1. Can two major diseases be jointly prevented?
Alzheimer’s disease is the common name of Alzheimer’s disease, named because it occurs in old age and has dementia as the main symptom.
A large number of epidemiological surveys at home and abroad have confirmed that Alzheimer’s disease is a common disease that crosses national boundaries, race, gender, and even educational level.
However, the clinical confusion is.
(1) low detection and diagnosis rates, especially early detection rates.
(2) No very precise and effective prevention methods have been found.
(3) few pharmacological treatment options are available, and most of the drugs commonly used today for dementia treatment only partially improve symptoms and do not delay the natural course of the disease.
The reasons for this are many. But the deeper reasons are the lack of depth of medical interpretation of the disease and the low level of social awareness of the disease. First, medicine is not yet able to know exactly the cause and pathogenesis of the disease, and certainly cannot provide accurate information on prevention and treatment; second, both doctors and patients are more focused on the physical aspects of the disorder and are prone to habitually “ignore” the cognitive deficits of patients.
However, recent research advances have provided us with a new way of thinking about Alzheimer’s disease prevention and treatment. Traditionally, it was thought that a more dangerous, more common and more popular disease, atherosclerotic ischemic cerebral infarction (commonly known as stroke), and Alzheimer’s disease were two completely different diseases in terms of etiology, pathogenesis, clinical symptoms and clinical management.
But new research has found that there is no traditional “Chinese-Han line of dementia” between the two, and that the relationship between them is more like a taiji diagram of “you in me and me in you.
In layman’s terms, many of the same risk factors that trigger stroke also contribute to Alzheimer’s disease, such as the most familiar “three highs” of stroke: high blood pressure, high blood cholesterol and diabetes.
More importantly, a growing number of clinicopathological and neuroimaging studies have confirmed that Alzheimer’s disease has a distinct vascular basis in its pathogenesis.
Therefore, it is now considered likely that Alzheimer’s disease is a heterogeneous CNS disorder with a genetic background, vascular basis, inflammatory tendency, and most likely a local manifestation of a systemic disease in the CNS.
Taken together, these findings provide a new idea for the prevention and treatment of Alzheimer’s disease, which is to prevent Alzheimer’s disease like stroke, or to put the prevention of both diseases on the same platform.
2. At what stage of life is the best time to start joint prevention?
Many people are bound to question this. For example, the idea lacks large-scale evidence-based medical evidence, and the results of small-scale intervention trials have not been satisfactory, etc. But the problem is likely not in the unscientific choice of prevention and control methods, but in choosing the wrong time to start prevention.
In a nutshell: it’s too late!
To understand this new concept two traditional ideas must first be discarded.
(1) Alzheimer’s disease and atherosclerosis are both diseases of the elderly, and prevention is, of course, the business of the elderly.
(2) They are both diseases. Since they are diseases, there should be a more accurate starting point.
Actually, it is not.
Although both diseases occur in the elderly, and both have a clinical starting point. But in fact, they are not only diseases, but also a process, a pathological process that accumulates from birth to death, from quantitative to qualitative changes.
Almost everyone is accumulating, and almost everyone can get both diseases. The reason why some people will get the disease and others will be spared is that the amount accumulated is different for each person.
That is to say, although both diseases have a more definite clinical starting point, preferably in old age, the actual pathological starting point is far ahead of the clinical starting point! Even from conception onwards!
If this theory holds true, then it is clearly too late to prevent it now!
A review of current prevention strategies for atherosclerotic ischemic cerebral infarction (commonly known as stroke) reveals a multitude of flaws.
Flaw 1: Most patients begin to pay attention to prevention (secondary prevention) only after they have had a stroke, a small number of health-conscious patients begin stroke prevention (primary prevention) when common risk factors for stroke are identified, and only a very small number of people begin to pay attention to their stroke risk while they are still in a “healthy state” without any symptoms and Only a small minority of people start to be concerned about their risk of stroke when they are still in a “healthy state” without any symptoms and take active actions such as dietary control, physical activity, and pharmacological interventions.
As a result, the majority of people are ad hoc in their stroke prevention, which is the root cause of the high incidence and recurrence rates of stroke in China.
Deficiency 2: Current medical tools are not yet able to assess the genetic and environmental risks of various diseases at birth, but it does not mean that these two diseases cannot go for some easy and simple risk assessment, and future scientists will have the ability to invent a simple risk assessment scale that can be used to guide each of us in our healthy life planning.
For example, a baby born into a family with stroke should have a healthy diet from childhood, exercise, tighter weight control, earlier screening for stroke risk factors, and earlier pharmacological interventions for risk factors such as hypertension, diabetes, and hyperlipidemia.
The same is true for the current prevention strategy for Alzheimer’s disease. So where is the most practical point to start preventing Alzheimer’s and stroke at this stage?
The answer is: middle age!
Middle age is the bridge between youth and old age. Although it is more ideal to start at the adolescent or even infant stage, medical conditions are limited nowadays; although it is more acceptable to patients to start at the older age, it is indeed too late.
Therefore, starting to prevent these two major diseases at the middle age stage is the best choice, both from the practical and ideological levels.
3. How to jointly prevent Alzheimer’s disease and stroke?
The key to joint prevention and treatment lies in the following five points.
(1) First, it is important to realize that both have a relatively consistent vascular basis and that prevention needs to begin in middle age. This is the stage where there is often no discomfort or clinical symptoms, and the illusion of “being healthy” is easy to maintain.
(2) Early evaluation is important. If you have a close family member who has been diagnosed or suspected of having Alzheimer’s disease, or who has coronary heart disease, stroke, hypertension, or diabetes, you are much more likely to have Alzheimer’s disease and stroke, and should see a specialist at least once in midlife for a comprehensive examination.
(3) Joint prevention cannot rely solely on medications, but more importantly on life pattern modification, such as adopting healthier eating habits and more regular living habits, stricter weight control, regular physical exercise within your means, quitting smoking and alcohol, and adjusting your mindset (reducing stress in life and slowing down the pace of life). Pharmacological prevention is considered only when the desired goals cannot be achieved through changes in lifestyle patterns.
(4) Pharmacological prevention is mainly based on the use of atherosclerosis prevention drugs, which are often referred to as “ASA” treatment by specialists.
The first “A” refers to Anti-hypertensive (anti-hypertensive drugs, for those with hypertension. The first “A” refers to Anti-hypertensive (anti-hypertensive drugs for people with hypertension), but the 2007 US guidelines for stroke prevention and control mention that even people at high risk of stroke without hypertension may benefit from taking antihypertensive drugs. (Of course attention should be paid to the magnitude of the blood pressure reduction, the side effects of antihypertensive drugs and the corresponding financial burden on the patient).
The “S” refers to Statins (a statin whose main effect is to lower cholesterol levels, and which current evidence shows can greatly reduce the occurrence of cardiovascular events such as coronary heart disease and stroke, and some statins may also reverse atherosclerotic plaques. (In recent years, studies have pointed to such drugs as potentially effective in the treatment of Alzheimer’s disease and osteoporosis).
The second “A” refers to Anti-platelet (anti-platelet drugs, mainly used to prevent heart attacks and strokes, in recent years, some studies have shown that they can also prevent Alzheimer’s disease, and are used with caution or prohibited in patients with stomach problems)
(5) For people who have already developed some memory impairment in the early age (about 45-65 years old) but whose general social life functions are still normal (usually this state is called mild cognitive disorder; MCI), they should go to a neurologist for a comprehensive cognitive function assessment as soon as possible.
A basic neuroimaging examination (preferably an MRI with hippocampal measurements and cerebral angiography) should also be completed, provided that financial conditions allow. If MCI is identified, all relevant pharmacological interventions excluding life pattern modification, such as initiation of cholinesterase inhibitor (Anlisin) therapy, can be considered.