浅谈MCI的情志病机及气郁体质致MCI的认知神经心理学研究思路

An Overview of the Emotional Pathogenesis of MCI and the Cognitive Neuropsychological Research Ideas of MCI Caused by the Constitution of Qi-Stagnation

处于正常脑老化和老年痴呆之间的轻度认知功能障碍(Mild cognitive impairment,MCI)被公认为是延缓认知衰退进展为痴呆甚至逆转为正常脑老化的关键窗口期。益智缓衰、护脑防老和未病养生是中医体质学说的优势领域,其中长期情志不畅的气郁体质与MCI的发生发展和恶化休戚相关,是MCI的好发体质之一。迄今为止尚无公认和高质量证据报道的认知衰退早期特征性成分,近期多项研究表明大脑认知控制核心成分之一的认知灵活性损伤发生在认知衰退的更早期阶段,可能是MCI的早期特异敏感指标。本文初步梳理了MCI的长期情志不畅肝气郁结、肝气亢逆和肝气虚弱病因病机,并基于认知灵活性视角试提出使用神经心理学量表结合现代认知神经科学技术如事件相关电位、功能磁共振成像、眼动和近红外光谱成像等以多角度、全方位、立体化考察长期情志不畅气郁体质致脑老化加速的研究思路,为MCI的情志病因病机研究提供理论参考,为从中医肝藏象和体质学说入手“调体干预”认知功能衰退过速类疾病提供新视角、方法和思路。

Mild cognitive impairment(MCI)between normal brain aging and senile dementia is recognized as a key window to delay the progression of cognitive decline to dementia or even reverse to normal brain aging.Enlightening and delaying aging,protecting the brain and preventing aging,and maintaining health before illness are the dominant areas of the physique theory of traditional Chinese medicine,among which the constitution of Qi-stagnation with long-term emotional disorder is closely related to the occurrence,development and deterioration of MCI,which may be one of the prone physique of MCI.So far,there is no recognized and high-quality evidence to report the characteristic components of the early stage of cognitive decline.Recent studies have shown that the impairment of cognitive flexibility of one of the core components of brain cognitive control occurs in the earlier stage of cognitive decline,it may be an early specific sensitive index of MCI.This paper preliminarily combs the etiology and pathogenesis of MCI with long-term dysphoria and stagnation of liver-qi,hyperactivity of liver-qi and weakness of liver-qi,and puts forward the research idea of using neuropsychological scale combined with modern cognitive neuroscience techniques such as event-related potentials,functional magnetic resonance imaging,eye movement and near-infrared spectroscopy imaging to investigate the acceleration of brain aging caused by long-term emotional disturbance and qi depression in multi-angle,omnidirectional and three-dimensional way.The purpose of this study is to provide theoretical reference for the study of emotional etiology and pathogenesis in MCI,and to provide new perspectives,methods and ideas for the treatment of diseases with excessive cognitive decline from the perspective of liver visceral manifestations and the constitution of traditional Chinese medicine.