Clinical significance of nutritional intervention in four-level prevention strategy of Alzheimer's disease
1Xu Jun ,1Jiang Jiwei ,2Shi Hanping
1Department of Cognitive Impairment Neurology Center Beijing Tiantan Hospital Capital Medical University National Clinical Research Center for Neurological Diseases Beijing 100070 China
2Department of Gastrointestinal Surgery / Clinical Nutrition Beijing Shijitan Hospital Capital Medical University Key Laboratory of Cancer FSMP for State Market Regulation Beijing 100038 China
摘要随着老龄化程度日益加剧,阿尔茨海默病(AD)作为老年人最常见的痴呆原因,现已成为我国公共卫生面临的巨大
且严峻的挑战。 近年来,基于 Aβ 蛋白、病理性 Tau 蛋白及神经变性生物标志物的“ATN”研究框架的提出,强调了 Aβ 蛋白和
过度磷酸化的 Tau 蛋白在 AD 连续疾病谱中的核心地位,但在过去的 20 年里,单一靶向清除 Aβ 蛋白和磷酸化 Tau 蛋白的药
物临床试验均以失败告终。 AD 仍以对症治疗为主,代表药物是胆碱酯酶抑制剂和美金刚,是药物治疗研究进展中最缓慢的
领域之一。 这些证据提示 AD 作为多因素、多病理途径参与的复杂脑疾病综合征,“基因—蛋白—疾病”的简单还原论必将陷
入误区,应将营养、生活方式、危险因素调控等非药物干预作为预防或延缓 AD 的基本措施。 最新发布的专家共识提出“早期、
协同、整体、长期”的营养干预原则,强调膳食营养等生活方式调节作为 AD 相关认知障碍的管理策略,在预防和延缓疾病进
程、改善整体预后中的重要地位。 然而,临床对现代膳食结构和生活方式带来的影响仍认识不足,AD 脑健康营养干预理念严
重滞后,神经病学、老年医学、营养学等在 AD 的多学科综合管理体系仍未建立。 鉴于此,本文梳理了目前国内外关于 AD 和
膳食营养的研究证据,提出 AD“四级预防”策略这一新的理念,并强调膳食营养干预在每一级预防中的重要地位,为我国 AD
相关认知障碍的综合防治水平提供新的思路。
Abstract：With the rising aged tendency of population Alzheimers disease AD the leading cause of dementia in the elderly is
the greatest and sharp increasing challenge for global public health and social care in the 21st century. Recently ATN research
framework has emphasized the core role of amyloid β Aβ plaques and hyperphosphorylated Tau-protein in the AD continuum. However over the past two decades clinical trials of single-agent drug targeted Aβ and Tau have frequently failed to cure or prevent disease progression in AD. Ad is still based on symptomatic treatment and the representative drugs are cholinesterase inhibitors and memantine. AD is among the least well-served therapeutic areas for drug treatments. These evidence have suggested that AD as a complex
and multifaceted disease its management should turn the attention from single-agent drug to diet and lifestyle regulation and risk factors control. However there are significant gaps in knowledge in the impact of modern dietary structure and lifestyle changes. The important value of brain health and nutrition intervention in AD still remain unclear. The multidisciplinary comprehensive management
strategy of Neurology Geriatrics and Clinical Nutrition is yet to be established. This review summarized the current evidence on diet
and nutrition in AD patients. We wish to propose the term of four- level prevention strategy of AD and the effect of nutrition in each
level of prevention to provide new direction for the comprehensive management of AD in China.
