Prof. Craig Ritchie, University of Edinburgh, United Kingdom,
J Prev Alzheimers Dis. 2022;9(2):348-358. doi: 10.14283/jpad.2021.63.
In order to address the oft-cited societal, economic, and health and social care impacts of neurodegenerative diseases, such as Alzheimer's disease, we must move decisively from reactive to proactive clinical practice and to embed evidence-based brain health education throughout society. Most disease processes can be at least partially prevented, slowed, or reversed. We have long neglected to intervene in neurodegenerative disease processes, largely due to a misconception that their predominant symptom - cognitive decline - is a normal, age-related process, but also due to a lack of multi-disciplinary collaboration. We now understand that there are modifiable risk factors for neurodegenerative diseases, that successful management of common comorbidities (such as diabetes and hypertension) can reduce the incidence of neurodegenerative disease, and that disease processes begin (and, crucially, can be detected, reduced, and delayed, prevented, or treated) decades earlier in life than had previously been appreciated. Brain Health Scotland, established by Scottish Government and working in partnership with Alzheimer Scotland, propose far-reaching public health and clinical practice approaches to reduce neurodegenerative disease incidence. Focusing here on Brain Health Scotland's clinical offerings, we present the Scottish Model for Brain Health Services. To our knowledge, the Scottish Model for Brain Health, built on foundations of personalised risk profiling, targeted risk reduction and prevention, early disease detection, equity of access, and harnessing comprehensive data to assist in clinical decision-making, marks the first example of a nationwide approach to overhauling clinical, societal, and political approaches to the prevention, assessment, and treatment of neurodegenerative disease.
为了解决神经退行性疾病（如阿尔茨海默病）给社会、经济以及健康和社会保健带来的常被提及的影响，我们必须果断地从被动的临床实践转向主动的临床实践，并在整个社会中嵌入基于证据的大脑健康教育。大多数疾病过程至少可以部分预防、减缓或逆转。我们长期以来忽视了对神经退行性疾病过程的干预，主要是因为存在一种误解，即其主要症状——认知能力下降——是一种正常的、与年龄相关的过程，但也因为缺乏多学科合作。我们现在知道，神经退行性疾病有可改变的风险因素，成功管理常见的合并症（如糖尿病和高血压）可以降低神经退行性疾病的发病率，而且疾病过程早在人们意识到的几十年前就开始了（而且至关重要的是，可以被检测、减少、延迟、预防或治疗）。苏格兰大脑健康组织由苏格兰政府成立，与阿尔茨海默病苏格兰组织合作，提出了深远的公共卫生和临床实践方法来降低神经退行性疾病的发病率。在这里，我们重点介绍苏格兰大脑健康服务的临床服务，提出苏格兰大脑健康服务模式。据我们所知，苏格兰大脑健康模式建立在个性化风险分析、有针对性的风险降低和预防、早期疾病检测、公平获得服务以及利用综合数据协助临床决策的基础上，这标志着全国范围内彻底改革预防、评估和治疗神经退行性疾病的临床、社会和政治方法的第一个范例。
