血管性痴呆诊断、辨证及疗效评定标准(研究用)

Criteria for the diagnosis, the differentiation of syndrome and the evaluation of efficacy of vascular dementia for research studies

血管性痴呆 (Va D)是由缺血性或出血性中风或缺血缺氧性脑损害导致的以认知损害为特征的一个综合征。为了适应我国痴呆领域临床研究的需要 ,中国中医药学会内科延缓衰老专业委员会痴呆工作小组完成了血管性痴呆诊断、辨证及疗效评定标准 (研究用 )的研究 (简称《Va D标准 (研究版 )》)。与我国现行的其他标准相比 ,本标准强调 :(1 )血管性痴呆的诊断必具痴呆、脑血管病和上述两种损害之间的因果关系 ;(2 )痴呆程度 (可疑、轻、中、重 )的确定采用临床痴呆评定表 (CDR) ;(3)痴呆中抑郁症评定量表 (CSDD) >8分与抑郁症鉴别 ,Hachinski缺血量表≥ 7分 ,除外阿尔茨海默病 ;(4)中医辨证采用 SDSVD量表 (肾精亏虚、痰浊阻窍、瘀血阻络、肝阳上亢、热毒内蕴、腑滞浊留、气血两虚 ) ;(5)疗效判定分为显效、有效、无效和恶化 ,并循证评价认知、行为、日常生活能力、总体印象和中医证候的疗效。本标准可作为临床研究中病例选择和疗效评定的指南 ,期待着试用和验证 ,并进一步修订和完善。

Criteria for the diagnosis, the differentiation of syndrome of vascular dementia and the method of evaluating effectiveness readily applicable in a variety of settings are urgently needed for both clinical and research purposes in China. To address this need, the Delaying-ageing Committee of Internal Medicine Branch of China Association of Chinese Medicine and Pharmacy (CNCMP-DCIMB) National Workgroup has completed a project,funded by the Scientific Research Foundation of Health Ministry of China, resulting in research criteria for the diagnosis and the differentiation of syndrome and evaluation of efficacy in VaD. Compared with other current criteria used, these guidelines emphasize: (1) the diagnosis of VaD met the NINDS-AIREN criteria; (2) the severity of dementia rated on the CDR,stratified by levels of certainty (questionable, mild, moderate, severe); (3) the exclusion of depression and AD respectively based on the CSDD and the HIS; (4) the differentiation of syndromes in Chinese medicine based on the SDSVD,differentiated by differences of certainty (deficiency of kidney essence, brain disturbed by phlegm, vessels obstructed by blood stasis, brain aggressed by liver's Yang, heat & toxin excess inside brain, constipation & toxin in intestines,insufficiency of Qi &blood); (6) the evidence-based efficacy in cognitive domains, behaviours, activities of daily living, global changes and syndromes in Chinese medicine evaluated by levels of certainty (cure, much better, better, no changes, worse). These criteria are intended as a guide for case definition and efficacy evaluation in neuroepidemiologic studies or clinical trials. They wait testing and validation and will be revised as more information becomes available.