| Objective1.To evaluate the sensitivity,specificity and the best demarcation of the Addenbrooke's Cognitive Examination-Revised(ACE-R)in screening Vascular Cognitive Impairment(VCI)and its main subtype Vascular Demantia(VaD).2.To compare the validity of ACE-R,Montreal Cognitive Assessment(MoCA),and Mini-Mental State Examination(MMSE)in screening VCI and VaD.3.To observe the distribution of traditional Chinese medicine syndromes of VCI.Methods1.We conducted a cross-sectional study to survey the patients which had been admited in Guangdong Provincal Hospital of Traditional Chinese Medicine from June 2017 to February 2018.2.All the subjects administered a neuropsychological tests battery,ACE-R,MoCA,MMSE and Syndrome Differentiation Scale of Vascular Dementia(SDSVD).3.According to the results of neuropsychological tests battery and Instrumental Activities of Daily Living(IADL),all the subjects were divided into three group: the group of VaD,the group of Non-Dementia Vascular Cognitive Dysfunction(VCIND),cognitive normal group.4.Constructed the Receiver Operating Curve(ROC curve)of ACE-R,MoCA and MMSE,valuated the sensitivity and specificity of ACE-R and determined the best cut-off value.Comparison of ACE-R,MoCA and MMSE in screening VCI and VaD.5.According to the size of the Area Under the Curve of ROC(AUC),we compared the diagnostic efficiency of ACE-R,MMSE,MoCA for VCI and VaD.6.The distribution of the Traditional Chinese Medicine(TCM)syndromes of VCI were analyzed.Results1.Fifty-eight patients met the criteria of VCI,and 24 of them were diagnosed as VaD,34 of them were diagnosed as VCIND.the other 20 subjects were cognitive normal.2.There were no significant difference in sex,age and education between the three groups(P>0.05).The three groups had no statistical difference in the past history of smoking,hypertension,diabetes,hyperuricemia and coronary heart disease(P>0.05).The stroke history of three groups were significant differences(P<0.05).3.The optimal cut-off score for ACE-R for detecting VCI was 83 with a sensitivity of 91.38% and a specificity of 100.00%,the corresponding Youden index was 0.914.The highest Youden index(0.963)was found for ACE-R with a sensitivity of 100.00% and a specificity of 96.30% when the cut-off score was 69 for discriminating between VaD and non-VaD.4.Receiver operating characteristic area under the curve(AUC)of ACE-R(0.993±0.006),AUC of MoCA(0.978±0.026),AUC of MMSE(0.937±0.013),The discriminant validity in detecting VCI was the ACE-R superior to the MMSE(P<0.05).The discriminant validity in detecting VaD was similar for the ACE-R,the MoCA and the MMSE(P>0.05).5.The frequency of renal essence deficiency syndrome,blood stasis obstructing collaterals,and phlegm obstructing orifices in VaD group were 66.71%,58.33%,50.00%,and the frequency in VCIND group were 64.71%,61.76%,23.53%.Comparison of Qi and blood deficiency syndrome is statistical significance among three groups while no significant difference in others syndrome of TCM was found(P>0.05).The renal essence deficiency syndrome was the most prominent TCM syndrome type in VaD and VCIND groups.The syndrome of blood stasis obstructing collaterals was the most prominent in the normal cognitive groups.The mixed syndrome types is the majority in group VaD.Conclusion1.The ACE-R has good sensitivity and specificity in detecting VCI and VaD.2.The ACE-R as a screening instrument in detecting VCI is superior to the MMSE.3.The discriminant validity in detecting VaD is similar for the ACE-R,the MoCA and the MMSE.4.The main syndromes differentiation of TCM in patients with VCI are renal essence deficiency,Qi and blood deficiency syndrome,blood stasis obstructing collateral,and phlegm obstructing orifices.Qi and blood deficiency syndrome,sessence deficiency syndrome are the main Pathogenesis of VCI. |
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