness is divided into benign forgetfulness and pathological forgetfulness, and not all forgetfulness is a precursor to AD. And benign forgetfulness can be corrected through self-learning and will not develop into dementia. ”

In the specific distinction, there are mainly six points: forgetfulness is a near-memory disorder, which can be remembered after prompting, while AD patients cannot; Forgetfulness is not accompanied by other cognitive deficits, while AD is often accompanied by executive function, visuospatial function, and language dysfunction; Forgetful people have normal emotions, while AD patients become apathetic and lack basic emotional performance; Forgetful people have clear thinking, while AD patients have confused thinking; Forgetful people will show anxiety about memory loss, while AD patients are not aware of the problem; Forgetful elderly people can maintain normal self-care ability, while AD patients will gradually lose their ability to live independently even if they do not have physical diseases.

In terms of pathogenesis, AD is mainly related to genetic factors, environmental factors and aging factors. Among them, inherited gene mutations include disease-causing genes and risk genes, and common disease-causing genes include PS1 gene, PS2 gene and APP gene, but the population carrying disease-causing genes accounts for a minority. A common risk gene is the APOEε4 gene, and carriers have potential harm for memory loss. Jia Jianping’s team found that 19.4% of Chinese carry high-risk genes for senile dementia, totaling 270 million people.

“Although the exact mechanism between AD risk and the APOEε4 gene is unknown, the data show that people with the APOEε4 allele are 5 to 6 times more likely to develop AD than normal people, and ‘homozygous’ gene carriers are up to 10 to 15 times more likely to develop AD.” Jia Jianping said.

In addition, poor lifestyles such as excessive work pressure, anxiety, depression, lack of sleep, and dieting will have varying degrees of impact on the incidence of AD. For the elderly group, multi-disease comorbidity is one of the influencing factors that cannot be ignored.

Prevention is greater than cure: adhere to six healthy lifestyles

At present, there is no specific drug to improve memory in the world, how to overcome the problem of memory loss, the significance of prevention is far greater than cure. To this end, Jia Jianping led a nationwide cohort study for more than 10 years.

The research team selected areas with representative conditions such as geographical location, environmental climate, customs and habits, and economic development level in China, and conducted long-term follow-up monitoring of more than 29,000 elderly people with normal brain health. In long-term clinical practice, Jia Jianping’s team has summarized 6 healthy lifestyles that affect brain health, namely, adhering to more than 7 recommended diets, not less than 150 minutes of moderate-intensity or 75-minute high-intensity physical exercise per week, social activities at least twice a week, reading, thinking and writing at least twice a week, and controlling tobacco and alcohol. Among them, the diet recommended by the research team includes cereals, legumes, vegetables, fruits, meat, eggs, nuts, dairy products, appropriate amount of salt, oil, fish, and tea drinking, a total of 12 types.

AD has a long course of disease, and patients can only be detected by blood tests for the first 15~20 years before the onset of symptoms. But the results of the study showed that more than 60% of asymptomatic AD can be prevented if these six healthy lifestyles are adhered to. At the same time, 1/3 of people with mild cognitive impairment can be cured by non-pharmacological interventions.

In addition, about 20% of the subjects in the study cohort carried the APOEε4 risk gene, and through the evaluation of this population, Jia Jianping’s team found that a healthy lifestyle can not only effectively protect memory, but even offset the risk of genetic factors.

Jia Jianping summed up this method as “control your mouth, open your legs, use your brain diligently, socialize more, and have a good memory.” “This is a non-pharmaceutical therapy that can be seen, touched, carried out and grounded, and it is easier for the general public.”

It is reported that after treatment, Xiao Cheng’s condition has improved significantly, and his academic performance is gradually recovering. “Most people think that AD is incurable, in fact, this is a misunderstanding, whether AD can be cured, the key is when and how to treat.” Jia Jianping said that many AD patients have a sense of stigma, which has a negative impact on the treatment of the disease, and the public should give more respect and care to this group, and provide assistance within their capacity.

Practicing medicine for half of his life, Jia Jianping has always been obsessed with the study of memory. He said that memory is the soul of life and runs through life. Paying attention to brain health is not only a matter for the elderly, but also for the young, because the world belongs to young people, and good memory is the fundamental competitiveness of social survival. “Fortunately, memory can be self-tested and self-aware, as long as everyone prevents it early, everyone can retain good memories and present the true meaning of life.” (Source: Chen Yiqi, China Science News)

Related paper information:https://doi.org/10.3233/JAD-221065

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