老年人轻度认知损害的中医证候研究

Study on the Syndrome of Senile Minor Cognitive Injury

目的 探讨老年人轻度认知损害 (MCI)患者的中医证候特点及其与神经心理学特征的关系 ,为中医早期干预痴呆提供辨证依据。方法 选择有轻度认知损害但尚不符合DSM -Ⅳ和NINCDS-ADRDA痴呆诊断标准的患者为观察对象。应用Folstein简易精神状态检查 (MMSE)和田金洲修订的Bristol最新神经心理学成套测验对MCI患者进行认知评估。参照《血管性痴呆辨证量表》拟订MCI的辨证草案 ,对MCI患者进行辨证 ,并对证候进行半定量积分。结果 MCI患者的最常见证候是肾精亏虚证 ,其次是痰浊阻窍证、瘀血阻络证、热毒内盛证、肝阳上亢证。经相关分析发现中医证候积分与认知指标得分呈负相关 :①肾精亏虚证与相似性显著相关 ;②痰浊阻窍证与完成图画、词语学习辨别指数非常显著相关 ,与即刻回忆故事、接受力、抄写数字速度显著相关 ;③瘀血阻络证与MMSE、延迟回忆故事、词语学习辨别指数显著相关 ,与接受力非常显著相关 ;④热毒内盛证与完成图画、完成图画年龄矫正分、接受力显著相关 ;⑤肝阳上亢证与词语学习辨别指数、抄写数字速度显著相关。结论 在MCI患者中 ,多见肾精亏虚证、痰浊阻窍证、瘀血阻络证、热毒内盛证和肝阳上亢证 ,它们与认知损害之间具有密切关系。我们认为肾精亏虚、痰浊、瘀血。

Objective Exploring into the characteristics of the syndrome of senile minor cognitive injury (MCI) and the relationship between which with neuropsychology, and providing differentiation basis for early intervention of dementia with TCM. Method Patients who suffered from MCI but not meet the diagnosis standard of DSM-IV and NINCDS-ADRD were chosen as observing objects. Folstein MMSE and the newest neuropsychological test battery of Bristol revised by Tian Jinzhou were applied to measured above patients. Then a syndrome differentiation plan of MCI was made out by reference to Differentiation Scale of Vascular Dementia with which the patients' syndromes were differentiated and their half-quantitative integrals were defined. Result The most common syndrome of MCI was kidney deficiency. The other ones were phlegm obstructing orifices, blood stasis in collaterals, heat-poison in the interior and hyperactivity of liver-yang. There was a negative correlation between syndrome integral and cognitive index score by the relative analysis. 1. There was a remarkable correlation between the syndrome of kidney deficiency and resemblance. 2. There was a remarkable in the extreme correlation between the syndrome of phlegm obstructing orifices and picture-finishing, distinguish index of word-learning, and a notable correlation with instant story-recalling, receptivity and speed of number-copying. 3. There was a remarkable correlation between the syndrome of blood stasis in collaterals and MMSE, delay story-recalling and distinguish index of word-learning, and a notable in the extreme correlation with receptivity. 4. There was a remarkable correlation between the syndrome of heat-poison in the interior and picture-finishing, its age rectify score and receptivity. 5. There was a remarkable correlation between the syndromes of hyperactivity of liver-yang and distinguish index of word-learning, speed of number-copying. Conclusion Among MCI patients, syndromes of kidney deficiency, phlegm obstructing orifices, blood stasis in collaterals, heat-poison in the interior and hyperactivity of liver-yang were common, which had close relationship with cognitive injury. We thought that the syndromes of kidney deficiency, phlegm obstructing orifices, blood stasis in collaterals, heat-poison in the interior and hyperactivity of liver-yang were basic pathologic factors causing cognitive injury as well as objective basis of syndrome differentiation and treatment of MCI patients. TCM can be used to intervene MCI starting with these factors. It will be significance for preventing dementia.