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      Comprehensive Management of Daily Living Activities, behavioral and Psychological Symptoms, and Cognitive Function in Patients with Alzheimer's Disease: A Chinese Consensus on the Comprehensive Management of Alzheimer's Disease

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          Abstract

          Alzheimer's disease (AD) is the most common cognitive disorder in the elderly. Its main clinical manifestations are cognitive decline (C), behavioral and psychological symptoms (B), and a decline in the activities of daily living (A), also known as ABC symptoms. Early identification and evaluation of ABC symptoms are helpful for establishing the accurate diagnosis, comprehensive treatment, and prognosis of AD. To guide Chinese clinical practice for optimization of the comprehensive management of AD, in 2018, The Academy of Cognitive Disorder of China gathered 22 neurologists and gerontologists in China to build a consensus on the comprehensive management of AD. Based on a review of the evidence, the consensus summarizes the pathogenesis, pathological changes, clinical manifestations, evaluation, diagnosis, drug and non-drug treatment, and patient care for AD. Focus group discussion was used to establish a flowchart of comprehensive ABC management for AD patients. The new consensus provides a feasible AD management process for clinicians.

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          NIA-AA Research Framework: Toward a biological definition of Alzheimer’s disease

          Clifford R. Jack, David Bennett, Kaj Blennow … (2018)
          In 2011, the National Institute on Aging and Alzheimer’s Association created separate diagnostic recommendations for the preclinical, mild cognitive impairment, and dementia stages of Alzheimer’s disease. Scientific progress in the interim led to an initiative by the National Institute on Aging and Alzheimer’s Association to update and unify the 2011 guidelines. This unifying update is labeled a “research framework” because its intended use is for observational and interventional research, not routine clinical care. In the National Institute on Aging and Alzheimer’s Association Research Framework, Alzheimer’s disease (AD) is defined by its underlying pathologic processes that can be documented by postmortem examination or in vivo by biomarkers. The diagnosis is not based on the clinical consequences of the disease (i.e., symptoms/signs) in this research framework, which shifts the definition of AD in living people from a syndromal to a biological construct. The research framework focuses on the diagnosis of AD with biomarkers in living persons. Biomarkers are grouped into those of β amyloid deposition, pathologic tau, and neurodegeneration [AT(N)]. This ATN classification system groups different biomarkers (imaging and biofluids) by the pathologic process each measures. The AT(N) system is flexible in that new biomarkers can be added to the three existing AT(N) groups, and new biomarker groups beyond AT(N) can be added when they become available. We focus on AD as a continuum, and cognitive staging may be accomplished using continuous measures. However, we also outline two different categorical cognitive schemes for staging the severity of cognitive impairment: a scheme using three traditional syndromal categories and a six-stage numeric scheme. It is important to stress that this framework seeks to create a common language with which investigators can generate and test hypotheses about the interactions among different pathologic processes (denoted by biomarkers) and cognitive symptoms. We appreciate the concern that this biomarker-based research framework has the potential to be misused. Therefore, we emphasize, first, it is premature and inappropriate to use this research framework in general medical practice. Second, this research framework should not be used to restrict alternative approaches to hypothesis testing that do not use biomarkers. There will be situations where biomarkers are not available or requiring them would be counterproductive to the specific research goals (discussed in more detail later in the document). Thus, biomarker-based research should not be considered a template for all research into age-related cognitive impairment and dementia; rather, it should be applied when it is fit for the purpose of the specific research goals of a study. Importantly, this framework should be examined in diverse populations. Although it is possible that β-amyloid plaques and neurofibrillary tau deposits are not causal in AD pathogenesis, it is these abnormal protein deposits that define AD as a unique neurodegenerative disease among different disorders that can lead to dementia. We envision that defining AD as a biological construct will enable a more accurate characterization and understanding of the sequence of events that lead to cognitive impairment that is associated with AD, as well as the multifactorial etiology of dementia. This approach also will enable a more precise approach to interventional trials where specific pathways can be targeted in the disease process and in the appropriate people.
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            Dementia prevention, intervention, and care

            Gill Livingston, Andrew Sommerlad, Vasiliki Orgeta … (2018)
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              The Clinical Dementia Rating (CDR): current version and scoring rules.

              J Morris (1993)
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                Author and article information

                Contributors
                Jianjun Jia:
                ORCID: https://orcid.org/0000-0002-0747-4132
                jiajianjun301@126.com
                Journal
                Journal ID (nlm-ta): Neurosci Bull
                Journal ID (iso-abbrev): Neurosci Bull
                Title: Neuroscience Bulletin
                Publisher: Springer Singapore (Singapore )
                ISSN (Print): 1673-7067
                ISSN (Electronic): 1995-8218
                Publication date (Electronic): 29 May 2021
                Publication date PMC-release: 29 May 2021
                Publication date Collection: July 2021
                Volume: 37
                Issue: 7
                Pages: 1025-1038
                Affiliations
                [1 ]GRID grid.414252.4, ISNI 0000 0004 1761 8894, Department of Neurology, , The Second Medical Center, People’s Liberation Army General Hospital, ; Beijing, 100853 China
                [2 ]GRID grid.411617.4, ISNI 0000 0004 0642 1244, Department of Neurology, , Beijing Tiantan Hospital, Capital Medical University, ; Beijing, 100050 China
                [3 ]GRID grid.412536.7, ISNI 0000 0004 1791 7851, Department of Neurology, , Sun Yat-sen Memorial Hospital, Sun Yat-sen University, ; Guangzhou, 510120 China
                [4 ]GRID grid.452897.5, ISNI 0000 0004 6091 8446, Cognitive Impairment Department, , Shenzhen Kangning Hospital, ; Shenzhen, 518118 China
                [5 ]GRID grid.410570.7, ISNI 0000 0004 1760 6682, Department of Neurology, , Daping Hospital, Army Medical University, ; Chongqing, 400042 China
                [6 ]GRID grid.412636.4, Department of Neurology, , The First Hospital of China Medical University, ; Shenyang, 210112 China
                [7 ]GRID grid.412528.8, ISNI 0000 0004 1798 5117, Department of Gerontology, , Shanghai Jiaotong University Affiliated Sixth People’s Hospital, ; Shanghai, 200233 China
                [8 ]GRID grid.452438.c, Department of Neurology, , The First Affiliated Hospital of Xi’an Jiaotong University, ; Xi’an, 710061 China
                [9 ]GRID grid.413259.8, ISNI 0000 0004 0632 3337, Department of Neurology, , Xuanwu Hospital Capital Medical University, ; Beijing, 100053 China
                [10 ]GRID grid.413597.d, ISNI 0000 0004 1757 8802, Department of Neurology, , Huadong Hospital Affiliated to Fudan University, ; Shanghai, 200040 China
                [11 ]GRID grid.413247.7, Department of Neurology, , Zhongnan Hospital of Wuhan University, ; Wuhan, 430071 China
                [12 ]Department of Psychology, Chinese Academy of Sciences Cancer Hospital of the University of the Chinese Academy of Sciences, Hangzhou, 310022 China
                Author information
                https://orcid.org/0000-0002-0747-4132
                https://orcid.org/0000-0003-1046-6536
                Article
                Publisher ID: 701
                DOI: 10.1007/s12264-021-00701-z
                PMC ID: 8275730
                PubMed ID: 34050523
                SO-VID: f9db043d-57c5-45e8-9925-1b7413fb4d01
                Copyright © © The Author(s) 2021, corrected publication 2021
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 8 September 2020
                Date accepted : 6 January 2021
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences 2021

                Keywords: alzheimer's disease,comprehensive management,activities of daily living,behavioral and psychological symptoms,cognitive function
                Data availability:
                Keywords: alzheimer's disease, comprehensive management, activities of daily living, behavioral and psychological symptoms, cognitive function

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