首页 / 新闻 / 推进社区层面疾病“早诊早治”,2021年度“国际阿尔茨海默病月”大型宣教义诊活动在杭举办

推进社区层面疾病“早诊早治”,2021年度“国际阿尔茨海默病月”大型宣教义诊活动在杭举办

早期诊断和早期干预是阿尔茨海默病(AD)治疗的首要原则,为此国际老年痴呆协会给2021年国际阿尔兹海默症月设立了“知己知彼,早诊早治”的主题,强调阿尔茨海默病公众认知和早期发现干预的重要性。为增进公众对阿尔茨海默病的了解,响应今年国际阿尔兹海默病月的主题精神,由浙江省人民医院牵头、浙江大学医学院邵逸夫医院、浙江大学精神卫生中心(杭州7院)、杭州市第一人民医院共同参与的2021年“国际阿尔茨海默病日”大型宣教义诊活动于近期在杭州市浙江省人民医院开展。

本次患教义诊活动邀请了当地许多知名专家到场,包括浙江省肿瘤医院党委书记于恩彦教授、浙江大学医学院附属邵逸夫医院精神卫生科主任陈炜教授、浙江大学精神卫生中心(杭州七院)副院长 陈致宇教授,杭州市第一人民医院临床心理科主任谢健教授、浙江大学医学院附属第二医院精神科副主任林铮教授、浙江省人民医院临床心理科主任 苏衡教授,副主任廖峥娈教授。

于恩彦教授向到场的患者和家属展开AD疾病科普宣教,随后和其他6位专家和到场老年朋友一起进行红歌PK、手指操等益智活动,并在现场为患者展开义诊活动。

会后,于恩彦教授和廖峥娈主任接受了采访,两位专家多次强调了阿尔茨海默病社会认知与早期筛查、早期治疗的重要性,并且在阿尔茨海默病诊疗现状以及疾病管理层面展开了广泛的分享。

图:国际阿尔茨海默病月大型认知教育活动现场

正确的疾病认识对阿尔茨海默病干预十分重要

由国际老年痴呆协会发布的《照料者学员培训手册》指出:“对疾病认知的缺乏将给AD患者家属、照料者带来很多的困难,并使其执行错误的AD治疗策略[1]。”所以,患者教育对照料者和患者来说十分重要,如果对AD认知不够,不但会耽误患者的治疗,还会给患者、家属(照料者)带来严重的负面生活影响。对此,廖峥娈主任表示:“病人发现、识别的难点主要在于对疾病的认识不够,思想上不够重视,以及病耻感。疾病认识不够,就会导致早期发现不了,把老年痴呆当住正常的老化,觉得人老了就这样。或者保持侥幸心理,错过最佳干预时机。也有些患者或家属对疾病仍有病耻感,拒绝看病。这些都是导致错过早期识别的主要原因。”

疾病知晓率将导致严重的社会问题,于恩彦教授表示:“目前阿尔茨海默病的知晓率在乐观的估计下不会超过50%,知晓率非常低,我们要对它进行识别就非常困难。所以现在我们的病人都是已经达到症状都痴呆了才来看门诊,到这个时候从痴呆的角度来说他已经进入到不可逆的阶段。”应振华教授也强调:“国际阿尔兹海默病协会调查显示,95%的受访者认为他们可能在有生之年患上失智症,有2/3的人认为失智者患者干扰了正常生活,很多人把健忘当成是老了以后当然的事,导致很多的阿尔兹海默病错过了最佳的治疗时机。面对我国日益老龄化的现状,阿尔兹海默病的早期了解、早期识别、早期诊断、早期治疗刻不容缓。”

图:于恩彦教授在科普讲座

早期治疗和干预可最大程度降低阿尔茨海默病的负担

作为新兴的老龄化大国,我国老年痴呆患病率呈不断上升趋势。目前我国约有1000万阿尔茨海默病的患者,每100个60岁以上的人中就有6人罹患此病;如果不及时采取措施,预计到2050年,我国将有4000万的阿尔茨海默病患者。于恩彦教授表示:“老年痴呆患病率越来越高本身就是一个很大的危害,另一个危害是它花钱很多。2015年的阿尔茨海默病世界报告显示,全世界花在老年痴呆的治疗费、照料费等各种费用,相当于全球GDP的1.09%,这是相当大的数字;中国患者一年要为它花12.2万元,负担也十分沉重。目前对这个病最好的办法就是预防,也就是让它不出现,至少让它晚一点出现;一旦出现了,要及时干预让这个病轻一点。”

图:于恩彦教授和谢健教授现场展示简单易学有趣的手指操

于恩彦教授还指出:“预防和干预阿尔茨海默病要遵循科学性和系统性,这些认识来源于科学研究和实践;包括营养指导、锻炼、认知训练、社交社会、控制代谢和血管因素这些层面,都需要加强教育。早期预防是指预防可改变的风险因素因素,比如说心血管病、高血压、糖尿病、肥胖、忧郁、体育锻炼、智力活动、吸烟、生活方式等。对已经得的病的患者,我们还要进行积极的治疗,生活干预、方方面面的干预,包括学习、锻炼、饮食进行改变;对这种病的治疗必须是系统性的和长期的,系统性干预,就是在医生的指导下制定计划,定期评估,修正方案;长期就是痴呆这种病一旦给它治疗、给它预防,就不能停歇,必须是持续的,这是由这种疾病性质决定的。”

对因机制新药或将改善阿尔茨海默病诊疗局面

由于疾病的直接成因尚未完全阐明,目前阿尔茨海默病在临床治疗方案上有较大瓶颈。廖峥娈主任对此表示:“临床上对阿尔茨海默病的治疗目标以早期发现和早期干预为主,治疗主要以改善症状、阻止痴呆的进一步发展、维持残存的脑功能、减少并发症为主要原则。因此,治疗目标应切实可行,不能期望过高。这些目标包括:改善或保持患者认知功能或延缓认知衰退,控制患者的BPSD,减少症状的发生,降低疾病给患者和照料者带来的苦恼与伤害,保持患者的社会功能,提高患者生活质量,减少照料者负担。”

可用药物很少以及新药研发困难是阿尔茨海默病治疗领域难有进展的关键,于恩彦教授指出:“新药开发非常困难,有研究表明2000年到2012年间有244种阿尔茨海默病药物进入研发管线,最后有243个药物都失败了,失败率很高。我们目前主要用的药物就是乙酰胆碱脂酶抑制剂、N-甲基-D天冬氨酸受体拮抗剂(美金刚)和2019年上市的九期一®(甘露特钠胶囊),九期一®是我国原研的一款新药,目前临床上看这个药是有效的。”

靶向肠道菌群、神经炎症的九期一®被我国批准以及最近美国FDA的监管动向表明,全球阿尔茨海默病药物研发的主流方向已经转向以针对疾病成因为基础的疾病修饰疗法上,这个趋势或将改变目前以对症治疗为主的阿尔茨海默病治疗局面。作为一款中国原研寡糖类疾病修饰类小分子药物,九期一®通过重塑肠道菌群,降低异常代谢产物,减轻外周炎性免疫细胞向大脑的浸润,减轻神经炎症;同时可直接与Aβ结合,抑制Aβ聚集、促进Aβ斑块解聚,从而系统性应对阿尔茨海默病复杂疾病机制[2] [3]。中国三期临床研究表明该药物在36周观察期内持续改善患者认知功能。

由于患病后认知功能受损,对阿尔茨海默病患者来说,家属的决策和照护对患者的治疗和生活将起到关键的作用。参加活动的患者家属藤大爷在现场分享长期治疗及照护经验时提到:“我老伴确诊这个病5年多了,一开始只是记性差,后面性格也改变,经常跟我作对,照顾她很困难。确诊后吃了一年多的药,因为副反应停过药,后面国产新药获批后开始继续坚持治疗,目前已经坚持治疗9个月。主要感觉就是病情稳定了,也没有恶化,现在我老伴话变多了,医生告诉我话变多了就是好的。我在照顾我老伴那么多年的经验是,要多跟病人交流,说话、做事要多顺着她,生活中要多鼓励,要坚持治疗和随访,我有这样的体会。”

图:参与此次宣教义诊活动的所有专家

参考文献:

[1]. Alzheimer’s Disease International.帮助照料者进行照料-学员培训手册.retrieved from https://www.alzint.org/u/2020/09/Helping-carers-trainees-manual-Chinese.pdf

[2]. Wang X, Sun G, Feng T, et al. Sodium oligomannate therapeutically remodels gut microbiota and suppresses gut bacterial amino acids-shaped neuroinflammation to inhibit Alzheimer’s disease progression[J]. Cell research, 2019, 29(10): 787-803.

[3]. Xiao S, Chan P, Wang T, et al. A 36-week multicenter, randomized, double-blind, placebo-controlled, parallel-group, phase 3 clinical trial of sodium oligomannate for mild-to-moderate Alzheimer’s dementia[J]. Alzheimer’s research & therapy, 2021, 13(1): 1-11.

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