Dr. Long Chelsea98.com Huizhou Education_Millions of Dragons Health
September 21 is "World Alzheimer's Day".
Alzheimer's Disease (AD) is a kind of "Alzheimer's disease", commonly known as Alzheimer's disease, Alzheimer's disease, and dementia. German psychiatrist Alois Alzheimer (Alois Alzheimer) first reported this disease in 1907, hence the name Alzheimer's disease. In European and American countries, the incidence of AD among the elderly over 65 years old is 5%, and the incidence over 85 years old is above 30%; currently, there are an estimated 50 million patients worldwide, and it is estimated that there will be approximately 130 million patients worldwide in 2050. It has been more than 100 years since AD was discovered. The medical profession generally believes that there is still no particularly effective drug or treatment to cure the disease, and that nearly 70% of the risk factors are genetically related. AD is mainly divided into familial AD and Alzheimer's AD, of which the latter is more common. Only early detection and early treatment can delay the development of the disease.
Alzheimer’s disease is a group of symptoms caused by neurodegeneration, cerebrovascular disease, infection, trauma, tumor, nutritional and metabolic disorders and other reasons. It is a lasting and comprehensive loss of intelligence that occurs when the patient is conscious. It is manifested as memory, calculation, judgment, concentration, abstract thinking ability, language function decline, emotional and behavioral disorders, and loss of independent living and working ability. Among them, AD is the most common type, followed by vascular dementia, and other common types include Parkinson's disease dementia, Lewy body dementia/frontotemporal dementia and so on.
The American Institute of Neural and Communication Disorders and Stroke (NINCDS, now renamed the American Institute of Neurology and Stroke) and the Alzheimer’s and Related Diseases Association (ADRDA) established the diagnostic criteria for NINCDS-ADRDA-AD in 1984. One of the most commonly used diagnostic criteria, the latest version was updated in 2007. The clinical diagnostic criteria include cognitive impairment, suspected dementia symptoms, and confirmed by neuropsychological evaluation. The Global Deterioration Scale (GDS) is a validated and reliable tool used to describe the clinical progression of dementia.
ADTen warning symptoms of
(1) Memory loss in insidious attacks, especially memory loss of recent events, affects daily life.
(2) Planning or solving problems is more difficult than before.
(3) It is difficult to complete familiar things at home and work.
(4) It is difficult to distinguish time and place.
(5) Inability to understand visual images and spatial relationships.
(6) Difficulties in speaking words.
(7) Leaving things indiscriminately and losing the ability to retrieve them.
(8) Reduce or lose the ability to judge.
(9) Decrease in social activities.
(10) Changes in mood and character.
ADType of disease course and stage of disease course
AD is divided into early-onset and late-onset. The onset before the age of 65 is early onset, accounting for only about 5% in all AD patients. Most people with early onset are in their fifties and early sixties, and there are very few people in their forties, and the incidence of disease in their thirties is very low. Studies have shown that the incidence rate in high-income countries (doubling every 5.8 years, from 3.4/1000 person-years to 202.2/1000 person-years) is higher than that in low- and middle-income countries (doubling every 6.7 years, from 2.9/1000 person-years to 99.4 /1000 person-years). Overall, the incidence of AD in low- and middle-income countries is 36% lower than in high-income countries.
AD patients are divided into three stages: morning, middle and late. The early symptoms are mild, mainly memory and calculation ability decline, this stage can last for 2 to 4 years; after entering the middle stage, the cognitive functions of the elderly are significantly reduced, their living ability is reduced, and they can only take care of part of their life and begin to need Help from others; in the late stage, the patient will not even know his family, and rely on others for most of his life. In the end, he lives on a wheelchair or in bed, completely unable to take care of himself. Most of the patients are in the middle and late stages of illness, and only see a doctor until the symptoms become obvious, and miss the best period of drug improvement in the early period (the first five years).
In many cases, AD is often mistaken for normal forgetfulness, thinking that it is just like getting older. "Old confused" is a normal phenomenon for the elderly, without realizing that it is actually a disease. The family members found that the patient’s first symptom is usually forgetting what happened recently, that is, the decline in near memory, accompanied by a decline in thinking and judgment ability, language function, and time and space perception ability, which leads to the patient’s loss in life, repeated inquiries, and when going out. Lost, will not change clothes according to the weather, and cannot independently shop, cook, bathe, go to the toilet, etc. Some elderly people will also have mental behavior problems such as doubts, hallucinations, personality changes, and purposeless activities.
The life expectancy of AD patients is relatively short. The life expectancy after diagnosis is about three to ten years. People with less than 3% can live more than 14 years. Features that can cause a significant reduction in the number of years of survival include increased severity of cognitive impairment, decreased life function, previous falls, and neurological problems. Other comorbidities such as cardiovascular disease, diabetes, and previous alcoholism are all related to the decrease in survival years; although patients diagnosed at younger ages have longer survival years, in fact, younger patients live shorter lives than healthy people; The prognosis of men is also worse than that of women; pneumonia and dehydration are the most common causes of immediate death in AD patients; compared to the average person, AD patients have a lower rate of death due to cancer.
Current status of Alzheimer's disease in China
As of the end of 2018, the number of elderly people aged 60 and over in China reached 249 million, accounting for 17.9% of the total population; the number of elderly people aged 65 and over reached 166 million, accounting for 11.9% of the total population. The 2017 National Mental Illness Epidemiological Survey showed that the prevalence of AD among people aged 65 years and over in China was 5.56%. At present, the number of AD patients in China is estimated to be 10 million, and there are 24 million patients with mild cognitive impairment. AD patients in China rank first in the world, and there are an average of 300,000 new cases each year. It is estimated that by 2050, it will exceed 40 million.
The Journal of Alzheimer's Disease Research pointed out that after the diagnosis of AD, the average survival time of patients is 7 years, and the patients who survived more than 14 years after diagnosis have less than 3%. In recent years, China’s awareness of AD has increased significantly, and the rate of consultation within one year of symptoms has increased compared with 2012, reaching 77.43%. With the gradual aging of the world's population, at most 30 years later, the number of people with AD in the world will exceed 100 million, and China's population will be close to 45 million. Many people even pessimistically believe that if we are lucky enough to live a long life, then, in the future, at least 1 out of every 4 elderly over 85 years old will suffer from AD.
Compared with the large number of patients, AD public awareness is low, the rate of patient visits is low, the lack of innovative and effective treatment methods, and the high cost of family and social care. According to estimates, in 2015, China's total cost of AD was 167.74 billion US dollars (calculated at the average exchange rate of the year, about 1.04 trillion yuan), accounting for about 1.5% of the total GDP that year. At present, the rate of consultation for dementia including AD in China is only 26.9%, and the rate of receiving standardized treatment is only 21.3%. In addition to medical expenses, due to the continuous decline of cognitive function and the development of cognitive dysfunction, many AD patients cannot live independently, and long-term care and nursing expenses are indispensable. For example, AD is accompanied by the problem of missing elderly people who are frequently reported in the newspapers. According to public reports, China receives an average of 1370 cases of missing elderly police every day, and 728 cases are caused by AD. The direct medical expenses of AD patients are only 15%, while the indirect family and social care expenses are as high as 85%. The "Healthy China Action (2019-2030)" clearly stated that by 2022 and 2030, the incidence of disability among elderly people aged 65-74 will be reduced, and the growth rate of AD prevalence among people aged 65 and over will decline.
Current status of Alzheimer's in the United States
In the United States, AD is the third most expensive disease after cancer and cardiovascular disease, and AD is the sixth leading cause of death in the United States. One third of the elderly die of some form of dementia. The American Alzheimer's Association released the "2017 Alzheimer's Disease Facts and Figures" in 2017: On average, for every ten elderly people over 65 years old in the United States, one is AD with an incidence rate of 10%. Approximately two thirds of AD patients are women. For people 65 and older, it is the fifth cause of disability and health effects. An AD patient appears every 66 seconds. About two-thirds of AD patients are women. African Americans and Latino Americans suffer from AD or related diseases more often than whites. Currently, approximately 5.5 million people in the United States suffer from AD, of which 200,000 are early-onset AD patients, accounting for one-tenth of the total number of cases in the world. By 2050, there will be 16 million AD patients in the United States.
In the United States, the cost of AD care is twice that of cancer, but the scientific research investment is only 10% of cancer, which is far from enough. In 2016, there were 15.9 million family caregivers in the United States. Family caregivers provided 18.2 billion hours of unpaid care, equivalent to an economic value of $230.1 billion. In 2018, the cost of AD and dementia care in the United States was US$277 billion. In 2018, caregivers of patients with AD or other dementias provided approximately 18.5 billion hours of informal (ie unpaid) assistance, with a contribution value of US$233.9 billion to the country. By 2050, the costs associated with dementia may be as high as $1.1 trillion.
Current status of dementia in Canada
According to statistics from The Alzheimer Society of Canada, there are currently about 480,000 AD patients in Canada; the proportion of AD patients over 60 years old is 7%; and among the 90-year-old people, This ratio is as high as 49%. For this alone, the direct economic burden of Canada as a whole is 9.9 billion yuan. By 2030, it may reach 1.12 million. The total social cost caused by this would rise to 97 billion yuan, which should be an astronomical figure. These include the loss of productivity, social consumption and other consequences. According to the above estimation, it means that by 2030, 11.25 million Canadians are likely to spend the rest of their lives with AD. This is very costly for both the family and the whole society, and social pressure will be overwhelming.
On June 17, 2019, the Canadian government issued a national strategy on Alzheimer’s disease, announcing a grant of 50 million Canadian dollars to prevent the disease, support caregivers and find treatments. According to federal statistics, more than 480,000 elderly people in Canada have been diagnosed with some form of dementia. They need an average of 26 hours of help every week, which are mainly undertaken by relatives and friends. Data show that most people suffering from dementia are women, and most of the people who take care of these people on a regular basis are also women.
ADAnd other dementia treatments
(1) Oral drugs
The cholinergic hypothesis is the first proposed hypothesis, and it is also the theoretical basis on which most AD drugs and functional nutritional preparations are based. This hypothesis believes that AD is caused by the reduction of the neurotransmitter acetylcholine in the nervous system. Although the cholinergic hypothesis has a long history, it has not been widely supported, mainly because the use of drugs to treat acetylcholine deficiency has limited efficacy for Alzheimer's disease.
At present, the clinical drugs for the treatment of AD are acetylcholinesterase inhibitors (AchEI), glutamate receptor antagonists, Ares Donepezil Hydrochloride Tablets, but there are too few types of these drugs. There are five commonly used drugs to improve AD cognitive impairment, four of which are acetylcholinesterase inhibitors (Dakonine, Insulin, Galantamine, and Amex), and the other is NMDA receptor antagonist Agent (Memantine). But the benefits of these drugs are not great.
Clinically used: Donepezil (approved for marketing in 1996), Huperzine A (Chinese original drug, approved for marketing in 1996), Rivastigmine (approved for marketing in 2000) and Galantamine (approved for marketing in 2001). In 2019, Biogen announced that aducanumab, the world's first drug that can treat AD, has passed clinical trials and is awaiting FDA approval and is expected to be mass-produced.
Taking cholesterol-lowering statins (Statins) cannot effectively prevent the occurrence of Alzheimer's disease or delay its progress. Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) was thought to be associated with a lower incidence of Alzheimer's disease in 2007. There is also evidence that NSAIDs can reduce inflammation associated with amyloid plaques. However, due to high side effects, related clinical trials were terminated early.
(2) Patch drugs
The treatment drugs for AD are mainly divided into two categories: oral drugs and patches. The main effects are to improve the condition and delay the disease. Oral drugs are the mainstream at present, but there are many interference factors in the process of medication, so that oral drugs often fail to exert their due effects. For example, AD patients are often accompanied by chronic diseases such as hypertension, diabetes, etc., and some patients are also accompanied by symptoms such as anxiety, depression, and behavioral disorders. They need to be combined with drugs for a long time, and there will be interactions between drugs.
Patch drugs may be a new hope for AD patients who have difficulty in taking medication and have poor results. The patch on the skin allows the drug to pass through the skin directly into the blood, not through the gastrointestinal tract, avoiding the first pass effect. Transdermal administration once a day or once a day can visually see the continuous efficacy of the patch, simplify medication management, improve compliance, and help patients obtain more significant and lasting clinical effects. It can significantly improve the cognitive function and overall function of AD patients, which is equivalent to the effect of oral capsules. Clinical experience has also confirmed that its tolerability, safety, compliance, and ease of operation are also significantly better than oral drugs.
2. Ultrasound therapy
The team of Professor Jürgen Götz from the University of Queensland has discovered a promising new method for the treatment of AD. Research by him and his colleagues showed that by repeatedly performing scanning ultrasound (SUS) processing on AD mice, the Aβ protein in the brain of the mice can be effectively eliminated, and the memory function can also be restored. This exciting result was published in "Science Translational Medicine" (Science Translational Medicine).
Experiments have shown that after ultrasound treatment, microglia are significantly activated. Further research results suggest that after ultrasound treatment briefly opens the blood-brain barrier, a protein called albumin may be able to enter the brain and bind to Aβ protein, thereby helping microglia to engulf Aβ protein.
3. AD vaccine
In 2019, according to a report by CBS in the United States, the University of New Mexico, after years of hard work and spent billions of dollars, has initially developed the world's first AD vaccine and has entered the experimental stage. This vaccine can not only prevent AD, but can even alleviate some irreversible brain damage to varying degrees after the onset of disease, thereby saving millions of AD patients and victim families worldwide!
According to the existing scientific research, AD is caused by the abnormality of β-amyloid and Tau protein in the brain. These two proteins are the hallmark proteins of AD and work together to cause neuron damage. For example, normal β-amyloid protein is dominated by helical structure, while AD patients become lamellar structure, so that they cannot perform normal functions. The newly developed vaccine is aimed at the formation of β-amyloid and tau protein in the brain. In the next few years, Flinders University will jointly conduct clinical trials with the University of California and the Institute of Molecular Medicine.
4. Chinese medicine therapy
Chinese medicine believes that the occurrence of this disease is mainly related to deficiency of kidney essence, deficiency of heart and spleen, hyperactivity of liver yang, and turbid phlegm. The brain is the home of the soul, and the brain is the sea of marrow, which is closely related to the functions of human spirit, memory, and thinking. Deficiency of the kidney results in decreased marrow function, lack of marrow sea, and degeneracy. The spleen masters the meaning, the mind keeps things in the past, while thinking is also the heart. Nowadays, when the spleen is ill and the gods are blocked, the mind is unclear, and the restlessness makes people forgetful. If the liver yin is insufficient, the wind and yang are disturbed, and the gods are blocked, the spirit is upset. If the lungs, spleen and kidneys are dysfunctional, causing dampness to produce phlegm, and phlegm to clear orifices, symptoms such as dizziness, forgetfulness, and fatigue will occur.
Specifically, the main types of AD are as follows:
(1) Deficiency of kidney essence type: mostly manifested as deficiency in the original, heart, liver, spleen and kidney as the core, endogenous phlegm and blood stasis, qi and blood inversion as the indicators, symptoms include memory loss, slow response, fatigue, waist and knees Sour and soft, pale tongue, heavy and thin pulse. Kidney accumulates essence, engenders the marrow and promotes the brain, and invigorates the kidney has become an important method for preventing and treating dementia with deficiency syndrome. You can choose medicine such as rehmannia, purple river car, rehmannia, eucommia, asparagus, tortoise shell, phellodendron, poria, dodder, medlar. In addition, traditional Chinese medicines such as Liuwei Dihuang Pills, Buzhong Yiqi Pills, and Tianwang Buxin Pill have anti-aging and anti-oxidant effects, and have good curative effects on early Alzheimer's disease.
(2) Liver-yang hyperactivity type: manifested as irritability, dizziness, forgetfulness, red tongue, thin pulse, etc. Such patients generally have a history of hypertension and have a rapid onset. Governance: the method of calming the liver and suppressing yang can be used. Treat with Qiju Dihuang Wan or Tianma Gouteng Decoction, medicinal rehmannia, chrysanthemum, dogwood, medlar, yam, Chuan achyranthes, motherwort, eucommia, motherwort, mulberry parasitic, Fushen, etc.
(3) Thinking about hurting the spleen type: manifested as mental exhaustion, weight loss, heart palpitations, forgetfulness and insomnia, weak tongue, weak pulse, etc. Governance: the method of nourishing the heart and spleen can be used. For medicinal purposes, Poria, Atractylodes, Longan, Astragalus, Sour Date Seed, Polygala, Jujube, Ginger, Codonopsis, etc.
(4) Phlegm-damp obliteration type: Symptoms are slow response, apathy, sluggish expression, memory loss, obesity, slippery tongue, and thin pulse. Governance: the method of exempting phlegm and resuscitation is available. Suhexiang pills are used in addition and subtraction, and the medicinal use Pinellia, orange, Citrus aurantium, Poria, Dannanxing, etc.
For the elderly, brain aging is an irresistible natural law. Anti-aging and brain-invigorating products that can be taken, such as Liuwei Dihuang Pills, Bawei Dihuang Pills, Tianwang Buxin Dan, Guipi Pills, antlers and velvet antlers , Polygonum multiflorum, Ganoderma lucidum, Cordyceps sinensis, etc., are an effective method for early prevention of AD or other dementias (Chinese medicine prescription from Ningbo Second Hospital).
5. Acupuncture and cupping therapy
(1) Shen's acupuncture: take Hegu, Shenmen, Jianshi, Zusanli, Sanyinjiao, Taichong, and Shenting as the main points, add Fengchi and Taixi for irritable fires; add dicang and cheek carts for more than salivation; Add Lianquan for astringent; add Neiguan for chest tightness and palpitations; add Guanyuan and Zhongji for those with poor urination. Treatment of 40 cases, the effective rate was 76%.
(2) Sun's acupuncture and moxibustion: Acupuncture mainly at Sishen points, combined with Guanyuan, Dazhu, Zusanli, Tianshu, Xuehai, Sanyinjiao and other points. The needles were retained for 30 minutes, and 70 cases were treated. The effective rate is 95.5%.
(3) Li's acupuncture and moxibustion: 43 cases were treated with electroacupuncture, the main points were: Baihui, vasomotor zone, Fengchi, Neiguan, the total effective rate was 79.49%. It is better than the hydrogenated ergot base control group (effective rate 20.6%, P<0.01).
(4) Lai’s acupuncture: use Sishen acupuncture, Zhisan acupuncture (intrinsic, Shenting), Shuigou as the main acupoints, with Shenmen, Houxi, Zusanli, and Taixi, combined with electric acupuncture and manipulation to treat vascular dementia 30 For example, the total effective rate is 87.6%.
(5) Jiang's acupuncture: take Fengchishuang, Fengfu, Baihui, Jiaji points 3-7 on the neck, and perform tonic methods. Conventional intravenous infusion of Qingkailing, citicoline or cerebrolysin and other drugs, treated 32 cases, the total effective rate was 93%.
(6) Duo's acupuncture: Treat with Fuzhi Decoction (Rehmannia glutinosa, Lycium barbarum, Polygala, Cornus, Yizhiren, Polygonatum, etc.) plus scalp acupuncture (parafrontal 3 lines, frontal midline, parietal temporal anterior oblique and supraoccipital midline) In 54 patients with kidney deficiency, the total effective rate was 91%.
(7) Yang’s acupoint injection: Citicoline was injected into Shenting, Toulinqishuang, Touweishuang, Hegu, and Fengchishuang. 25 cases were treated, and the total effective rate was 92%.
(8) Yang's cupping: Use the negative pressure suction cup to slowly move back and forth 3 times on the governor channel on the patient's back, leaving the cup at Dazhui point, and walking the cup from Shenshu to Dazuo point in the left and right order, the same as the previous method. Follow the sequence of supervision → left → right → repeatedly take the can and draw until the skin is flushed, leave the can for 30 minutes. Treatment of 18 cases, the total effective rate is 89% (Chinese medicine prescription from Ningbo Second Hospital).
5. Acupoint therapy
(1) Bilateral Fengchi acupoint: The location of Fengchi acupoint is parallel to the earlobes on both sides of the large tendons behind the forehead. Massage this point is mainly used for headache, light head-heavy, eye fatigue, neck pain, stiff neck, insomnia, hangover.
(2) Yifeng Point: Yifeng Point, the root of the ear in front of the Fengchi, is covered by the earlobe, behind the earlobe, the depression between the temporal bone mastoid and the rear edge of the mandibular branch. Indications: tinnitus, deafness, crooked mouth and eyes, swollen mouth, swollen cheeks, toothache, scrofula, darkening, dental pain, wet and itchy ears, red and swollen ears, unclear vision. It can also treat facial paralysis, mumps, deafness, and temporomandibular joint pain.
(3) Sibai point: The position of Sibai point is: look squarely with the pupil straight down. When the upper cheekbone is in the depression, that is, the midpoint of the lower orbit, it is about 0.5 cm below the depression. Indications are red itchy eyes, clouded eyes, crooked eyes and mouth, headache and dizziness.
(4) Yintang Point: This point is located on the face of the human body, at the midpoint of the line between the two brows. Traditional Chinese medicine believes that its main function is to clear the head, improve eyesight, and clear the nose. The superior trochlear nerve branch of the frontal nerve, the branch frontal artery of the ophthalmic artery and the accompanying veins are distributed in the depressor muscle.
(5) Weizhong point: Weizhong point is located at the midpoint of the transverse stripes of the popliteal fossa, which is the middle of the biceps femoris tendon and the semitendinosus tendon. This point treats sciatica, calf fatigue, stomach pain, neck pain, waist pain or fatigue, hip pain, and knee pain. This acupoint is one of the important acupoints in the human body’s foot-sun bladder meridian. Massage this acupoint to treat the sequelae of fracture scars and acupressure to enhance sexual vitality. The meridian circulation can connect to the brain from the top of the head, stimulate this part, and directly reach the brain house, so that the mind is clear and the body is refreshed (Chinese medicine prescription from Ningbo Second Hospital).
6. Nutritional therapy
(1) Ordinary diet
-People who are usually healthy, Japanese, and Mediterranean dieters show a lower chance of developing AD. The Mediterranean diet can also improve the prognosis of patients. Diets containing high fatty acids and simple carbohydrates (monosaccharides or disaccharides, etc.) have a higher risk of disease.
-Limited evidence shows that moderate alcohol consumption is associated with a lower incidence of AD, especially red wine. There is also evidence that: caffeine may be a protective factor for AD. Foods that contain high amounts of flavonoids, such as cocoa, red wine, tea, etc., may also be associated with a lower risk of AD.
— Eat more fish, especially high-fat fish (omega-3), such as salmon, trout, and squid, which may prevent AD; more lecithin can prevent AD; soybeans and their products, fish brain, egg yolk, pig Liver, sesame, yam, mushrooms, peanuts, etc. are all foods rich in lecithin, which can provide beneficial nutrients to the brain, improve intelligence, and delay mental decline.
-For medicinal diet therapy, it can be supplemented with yam poria cakes, walnuts, sesame, fleece-flower root, hawthorn, etc.
(2) Functional nutrients
Choline, Acetylcholine, Seal Oil, Coenzyme Q10, Calcium Magnesium, VB, VC, Astaxanthin, Curcumin, Ginkgo, Cannabinoid, etc. For details on how to choose and match to improve and relieve related symptoms, please consult the author of this article.
7. Music therapy
At present, music therapy for AD in European and American countries is relatively mature, and the federal law in the United States even stipulates that medical institutions for geriatric diseases must have music therapy. Its advantages are:
(1) Music therapy helps to improve memory;
(2) Music therapy helps to improve cognitive behavior;
(3) Music therapy helps to improve depression (the incidence of depressive symptoms in AD patients has reached 20%-30%).
8. Health management
Health management, on the one hand, is to prevent the occurrence of various dementias, and to make mid- and long-term health plans in advance; on the other hand, it is to manage life, diet and drugs for patients with AD or other dementias of different physiques to save social resources. Save family expenses. Specific health management measures can be customized privately. Please consult the author of this article. Generally speaking, in addition to establishing personal information files and standardized medical programs, specific measures for health management include: (1) Scientific and effective brain-building programs are important methods to delay and improve the occurrence of various dementias; (2) You can always adhere to appropriate exercises or exercises, such as qigong, tai chi, health exercises, square dances, ballroom dancing for the elderly, etc., which will help your physical and mental health, maintain social interaction and life ability; (3) listen to radio, music, and musical instruments , Painting and calligraphy, etc., often talk with old friends, and recovery training for language and limb dysfunction can help prevent, delay and improve the occurrence of various dementias; (4) The health management center can and should also provide AD and other Dementia recommends professional nursing service centers.
ADPatient assistance and care
In September 2019, the "2019 World Alzheimer's Disease Report" was released in London: (1) Almost the public at 80% are worried that they will develop dementia at some point, and a quarter of them believe that we are good at preventing dementia. (2) The caregivers of 35% in the world said they had concealed the diagnosis of dementia in their family members; (3) The caregivers of more than 50% in the world said that their health was harmed by the responsibility of care, even if they were The role expressed positive views; (4) Nearly 62% medical service providers around the world believe that dementia is part of normal aging; (5) The 40% public believes that doctors and nurses ignore dementia patients. So, how should the whole society provide help and care for patients with AD or other dementias?
1. Help from social groups
Most American nursing homes have established a special union for Alzheimer's disease to train professional nursing staff, but there is still no organization for Chinese patients. Canada also has similar nursing homes or institutions, such as Alzheimer's care, residential care homes, and so on. When AD patients progressed to the middle and late stages, Chinese still chose to stay at home to take care of them, not to save money, but to be reluctant to send them to nursing homes for the elderly. Chinese families felt that the nursing staff in the hospitals were insufficient and it was difficult to compare with their family members. In China, professional nursing institutions, nursing homes or elderly apartments cost 2,000-7,000 RMB per month for accommodation. If you add the cost of treatment and rehabilitation, this cost can be imagined, which is not what an ordinary urban family can do. Bearable.
In terms of policies, the government should encourage the development of community services and broaden the demand for community services, such as establishing community service centers to provide caregivers with respite care and day care services. In addition, it is important to regularly assess the health status and needs of family caregivers, and to provide them with related services based on their health level and nursing needs. For example, use the model of group psychological counseling to establish mutual support groups for caregivers in community service centers to relieve psychological pressure, impart knowledge about care, and help each other benefit each other.
2. Basic measures of nursing care
Although medication and intelligence training can delay the course of the disease, in real life AD patients lack the ability to take care of themselves and the awareness of self-safety. Most elderly people with AD are looked after by their families, so family care is an important means to improve the quality of life of patients. However, it is not easy to care for AD patients. In addition to taking care of daily life, it is also necessary to deal with TA's behaviors and behaviors with abnormal mental state. The more important the patient is, the more important the care is. Some basic measures include:
(1) Enhance TA's self-care ability. Set up a convenient and reasonable living environment for TA; arrange simple activities or exercises within its capacity.
(2) Delay the deterioration and functional decline of TA. The cognitive decline of the TA is related to the mental state. Good care can help the TA establish a happy and safe life attitude.
(3) Improve TA's quality of life and make them feel dignified. Appropriate nursing work will make TA's later life more meaningful.
(4) Minimize the conflict between TA and the outside world. Not only should we take care of TA’s life, medication, health care, nutrition, etc., but also TA’s psychological changes. The condition can affect the TA's mood. Nursing care can reduce fear, relieve anxiety, give TA a sense of security, and avoid injury or harm to others.
(5) Emotional support, master communication. Respect for his personality is very important, don't hurt his self-esteem. Always use touching movements and kind words to give TA care and love. When talking, the tone should be low, the attitude should be kind, the speech should be clear and slow, don't laugh at, and don't easily deny the TA's request.
(6) Strengthen protection to prevent accidents. Severely ill patients need to be accompanied 24 hours a day, and mildly ill patients only need to strengthen care during the TA activities. Don't let TA go out alone, so as not to get lost. It is best to put a security card with TA's name, home address, and contact number in the TA pocket. Pay attention to safety at home, such as letting TA wear non-slip soft-soled shoes; installing handrails in bathrooms and toilets; adding guardrails to the bedside of bed-ridden TAs.
(7) Arrange daily life reasonably. Daily diet should be rich and varied, regular and quantitative, based on healthy protein, healthy fat, high fiber, easy-to-digest soft food, and avoid refined food. Family members should often assist TA in personal hygiene, let TA do some simple housework such as making tea, washing dishes, sweeping the floor, drying clothes, shopping, etc., to establish a new conditioned reflex in the mind. Through various information media, provide TA with audiovisual external stimuli; often consciously let TA remember and judge, in order to achieve the purpose of exercising brain thinking activities.
(8) For patients with abnormal behaviors, intensive training should be repeated patiently. If the TA has the phenomenon of urinating and defecation anywhere, the family should grasp the patient's urination and defecation rules, and urge the TA to go to the toilet regularly, or prepare a simple sealed mobile toilet in the bedroom. Help the TA to develop a regular life. The activity time is not easy to be too long, and the surrounding environment should be relatively quiet; when the TA has unreasonable requirements, it should be dissuaded or distracted, or told that it is OK, but it needs to be delayed.
(9) Severely ill patients should take care of the mouth, teeth, ears and nose, hair, and clean and care of the perineum and skin. It is necessary to turn over, pat, and dry the bedding for bedridden patients, and ventilate regularly every day to prevent skin diseases or allergies. In addition, do some passive movement of the limbs and joints for the TA to maintain the normal functional position of the limbs and prevent joint deformities and muscle atrophy.
3. Other more specific details
(1) Family members and patients look at past photos together to train memory;
(2) Turn on the radio when nothing happens, listen to music, find a music channel, and perform music therapy;
(3) Watch TV news with the patient every day, explain the news, use the brain to strengthen the brain;
(4) Read the newspaper with the patient every day, explain the content, and use the brain to strengthen the brain;
(5) All things in daily life are written on the card, and if there is something, take a corresponding method to the patient;
(6) Let patients do more simple housework, take pictures with their mobile phones, show them when they are free, and train their memory;
(7) Accompany the patient to walk, go shopping, and shop, let others take pictures, and show the patients when they are free to train their memory;
(8) Set aside time every week to let the patient contact other relatives and friends by phone several times to enhance the feeling of home and train memory;
(9) Family members, relatives, and friends should strengthen their care for patients, visit and talk frequently to relieve psychological pressure;
(10) Equipped with anti-lost bracelets, mobile phones, shoes, etc., are all good measures.
4. Psychological counseling for the family members of patients
(1) Take care of your health, clothing, food, housing and transportation;
(2) Be patient and slowly develop your spiritual support;
(3) Relax and do what you like to do;
(4) Let family members, relatives and friends accompany more;
(5) It is important to encourage oneself and family members with more language;
(6) Have at least 1 hour of free time every day to relax yourself and relieve psychological pressure through activities such as walking, chatting, listening to music, etc.;
(7) Stay social and find your own "way of venting."
ADPrevention of other dementias
"The Lancet" International Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (Dementia prevention, intervention, and care: 2020 report of the Lancet Commission), the latest prevention and treatment strategy announced on July 30, 2020, the world over 40% dementia cases can be Effective prevention is achieved through intervention of risk factors. "The Lancet" International Committee on Dementia Prevention and Care (Karen Ritchie) proposed that "the care of dementia is first to strengthen prevention." A considerable part of the risk factors of dementia can be changed; the intervention process was simulated and found to be adopted. Public health prevention strategies can reduce the incidence of dementia by 30% in the next 10 years, or delay the onset of AD as much as possible. Even if it is delayed for 5 or 10 years, it will have a huge impact on the global economy. The program emphasizes risk factors that may change at multiple life stages, not just old age. The possible impact of the elimination of the strongest risk factors was evaluated and it was found that about 40% dementia cases could be attributed to 12 modifiable risk factors:
1. Early years (one item): 15 years of education can reduce the incidence of AD by about 7%;
2. Middle age (five items): hearing loss can increase the occurrence of AD by 8%; brain trauma can increase dementia by 3%; high blood pressure can increase dementia by 2%; alcoholism (drinking more than 21 units per week), yes Increase dementia by 1%; middle-aged obesity can increase dementia by 1%;
3. Old age (six items): Smoking can increase dementia by 5%; depression can increase dementia by 4%; social isolation (old loneliness) can increase dementia by 4%; lack of exercise can increase dementia by 2%; air pollution can increase dementia Increase dementia by 1%; diabetes, can increase dementia by 1%.
The addition of the above 12 risk factors can increase dementia by 40%, and these factors can be prevented. Of course, the health management of psychology, diet, and exercise is the most basic for the prevention of AD and other dementias. This is also the core content of health management.
The current medical level and various treatment methods have their own advantages or characteristics for AD and other dementias, but there are still many shortcomings. They can only delay symptoms. Prevention and health management are the most effective measures. These are issues that need to be addressed and improved by clinicians, nutritionists, health managers and researchers in order to unify their thinking and form a consensus. For the various complications of AD and other dementias, such as pneumonia, pyelonephritis, sepsis, multiple bedsores, side effects of drugs, mental trauma, etc., governments and communities at all levels should pay attention to the importance, feasibility and feasibility of health management. Effectiveness. I look forward to the cooperation between medical institutions, health management institutions and elderly care institutions at all levels to help patients with AD and other dementias pass the final stages of their lives, and to find the best solutions for each of us.
3. Gerhard Leinenga and Jürgen G?tz. Scanning ultrasound removes amyloid-β and restores memory in an Alzheimer's disease mouse model. Science Translational Medicine. 2015,7(278):278ra33. doi: 10.1126/scitranslmed.aaa2512
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