Cognitive Disorders Specialty

Ⅰ. Overview of Alzheimer’s Disease

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder characterized by insidious onset and gradual deterioration of cognitive function. It is the most common cause of dementia in older adults. The major clinical manifestations include progressive memory impairment, executive dysfunction, language impairment, and visuospatial deficits. As the disease advances, patients may develop neuropsychiatric and behavioral symptoms, accompanied by progressive loss of activities-of-daily-living capacity, and ultimately loss of functional independence. The prevalence of Alzheimer’s disease increases substantially with age. Epidemiological studies have consistently demonstrated that the burden of AD rises markedly among individuals aged 65 years and older and is particularly high in the oldest age groups. With continuing population aging worldwide, Alzheimer’s disease and other forms of dementia represent an increasingly important public health challenge.

Ⅱ. Specialized Treatment Approaches

1. Pharmacological Therapy

Anti-amyloid-β (Aβ) monoclonal antibodies represent an important advance in disease-modifying therapy for Alzheimer’s disease. These therapies target aggregated forms of amyloid-β and promote their cerebral clearance, thereby reducing cerebral amyloid burden and slowing clinical decline in appropriately selected patients with early-stage Alzheimer’s disease. Representative agents include lecanemab and donanemab, which have been approved in several countries or regions for appropriately selected patients with mild cognitive impairment (MCI) or mild dementia due to Alzheimer’s disease with confirmed amyloid pathology. The clinical application of disease-modifying therapies requires comprehensive patient selection and standardized evaluation, including confirmation of the underlying AD pathology, assessment of disease stage, identification of potential treatment-related risks, and appropriate monitoring throughout treatment.

2. Neuromodulation

Neuromodulation represents an emerging non-pharmacological approach that modulates neuronal and neural network activity through physical or electrical stimulation, with the aim of improving or preserving cognitive function. Non-invasive neuromodulation techniques explored in patients with cognitive impairment include repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), and transcutaneous auricular vagus nerve stimulation (taVNS). These technologies provide additional avenues for research and clinical exploration in cognitive disorders and may complement pharmacological treatment and cognitive rehabilitation within a comprehensive management strategy.

Ⅲ. Cognitive Disorders Team

Supported by the Tianjin Dementia Research Institute, the Cognitive Disorders Team of the Department of Neurology at Tianjin Huanhu Hospital has long been dedicated to the clinical care and research of Alzheimer’s disease, vascular cognitive impairment, frontotemporal dementia, dementia with Lewy bodies, Parkinson’s disease-related cognitive impairment and dementia, as well as cognitive dysfunction and neuropsychiatric symptoms associated with a broad range of neurological disorders. The team advocates a comprehensive strategy emphasizing early recognition, early screening, early diagnosis, and early intervention. In 2006, the hospital was among the earliest institutions in China to establish a dedicated Memory Clinic. The Dementia Diagnosis and Treatment Center of Tianjin Huanhu Hospital was established in 2011, followed by the establishment of the Tianjin Dementia Research Institute. In 2022, the hospital was approved as a National Advanced Center for the Diagnosis and Treatment of Cognitive Disorders (Development Unit). Following more than two decades of continuous development, the hospital has established a comprehensive clinical and research platform for dementia and cognitive disorders, with extensive expertise in the diagnosis, treatment, rehabilitation, and long-term management of patients with cognitive impairment. The team has also established academic collaboration and exchange with international institutions, including the Dementia Center at the University of Würzburg in Germany and Alzheimer’s disease research institutions at the University of South Florida in the United States. Leveraging the hospital’s multidisciplinary strengths, the Center has developed an integrated “education–prevention–diagnosis–treatment–cognitive rehabilitation” pathway bridging outpatient and inpatient services. The diagnostic platform incorporates advanced technologies including multi-tracer PET-CT/MRI, multimodal magnetic resonance imaging (MRI), genetic testing, and biomarker analysis of peripheral blood and cerebrospinal fluid (CSF) to support the early and precise diagnosis and differential diagnosis of cognitive disorders. A dedicated Cognitive Disorders Clinic has been established, staffed by specialists with extensive experience in the diagnosis and management of dementia and related disorders. Dedicated neuropsychological assessment rooms and trained professional assessors provide comprehensive standardized evaluation of multiple cognitive domains. Through the integration of clinical assessment, neuropsychological testing, advanced neuroimaging, molecular biomarkers, genetic testing, pharmacological treatment, neuromodulation, and cognitive rehabilitation, the Center provides individualized and comprehensive management throughout the course of cognitive disorders.

Ⅳ. Other Major Cognitive Disorders

1. Vascular Cognitive Impairment

Vascular cognitive impairment (VCI) encompasses a spectrum of cognitive impairment ranging from mild cognitive deficits to vascular dementia that is attributable to or associated with cerebrovascular disease and vascular risk factors. Compared with typical Alzheimer’s disease, patients with VCI may exhibit more prominent impairment in executive function, attention, and information-processing speed, although the clinical phenotype varies according to the location, type, and extent of cerebrovascular injury. Memory impairment may also occur, and some patients present with mood, behavioral, or personality changes. The underlying cerebrovascular pathology may include ischemic or hemorrhagic stroke, cerebral small vessel disease, white matter hyperintensities, lacunar infarcts, cerebral microbleeds, and enlarged perivascular spaces. These pathological processes may disrupt frontal–subcortical circuits and other cognitive networks, contributing to progressive cognitive decline. VCI represents an important cause of cognitive impairment and dementia, particularly among patients with a history of stroke or multiple vascular risk factors. Hypertension, diabetes mellitus, dyslipidemia, smoking, and other vascular risk factors may increase the risk of cognitive deterioration. Cerebrovascular pathology also frequently coexists with Alzheimer’s disease pathology, contributing to mixed dementia.

2. Dementia with Lewy Bodies

Dementia with Lewy bodies (DLB) is a major neurodegenerative cause of dementia. Its characteristic clinical manifestations include fluctuating cognition, recurrent well-formed visual hallucinations, REM sleep behavior disorder, and spontaneous parkinsonism. Cognitive fluctuations may occur over relatively short periods, while parkinsonian manifestations commonly include bradykinesia, rigidity, and gait impairment. Autonomic dysfunction and other neuropsychiatric manifestations are also common. Patients with DLB may exhibit marked sensitivity to certain antipsychotic medications, making accurate diagnosis particularly important for clinical management. The major pathological hallmark of DLB is the abnormal accumulation of α-synuclein in Lewy bodies and Lewy neurites throughout cortical and subcortical structures. Coexisting Alzheimer’s disease pathology is also frequently observed. Because the clinical manifestations of DLB overlap with those of Alzheimer’s disease and Parkinson’s disease dementia, comprehensive clinical assessment, biomarker evaluation when appropriate, and careful differential diagnosis are important for accurate recognition and individualized management.

3. Frontotemporal Lobar Degeneration

Frontotemporal lobar degeneration (FTLD) comprises a heterogeneous group of neurodegenerative disorders characterized predominantly by progressive degeneration of the frontal and temporal lobes and represents an important cause of young-onset dementia. Major clinical syndromes associated with FTLD include behavioral variant frontotemporal dementia (bvFTD) and forms of primary progressive aphasia (PPA). Patients with bvFTD typically develop progressive changes in personality, social behavior, emotional regulation, motivation, and executive function. Primary progressive aphasia is characterized predominantly by progressive impairment of language function.

At the neuropathological level, FTLD is heterogeneous and is commonly associated with abnormal accumulation of proteins including tau and TAR DNA-binding protein 43 (TDP-43), while other pathological subtypes also occur. FTLD frequently develops at a younger age than Alzheimer’s disease. Because early behavioral and personality changes may resemble primary psychiatric disorders, and progressive language abnormalities may initially be attributed to other neurological conditions, early recognition and accurate differential diagnosis are particularly important.

Through the integration of neurology, neuropsychology, advanced neuroimaging, molecular biomarkers, genetic testing, pharmacological therapy, neuromodulation, cognitive rehabilitation, specialized nursing, and long-term follow-up, the Cognitive Disorders Specialty at Tianjin Huanhu Hospital has established a comprehensive diagnostic and therapeutic pathway for patients with Alzheimer’s disease and other cognitive disorders.

The Center remains committed to advancing early detection, precise diagnosis, individualized intervention, cognitive rehabilitation, and full-course disease management, while promoting clinical research and multidisciplinary innovation in the field of cognitive disorders.