化呆醒神汤对大鼠血管性痴呆模型行为学影响的研究

为了观察化呆醒神汤对血管性痴呆大鼠行为学的影响 ,使用改良的四血管法复制成功血管性痴呆(VD)大鼠 ,术后当天即开始使用化呆醒神汤 (中药治疗组 )和喜得镇 (西药对照组 )治疗 ,行为学实验表明 ,化呆醒神汤和喜得镇两治疗组均能明显缩短水迷宫试验中游全程时间 ,减少进入盲端错误次数 ,改善VD大鼠空间学习辨别能力 ,且中、西药组相比无显著性差异 :在跳台和避暗试验中 ,两治疗组均能显著延长逃避潜伏期 ,明显减少错误次数 ,且在跳台试验中 ,中药组效果优于西药组 ,在避暗试验中 ,中、西药组相比无显著性差异。由此可见 ,化呆醒神汤可显著改善VD大鼠学习记忆障碍。

持续性植物状态(PVS)的中医证治

PVS是一种特殊类型的神昏,特征是睁眼若视,貌似清醒,静卧不动,不识人事,中医无此病名,应命名为"神呆"。其病因病机为先天不足,邪热犯脑,情志失调,颅脑损伤,毒邪入中,髓海不足;病位在脑,病性本虚标实,因实致虚,以虚为主;其气血亏虚,痰瘀阻窍,神明闭阻贯穿始终。病理关键是虚、瘀、痰三端。因此,宜益气养血、化痰祛瘀、开窍醒神,药宜温而动;自拟益神启窍方,方用黄芪、当归、麝香、桃仁、石菖蒲、白芷。

化呆醒神汤对大鼠血管性痴呆模型病理变化及胆碱能纤维的影响

本实验采用反复缺血再灌方法复制出血管性痴呆 (VD)动物模型 ,以具有调理脾胃、消痰化瘀功效的化呆醒神汤进行治疗。光、电镜观察发现VD大鼠海马CA1区大量神经元出现变性、坏死及脱失 ,线粒体肿胀、空泡样变性、突触变性 ;组织染色及定量分析发现VD大鼠海马CA1区、额叶皮质内乙酰胆碱酯酶 (AchE)阳性纤维数量显著减少。化呆醒神汤可以明显减轻VD大鼠海马CA1区神经元损伤 ,增加海马CA1区、额叶皮质内AchE阳性纤维数量。

Role of antipsychotics for treating behavioral and psychological symptoms of dementia

Over the past three decades, concerns about the high prevalence of antipsychotic use in the nursing homes （NHs） for the management of behavioral and psychological symptoms of dementia continue to be emphasized and intervened by many. However, despite the numerous side effects and the recent blackbox warning by the United States Food and Drug Administration about the increased risks for stroke and sudden death associated with the use of antipsychotics in dementia, the preva-lence of antipsychotic use in NHs remains high. While the use of antipsychotics appeared to have modest effcacy in reducing symptoms of aggression and psychosis in dementia, there is insuffcient evidence to routinely rec-ommend the use of alternative psychopharmacological treatments for these symptoms. Hence, clinicians have to balance the safety warnings against the need to treat these symptoms in order to prevent harm to the resident that may result from his/her dangerous behaviors. Although the use of antipsychotics may be warranted in some cases, organizational, resource and training support should be provided to encourage and equip NH staff to participate in interventions so as to minimize inappropriate use of these medicines in NHs. This review will discuss the place in therapy, the trend and appropriateness of antipsychotic use in NHs, as well as the effectiveness of current and future strategies for reducing antipsychotic use in the NHs.

Atorvastatin attenuates oxidative stress in Alzheimer's disease

Objective： To investigate serum level of SOD, MDA, ox-LDL, AchE and Ach in AD, to study atorvastatin influence on serum level of SOD, MDA, ox-LDL, Ache and Ach in AD and its neuroprotection mechanisms. Methods Subjects were divided into： normal blood lipid level group with Alzheimer＇s disease （A）, higher blood lipid level group with Alzheimer＇s disease （AH）, normal blood lipid level Alzheimer＇s disease group with atorvastatin treeatment （AT）, higher blood lipid level Alzheimer＇s disease group with atorvastatin treeatment（AHT）. Ox-LDL was measured by enzyme linked immunosorbent assay; SOD, MDA, ox-LDL, AchE, Ach and blood lipid level in AD was measured by biochemistry. Results： The serum level of MDA, Ache in AH group after atorvastatin treatment is lower ;The serum level of SOD, Ach in AH group is more increased than that of in A group; The serum level of ox-LDL in AH, A groups is lower than that of in A group; The dementia degree is lower after atorvastatin treatment. Conclusion： Atorvastatin can decrease serum level of MDA, AchE and ox-LDL, and increase that of SOD, Ach, and attenuate dementia symptom in AD, especially, with hyperlipemia. The hypothesis of atorvastatin neuroprotection is concluded that atorvastatin may restrain free radical reaction and retard oxidation in AD.

A preliminary study of the Six-Item Screener in detecting cognitive impairment

Objective The present retrospective study was to explore the clinical value of Six-Item Screener （SIS）, which is constituted by 6 items from mini-mental status examination （MMSE）, to identify cognitive impairment. Methods A total number of 1976 patients aged over 50 years, from the Memory Clinic of Huashan Hospital were employed in a battery of neuropsychological tests including MMSE. Subjects with severe conditions, unable to cooperate, or having been previously enrolled, were excluded from this study. The employed subjects were divided into 3 groups： subjective memory complaints （SMCs） （475 cases）, patients with mild cognitive impairment （MCI） （440 cases）, and patients with Alzheimer＇s disease （AD） （1061 cases, including 555 mild, 339 moderate, and 167 severe）. A total score of MMSE and a score of SIS composed of date, month, year, three-word delayed recall from MMSE were calculated. Data were analyzed based on educational background. Results The cut-off of SIS score was 〈 2 for illiterate, 〈 3 for elementary, and 〈 4 for junior high school or above. The sensitivity and specificity of SIS for detecting mild AD were 88.5% and 78.3%, respectively, with an overall accuracy of 83.8%, while for detecting MCI, the sensitivity and specificity were 34.3% and 90.1%, respectively, with an overall accuracy of 63.2%. Conclusion SIS is an effective and reliable instrument for dementia detection in outpatient department. However, it has limited value for MCI identification.

Comparative Study on the Effect of Baihui （GV 20）, Shuigou （GV 26） and Shenmen （HT 7） on Cognition of Patients with Vascular Dementia

Objective： To study the relative specificity of Baihui （GV 20）, Shuigou （GV 26） and Shenmen （HT 7） in improving the cognitive function of patients with vascular dementia （VD）. Method： Fifty VD cases were randomized into 5 groups, which were treated with routine points, routine points plus Baihui （GV 20）, routine points plus Shuigou （GV 26）, routine points plus Shenmen （HT 7）, and routine points plus the above-mentioned three points together respectively. The scale of elderly cognitive function （SECF） was measured before and after the treatment for statistical management. Results： The total score of SECF was markedly increased after Baihui （GV 20）, Shuigou （GV 26） and Shenmen （HT 7） were added to the routine points, more specifically, with addition of Baihui （GV 20）, the patients with VD got increased scores in such aspects as orientation, instant memory, long-term anamnesis, animal names, cancellation and calculation, and classification and analogy; with addition of Shuigou （GV 26）, the patients with VD got increased scores in such aspects as orientation, cancellation and calculation, and classification and analogy; with addition of Shenmen （HT 7）, the patients with VD got increased scores in such aspects as digital scope, animal names, and classification and analogy. Conclusion： Baihui （GV 20）, Shuigou （GV 26） and Shenmen （HT 7） could improve the cognitive function of patients with VD, and the combination of the three points got the best result despite their respective specificity.

Specific Effects of Needling Different Acupoints of Patients with Vascular Dementia

Objective： To observe the effects of needling Baihui （GV 20）, Shuigou （GV 26） and Shenmen （HT 7） on cerebral glucose metabolism in patients with vascular dementia （VD） by cerebral functional imaging technique. Methods： Twenty-five patients with VD were divided into 5 groups （Group A, B, C, D and E） randomly. Patients in the Group A were treated by needling routine acupoints for hemiplegia （Acupoints of the three yang meridians of hand and foot）, and besides the routine acupoints, patients in the Group B were treated by needling Baihui（GV 20）, the Group C by Shuigou（GV 26）, the Group D by Shenmen（HT 7）, and the Group E by Baihui（GV 20）, Shuigou（GV 26）, and Shenmen（HT 7）. All the patients were examined by Positron Emission Tomography （PET） to detect the cerebral glucose metabolism in the bilateral frontal lobes（orbital gyri）, parietal lobes, temporal lobes（hippocampus and hippocampal gyrus）, occipital lobes, thalamus, lentiform nucleus, caudate nuclei, cingulate gyrus and cerebellum before treatments and after treatments. Results： After needling the routine acupoints for hemiplegia, glucose metabolism increased in lentiform nucleus and temporal lobe; needling Baihui（GV 20）, increased in frontal lobe, temporal lobe and lentiform nucleus; needling Shuigou（GV 26）, increased in frontal lobe, thalamus and lentiform nucleus; needling Shenmen（HT 7）, increased in parietal lobe and lentiform nucleus; and needling these three acupoints, increased in frontal lobe, temporal lobe, thalamus and lentiform nucleus. Conclusion： Needling Baihui（GV 20）, Shuigou（GV 26） and Shenmen（HT 7） affect glucose metabolism in different functional regions of the brain, and Baihui（GV 20）, Shuigou（GV26） and Shenmen（HT 7） relate to different functional regions of the brain.

Efficacy evaluation on electroacupuncture for Alzheimer's disease

Objective： To observe the clinical efficacy of electroacupuncture（EA） on Alzheimer＇s disease（AD）.Methods： A total of 50 AD patients were randomly allocated into a Western medication（WM） group（n=25） and an acupuncture plus medication（APM） group（n=25）. Patients in the WM group took oral huperzine A capsules. In addition to huperzine A capsules, patients in the APM group also received EA at Shenting（GV 24）, Baihui（GV 20）, Dazhui（GV 14）,Fengfu（GV 16）, Mingmen（GV 4） and Yongquan（KI 1）. The needles on the above points were connected to G6805-Ⅱelectric stimulator [3 pairs： Shenting（GV 24） and Baihui（GV 20）; Dazhui（GV 14） and Fengfu（GV 16）; and bilateral Yongquan（KI 1）]. The needles were retained 25 min. The treatment was done once a day, and 10 times made up a course of treatment.The patients received a total of 3 treatment courses. There was a 3-day interval between two courses. The mini-mental state examination（MMSE） and Hasegawa dementia scale revised（HDS-R） were conducted before and after treatment. The clinical efficacies were evaluated when the treatment was completed.Results： Before treatment, there were no between-group statistical differences in MMSE and HDS-R scores（both P〈0.05）.After treatment, the MMSE and HDS-R scores in the APM group were significantly higher than those in the WM group（both P〈0.05）. The total effective rate in the APM group was 88.0%, versus 76.0% in the WM group, showing a statistical difference（P〈0.05）.Conclusion： EA is effective for AD and can improve clinical symptoms in AD patients.

Therapeutic efficacy and mechanism of heat-sensitive moxibustion for adjuvant treatment of depression in Parkinson disease

Objective:To observe the clinical efficacy of heat-sensitive moxibustion for adjuvant treatment of depression in Parkinson disease and explore its mechanism.Methods:A total of 80 patients with Parkinson disease coupled with depression were randomized into an observation group and a control group,with 40 cases in each group.The control group was treated with levodopa and benserazide hydrochloride tablets and paroxetine tablets,while the observation group was treated with heat-sensitive moxibustion on the basis of the medications in the control group.The treatment course was 2 months.The Hamilton depression scale-17(HAMD-17),unified Parkinson's disease rating scale(UPDRS)and Parkinson's disease quality of life questionnaire-39(PDQ-39)were scored before and after the treatment,and the efficacy was evaluated after treatment.Levels of patients'serum dopamine(DA),5-hydroxytryptamine(5-HT),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)were detected before and after the treatment.Results:After treatment,the total effective rate of the observation group was higher than that of the control group(P<0.05).The HAMD-17 scores in the two groups decreased significantly after treatment(both P<0.05),and the score in the observation group was obviously lower than that in the control group(P<0.05).The component scores and total scores of UPDRS in both groups decreased significantly(all P<0.05),and the scores in the observation group were lower than those in the control group(all P<0.05).The score of PDQ-39 in the observation group decreased significantly(P<0.05),and was lower than that in the control group(P<0.05).After treatment,the serum DA and 5-HT levels in the observation group increased significantly(both P<0.05)and the TNF-αand IL-6 levels decreased significantly(both P<0.05),which were statistically different from those in the control group(all P<0.05).Conclusion:Heat-sensitive moxibustion has certain auxiliary effect in treating depression in Parkinson disease,significantly improving clinical symptoms and the quality of life,which may be related to the up-regulation of DA and 5-HT levels and down-regulation of TNF-αand IL-6 levels.

Moxibustion therapy improving delayed memory deficits via promoting neurogenesis and angiogenesis of hippocampus in a vascular dementia rat model

Objective:To investigate the alteration of delayed memory and its relationship with neurogenesis and angiogenesis in vascular dementia(VD)rats after moxibustion therapy.Methods:Two hundred adult male SPF Wistar rats were chosen for the experiment.Thirty-six rats were randomly selected as the sham operation group.Except for rats in the sham operation group(n=36),the others were made into VD models by bilateral comm on carotid arteries occlusi on(BCCAo).After modeli ng,the 108 survived rats were ran domly divided into 3 groups:a model group,a neural stem cells(NSCs)plus endothelial progenitor cells(EPCs)moxibustion group and a NSCs moxibustion group.Co-transplanted implant was transplanted into the rats in the NSCs plus EPCs moxibustion group,and the rats in the NSCs moxibustion group were transplanted by NSCs only.The NSCs plus EPCs moxibustion group and the NSCs moxibustion group received suspended moxibustion therapy at Baihui(GV 20),Dazhui(GV 14)and Shenting(GV 24),(each group was divided into 3 subgroups by the treatment course as 1,2 and 3 courses).Every group was measured by Morris water maze to evaluate its delayed memory after 3 treatment courses and the rat's brain was taken out after perfusion of 4%paraformaldehyde one day after 1,2 and 3 treatment courses,respectively.Marker protein expression was detected by laser con focal microscope to an a lyze the effect on neuroge nesis and an gioge nesis.Results:VD rats showed delayed memory in Morris water maze test 3 d after ischemic injury.After 3 courses of moxibustion therapy,VD-induced delayed memory deficits were improved in the NSCs plus EPCs moxibustion group and the NSCs moxibustion group.The expressions of nestin,doublecortin(DCX)and CD34 increased significantly in the two moxibusiton groups after every treatment course(all P<0.05),which might contribute to the neurogenesis and angiogenesis in hippocampus.In addition,compared with the rats in the NSCs moxibustion group,the expressions of nestin,DCX and CD34 increased significantly in the NSCs plus EPCs moxibustion group(P<0.05).Conclusion:Moxibustion can reverse VD-induced delayed memory deficits,which may be related to the promotion of neurogenesis and angiogenesis.

Therapeutic efficacy and mechanism of heat-sensitive moxibustion for vascular dementia

Objective:To observe the clinical efficacy of heat-sensitive moxibustion for vascular dementia and explore its mechanism.Methods:A total of 70 patients with vascular dementia were randomized into an observation group and a control group,with 35 cases in each group.The control group was treated with piracetam,and the observation group was treated with heat-sensitive moxibustion on the basis of the treatment of the control group.The treatment lasted for 8 weeks.Before and after the treatment,the mini-mental state examination(MMSE),activity of daily living(ADL)and traditional Chinese medicine(TCM)symptom scores were assessed,and the levels of acetyl choline(Ach)and homocysteine(Hcy)were measured.The efficacy was evaluated after treatment.Results:The total effective rate of the observation group was significantly higher than that of the control group(P<0.05).After treatment,the MMSE and ADL scores in the observation group decreased significantly,and were lower than those in the control group(all P<0.05);the TCM symptom score of the observation group decreased significantly(P<0.05),while that of the control group had no significant change(P>0.05);the plasma Ach level in the observation group increased significantly(P<0.05),and the Hcy level decreased significantly(P<0.05),which were statistically different from those in the control group(both P<0.05).Conclusion:Heat-sensitive moxibustion plus piracetam is effective in treating vascular dementia.It can significantly improve dementia symptoms and ADL,which may be related to the correction of plasma Ach and Hcy levels.

Bamboo leaf extract improves spatial learning ability in a rat model with senile dementia

Senile dementia（SD） is a syndrome characterized by progressive neurological deterioration. Treatment for the disease is still under investigation. Bamboo leaf extract（B-extract） has been known for its biological efficacy in anti-oxidant and anti-cancer activities. However, study on B-extract for its protection against dementia is very limited. The effect of B-extract on a rat model with SD was examined. B-extract improved spatial learning ability of the dementia rats. The hippocampus of dementia model rats showed reduced levels of acetylcholine（ACh）, epinephrine（E）, norepinephrine（NE）, and dopamine（DA）, and increased activities of acetylcholine esterase（ACh E） and monoamine oxidase（MAO）. Treatment with B-extract 20 mg/（kg·d） for 7 weeks significantly inhibited the enzyme activity compared with untreated dementia rats, and raised the levels of ACh, E, and DA in the hippocampus. In addition, treatment with B-extract elevated the level of γ-aminobutyric acid（GABA）, but reduced the level of glutamate（Glu） in the brain. These data suggest that B-extract might be a potential drug in treating impairment of spatial memory in dementia rats by regulating the central neurotransmitter function.