The Research Of Dependablity Between Traditional Chinese Medicine Syndromes And Cognitive Function Of Vascular Cognitive Impairment

Objective: To Discuss VCI risk factors by researching the subject ofvascular cognitive impairment (VCI) after onset of acute stroke througha prospective cohort study. To supply the clinical foundation for etiology,pathogenesis and intervention of VCI in Traditional Chinese Medicine (TCM)by investigating the relation between characteristics of stroke syndromesand characteristics of VCI syndromes of VCI patients. In addition, studythe relationship between the cognitive impairment in the subjects and itssubtypes, explore the cognitive impairment characteristics of subtypes, toprovide the basic information for rehabilitation of VCI. In this research,we use three kinds of cognitive function test scales, compare the meritsand defects of them and explore different and related aspects of cognitivefunction. We also use canonical correlation analysis to research therelationship between the TCM syndrome scores and cognitive function scoresto explore the value of canonical correlation analysis in TCM syndromeresearch.Methods: Choose the stroke patients according to the selection andexclusion criteria. Record the gender, age, diagnosis, syndromes of TCM andimaging data in detail. After the acute phase of stroke, use the telephonesurveys to screen all stroke cases. Standardize and transform the initialscreening test to screen suspected VCI patients by NeurobehavioralCognitive Status Examination (NCSE). on the follow-up of patients withsuspected VCI, we use NCSE and Cornell Depression Scale to select definiteVCI patients. Then, for these definite VCI patients, we record the scoresof Mini-Mental State Examination (MMSE), Clock drawing test and the andthe syndrome of TCM in accordance with Scale for Differentiation of Syndromein Vascular Dementia (SDSVD).Use the 4th edition of Diagnostic and Statistical Manual of mental illnessof United States (DSM-â…£) as the diagnostic criteria for dementia and Hachinski Ischemic Scale (HIS) to assess the role of vascular factors onVCI patients. Classify the subtypes of VCI by relevant scales.Complete follow-up information table and record the data accurately indetail. Construct database by Epi software and analyze the data byChi-square test, single factor analysis of variance, multiple linearregression, logistic regression analysis of SPSS 11.5 and descriptiveanalysis. Use the Canonical Correlation Analysis of SPSS11.5 to analyze therelationship between cognitive impairment scores and symptom scores of TCM.Results: The study included 411 cases of acute stroke patients and bytelephone follow-up, we screened 177 cases of suspicious VCI patients thataccounting for 53.96% of all cases included. In 177 cases of suspicious VCIpatients, 97 cases were lost follow-up because they did not want to returnthe hospital, which accounted for 54.8% of suspicious VCI patients. So, thisstudy collected 82 patients confirmed with VCI by the follow-up and 153 casesof stroke without VCI. Compare the general features and cerebrovasculardisease (CVD) characteristics of VCI patients to the stroke patients. Wefound that the VCI patients age were significantly older than the patientsof stroke without cognitive impairment, the patients of lacunar,large-scale, bilateral hemispheric and basal ganglia damage of CVD weresignificantly more than the stroke without VCI and the patients of lefthemisphere damage significantly less than stroke patients without VCI.The most patients of acute stroke syndrome of VCI patients was Blockageof Wind- Phlegm- Blood stasis. The next most were Flare-up of Wind and Fire,Excess of Wind-Phlegm-Fire and Phlegm-Hotness-Constipation Syndromes.Compared to the stroke patients without VCI, the most patients of strokesyndrome of VCI was Excess of Wind-Phlegm-Fire. The patients number of otherstroke syndromes of VCI were not different from patients of stroke withoutVCI. In patients of seven VCI syndromes, the most is, followed by Qi-BloodDeficiency and Constipation-Turbid Stagnation. Phlegm Blockage of Orifice,Blood Stasis, Excess of Liver-Yang and Excess of Internal Fire were all few.In a logistic regression analysis that the stroke syndrome of TCM wasindependent variable and the VCI syndrome of TCM was dependent variable,the results showed that the VCI syndrome was not be affected by strokesyndrome of TCM.The main cognitive impairment of VCI patients were memory impairment and structural and organizational obstacles. The patients of concentration,understanding and naming ability impaired were few. In Clock drawing test,the abnormal patients of CLOX1 test were more than CLOX2 test. Illustratethat VCI patients with executive dysfunction were more than vision- spaceabnormalities relatively. The syndrome with VCI subtypes was same as theoverall distribution of the VCI syndrome approximately, the differencebetween them was that the Qi-Blood Deficiency syndrome score of VD patientswas higher than vascular MCI.MMSE was more sensitive to the detection of dementia, but nodementia-cognitive impairment, the detection rate was only 56.1%. The samecognitive function reflected by MMSE as NCSE was directional detectioncapabilities, the ability to repeat, organizational structure, memory andcalculation ability, but the other functions in NCSE. In the actual use ofMMSE, we found this scale can only reflected calculation ability in its ownitems of calculation and concentration ability and only repeating functionin its own language items. Moreover, the function of directional detectioncapabilities that was showed less in the patients of VCI without dementiaoccupied one-third of all items in MMSE. So, this scale had some defectsin the design. The design content is not suitable for the screening andevaluation of VCI.In the clock drawing test operation in this study, it was found that CLOXwas not sensitive enough as a screening tool for VCI. The same cognitivefunction reflected by CLOX as NCSE was organizational and calculatingability, but the other functions in NCSE. And NCSE can not reflect theexecutive functions of CLOX1 sensitively.The cognitive scale can detect different aspects of cognitive impairment.Results of this study indicated that with syndrome score growth, the scoreof three scales showed a downward trend. So, the VCI syndrome scores of TCMcan reflect the severity of cognitive impairment. The more score of syndrome,the more serious the cognitive impairment was.In the canonical correlation analysis, the canonical variable data showedthat the Qi-Blood Deficiency syndrome related with repeating, naming,structure and memory capacity more. The structure of the canonical datashowed that cognitive function was negatively correlated with the syndrome.The more syndrome score, the poorer cognitive function was. The result was same as the single-factor analysis of syndrome and cognitive scale. In theanalysis of relationship between syndrome score and NCSE score of VCIpatients, the canonical structural analysis showed the variables in NCSEcan be predicted by syndrome except the repeating ability. On the other side,the syndromes of kidney-essence deficiency, blood stasis and Qi-BloodDeficiency can be predicted better by NCSE. From the redundant analysis incanonical correlation analysis, we can see that the first canonicalcorrelation variables can not be strong enough to explain the correspondingand opposite original variables.Conclusion and prospect: From the above results, we know that because ofthe acute stroke attack, the morbidity rate of VCI is very high. However,for the delitescence of VCI onset, the patients and their families pay littleattention on VCI, the visiting rate is very low. Therefore, strengtheninstruction for stroke patients, raise the visiting rate is an importantway to prevent VCI without dementia evolving to VD. In this study, becausethe VCI patients had the features of high prevalence and high visiting lostrate, we collect less samples of VCI, which resulted in the less data ofimaging, classification and syndrome and some statistical effectiveness isnot ideal.The results show that age lacunar CVD are clear risk factors for VCI; largeand bilateral hemispheric lesions of CVD are related to morbidity of VCI;leukodystrophy can not be denied to be the risk factors of VCI. In this study,one of the results is that the morbidity of VCI is not related with thefrontal and parietal damage that have been accepted as the reason ofcognitive impairment. The reason is that the sample size of this study issmall and the cases with frontal and parietal damage are also small, whichleads to the low efficiency of statistics. In the VCI Group, we removed thepatient with serious acratia of right limbs and severe aphasia, which leadsto the results of left hemisphere lesions of VCI patients are less than thosein the control group. The study also comes the results that the basal gangliadamages are less than the control group. Because the head of caudate nucleus,globus pallidus and part nucleus of thalamus in basal ganglia may be thekey transit points of the former frontal-subcortical pathways. The multipledamage in this location cause cognitive function decline easily.The stroke syndrome of Phlegm-Fire excess in VCI patients is less than stroke without VCI because the VCI syndrome has tendency of less excess andhotness from the early onset of VCI. Except for this, the main acute strokesyndromes of the VCI patients and stroke without VCI patients are allexcessive. And after the acute phase, the main syndrome of VCI is deficiencyand the most is the Deficiency of Kidney-Essence, which because of thephysical characteristics of old persons and the features of VCI. Thesyndrome of VCI is based on the physiological characteristics of the oldperson, and not related to the incidence and syndrome of stroke. Thecognitive impairment of the five subtypes of VCI is same as the overallcognitive impairment of VCI.In the process of this study, we find that the directional impairment canbe as the differentiation of VCI without dementia from VCI with dementia.The dementia is the key point of cognitive impairment and the vascularfactors does not play a decisive role in the various aspects of cognitivefunction. Therefore, in future studies of cognitive impairment, VCI can bedivided into non-dementia and dementia two categories directly. Of course,this classification is simple relatively and can be adjusted according tothe research needs.Canonical correlation analysis showed that the score of syndrome isrelated to the severity of cognitive impairment, but only deficiency ofKidney-Essence, blood stasis and Qi-Blood Deficiency can represent the VCIsyndrome. The others all have poor representation. From the etiology andpathogenesis of stroke and VCI, we can conclude the syndrome of blood stasisshould play the significant role in the incidence and evolution of strokeand VCI. However, because the cases of VCI patients with blood stasissyndrome is too small in this research, we can not conduct further researchon this syndrome. We assess the syndrome of VCI patients by the Scale forDifferentiation of Syndrome in Vascular Dementia and the results show thatthe scale can reflect the severity of cognitive impairment, but can notreflect the characteristics of VCI syndrome. Because of the small samplesize in this study, the value of this scale for VCI is waiting for furtherresearch.This is the first use of canonical correlation analysis on the researchof relationship between syndrome of TCM and the cognitive function. TheObjective of this study is to research the relationship between cognitive function and syndrome, find the rehabilitation methods of combining TCM andwestern medicine on VCI and explore the value of canonical correlationanalysis in the syndrome research of TCM. From this study, we find that thecanonical correlation analysis can be used to study the relationship betweensyndrome of TCM and cognitive function and it can be helpful to identifythe practicality of various sub-items of cognitive function and syndromeof TCM, which is valuable for the screening and judgment of TCM syndrome.