Search JIM Advanced Search

Journal of Chinese Integrative Medicine ›› 2011, Vol. 9 ›› Issue (10): 1075-1082.doi: 10.3736/jcim20111007

Special Issue: Traditional Chinese Medicine

• Original Clinical Research • Previous Articles     Next Articles

Correlation between cognitive functions and syndromes of traditional Chinese medicine in vascular cognitive impairment

Jing Shi, Ming-qing Wei, Fu-yun Ma, Ying-chun Miao, Jin-zhou Tian()   

  1. Department of Geriatric Diseases, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
  • Received:2011-05-12 Accepted:2011-07-12 Online:2011-10-20 Published:2011-10-15
  • Contact: Tian Jin-zhou E-mail:jztian@hotmail.com

Objective: To investigate the correlation between cognitive function and the Chinese medicine syndrome characteristics of vascular cognitive impairment (VCI).

Methods: A total of 774 subjects (age from 41 to 87 years old) from Beijing of China accepted neuropsychological assessments and differentiation of Chinese medicine syndromes. The mini-mental state examination (MMSE) and clinic dementia rating (CDR) were used to access the global cognitive function; the Hachinski ischemia scale (HIS) and the Hamilton depression scale (HAMD) were used for differential diagnosis; the ability of daily living (ADL) scale was used to assess the ability of daily living; the clock drawing test was used to access the executive function; the investigation of syndrome manifestations and the syndrome differentiation scale of vascular dementia (SDSVD) were used for diagnosis of syndrome manifestations. According to the diagnostic criteria of vascular cognitive impairment, subjects were subgrouped as normal cognition (NC) group and VCI group, and then the correlation between the cognitive functions and Chinese medicine syndromes was analyzed.

Results: The correlation between cognitive scales and Chinese medical syndrome: in the VCI group, the syndrome of phlegm turbid blocking upper orifices showed negative correlation with the scores of MMSE and CDT (r=–0.525, r=–0.321, P=0.000, P=0.001), and the ADL demonstrated positive correlation to the syndrome (r=0.424, P=0.000). The correlation between cognitive function and Chinese medical syndrome: the phlegm turbid blocking upper orifices was closely correlated with the total orientation, time orientation and place orientation (r=–0.451, r=–0.448, r=–0.392, P=0.001, P=0.000, P=0.004); instant word recall and delayed word recall were closely correlated with the syndrome of phlegm turbid blocking upper orifices (r=–0.355, r=–0.225, P=0.000, P=0.021); calculation/attention, language function and executive function had negative correlation to the syndrome of phlegm turbid blocking upper orifices (r=–0.379, r=–0.448, r=–0.321, P=0.000, P=0.000, P=0.013). The scores of orientation, calculation/attention, delayed word recall and language function in the patients with phlegm turbid blocking upper orifices were significantly lower than the patients with non-phlegm turbid blocking upper orifices (P<0.05).

Conclusion: The syndrome of phlegm turbid blocking upper orifices is significantly correlated to the scores of MMSE and ADL, indicating that the phlegm turbid blocking upper orifices is related to the cognitive function and ability of daily living in the VCI patients. Treatment of the phlegm is important in the cognitive impairment in VCI patients.

Key words: vascular cognitive impairment, traditional Chinese medical syndrome, cognitive function

Table 1

Demographic characteristics of normal cognition and VCI groups"

Demographic characteristic Normal cognition group (n=251) VCI group (n=107) Z/χ2 P value
Age ($\overline{x}$±s, years) 61.64±8.72 68.12±9.45 39 574.50 0.000
Education ($\overline{x}$±s, years) 10.93±4.21 8.57±4.36 14 094.00 0.000
SexFemale (n, %) 159 (63.3%) 49 (45.8%) 9.49 0.002
Male (n, %) 92 (36.7%) 58 (54.2%)
Race Han (n, %) 40 (97.6%) 101 (94.4%) 0.66 0.416
Others (n, %) 1 (2.4%) 6 (5.6%)
MMSE score ($\overline{x}$±s) 28.16±1.29 21.56±6.13 1 340.00 0.000

Table 2

Scores of Chinese medical syndromes of normal cognition group and VCI group"

Syndrome Score ($\overline{x}$±s) Z value Pvalue
Normal cognition group (n=251) VCI group (n=107)
Kidney essence deficiency 7.09±4.62 8.57±4.63 42 438.000 0.003
Phlegm turbid blocking upper orifices 3.35±3.59 5.17±4.79 42 486.500 0.004
Blood stasis obstructing brain collaterals 5.30±3.06 9.02±4.38 38 006.000 0.000
Hyperactivity of yang due to yin deficiency 4.02±4.52 3.23±3.46 18 283.500 0.295
Excess of toxic heat 3.48±3.19 1.49±2.16 12 772.500 0.000
Viscera stagnation and turbid left 1.76±2.69 2.64±3.19 43 305.500 0.039
Blood and qi deficiency 2.85±3.05 1.43±2.48 14 487.500 0.000

Table 3

Distribution of Chinese medical syndromes in normal cognition group and VCI group"

Syndrome Percent (n, %) Zvalue Pvalue
Normal cognition group (n=251) VCI group (n=107)
Kidney essence deficiency 130 (51.8%) 73 (67.6%) 7.671 0.006
Phlegm turbid blocking upper orifices 46 (18.3%) 41 (38.0%) 15.857 0.000
Blood stasis obstructing brain collaterals 75 (29.9%) 84 (77.8%) 70.208 0.000
Hyperactivity of yang due to yin deficiency 75 (29.9%) 23 (21.3%) 2.804 0.094
Excess of toxic heat 32 (12.7%) 5 (4.6%) 5.385 0.020
Viscera stagnation and turbid left 16 (6.4%) 18 (16.7%) 9.329 0.002
Blood and qi deficiency 49 (19.5%) 8 (7.4%) 8.297 0.004

Table 4

Partial correlation coefficients between scores of cognitive scales and TCM syndromes in VCI patients"

Syndrome n Correlation coefficient
MMSE CDT ADL
Kidney essence deficiency 107 –0.187 –0.060 0.216*
Phlegm turbid blocking upper orifices 107 –0.525** –0.321** 0.424**
Blood stasis obstructing brain collaterals 107 0.186 0.196 –0.143
Hyperactivity of yang due to yin deficiency 107 0.104 0.000 –0.037
Excess of toxic heat 107 0.180 0.032 –0.009
Viscera stagnation and turbid left 107 –0.022 0.017 0.148
Blood and qi deficiency 107 0.145 0.002 –0.109

Table 5

Partial correlation coefficients between cognitive functions and TCM syndromes in VCI patients"

Cognitive function Correlation coefficient
Kidney essence
deficiency
Phlegm turbid
blocking upper
orifices
Blood stasis
obstructing
brain collaterals
Hyperactivity
of yang due
to yin
deficiency
Excess of
heat toxin
Viscera
stagnation
and turbid left
Blood and
qi deficiency
Total orientation (MMSE) –0.12 –0.45** 0.19 0.03 0.12 –0.05 0.12
Attention/calculation –0.15 –0.38** 0.14 0.09 0.10 0.01 0.06
Memory (MMSE)
IWR –0.17 –0.36** 0.10 0.15 0.17 –0.03 0.09
DWR –0.06 –0.23* 0.01 0.16 0.29 0.13 0.01
Total language (MMSE) –0.15 –0.45** 0.17 0.10 0.08 –0.10 0.19
Executive function (CDT) –0.06 –0.32** 0.20 0.00 0.03 0.02 0.00
[1] Hachinski VC, Bowler JV . Vascular dementia. 1993; 43(10):2159-2160.
[2] Hachinski V, Iadecola C, Petersen RC, Breteler MM, Nyenhuis DL, Black SE, Powers WJ , DeCarli C,Merino JG,Kalaria RN,Vinters HV,Holtzman DM,Rosenberg GA,Wallin A,Dichgans M,Marler JR,Leblanc GG.National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards[J]. Stroke, 2006,37(9):2220-2241
doi: 10.1161/01.STR.0000237236.88823.47
[3] Wentzel C, Darvesh S , MacKnight C,Shea C,Rockwood K.Inter-rater reliability of the diagnosis of vascular cognitive impairment at a memory clinic[J]. Neuroepidemiology, 2000,19(4):186-193
doi: 10.1159/000026254 pmid: 10859497
[4] Román GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH, Amaducci L, Orgogozo JM, Brun A, Hofman A, Moody DM, O’Brien MD, Yamaguchi T, Grafman J, Drayer BP, Bennett DA, Fisher M, Ogata J, Kokmen E, Bermejo F, Wolf PA, Gorelick PB, Bick KL, Pajeau AK, Bell MA, DeCarli C, Culebras A, Korczyn AD, Bogousslavsky J, Hartmann A, Scheinberg P . Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop[J]. Neurology, 1993,43(2):250-260
doi: 10.1212/WNL.43.2.250
[5] Hachinski VC, Lassen NA, Marshall J . Multi-infarct dementia. A cause of mental deterioration in the elderly[J]. Lancet, 1974,2(7874):207-210
[6] Hamilton M . A rating scale for depression[J]. J Neurol Neurosurg Psychiatry, 1960,23, 56-62
doi: 10.1136/jnnp.23.1.56 pmid: 495331
[7] Folstein MF, Folstein SE , McHugh PR .“Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician[J]. J Psychiatr Res, 1975,12(3):189-198
doi: 10.1016/0022-3956(75)90026-6
[8] Zhang ZX, Hong X, Li H, Zhao JH, Huang JB, Wei J, Wang JM, Li SW, Yang EL, Wu JX, Ji CJ, Wang XD . The mini-mental state examination in the Chinese residents population aged 55 years and over in the urban and rural areas of Beijing[J]. Zhonghua Shen Jing Ke Za Zhi, 1999,32(3):149-153
张振馨, 洪霞, 李辉, 赵洁皓, 黄觉斌, 魏镜, 王建明, 李舜伟, 杨恩立, 吴继星, 冀成君, 王新德 . 北京城乡55岁或以上居民简易智能状态检查测试结果的分布特征[J]. 中华神经科杂志, 1999,32(3):149-153
[9] Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL . A new clinical scale for the staging of dementia[J]. Br J Psychiatry, 1982,140, 566-572
doi: 10.1192/bjp.140.6.566
[10] Tian JZ, Liang XZ, Shi J, Zhu XF. Diagnosis and treatment of Alzheimer’s disease[M]. Beijing: People’s Medical Publishing House, 2009, 93-96
田金洲, 梁新政, 时晶, 朱晓峰 . 阿尔茨海默病的诊断与治疗[M]. 北京: 人民卫生出版社, 2009, 93-96
[11] Lawton MP, Brody EM . Assessment of older people: self-maintaining and instrumental activities of daily living[J]. Gerontologist, 1969,9(3):179-186
doi: 10.1093/geront/9.3_Part_1.179 pmid: 5349366
[12] Shulman K, Shedletsky R, Sliver IL . The challenge of time: Clock-drawing and cognitive function in the elderly[J]. Int J Geriatr Psych, 1986,1(2):135-140
doi: 10.1002/gps.930010209
[13] Tian JZ, Han MX, Tu JW, Zhou WQ, Yang CZ, Yang HM, Li JS, Fu WM, Zhao JJ, Wang YY . Criteria for the diagnosis, the differentiation of syndrome and the evaluation of efficacy of vascular dementia for research studies[J]. Zhongguo Lao Nian Xue Za Zhi, 2002,22(5):329-331
田金洲, 韩明向, 涂晋文, 周文泉, 杨承芝, 杨惠民, 李建生, 符为民, 赵建军, 王永炎 . 血管性痴呆诊断、辨证及疗效评定标准(研究用)[J]. 中国老年学杂志, 2002,22(5):329-331
[14] Liu H, Tian JZ . Research approach of the traditional Chinese medicine on the senile dementia[J]. Zhongguo Yi Yao Xue Bao, 2000,15(5):52-54
刘峘, 田金洲 . 老年期痴呆的中医药研究思路[J]. 中国医药学报, 2000,15(5):52-54
[15] Gorelick PB . Status of risk factors for dementia associated with stroke[J]. Stroke, 1997,28(2):459-463
doi: 10.1161/01.STR.28.2.459 pmid: 9040707
[16] Gorelick PB . Risk factors for vascular dementia and Alzheimer disease[J]. Stroke, 2004,35(11 Suppl 1):2620-2622
doi: 10.1161/01.STR.0000143318.70292.47
[17] Rocca WA, Hofman A, Brayne C, Breteler MM, Clarke M, Copeland JR, Dartigues JF, Engedal K, Hagnell O, Heeren TJ, Jonker C, Lindesay J, Lobo A, Mann AH , Mölsä PK,Morgan K,O’Connor DW,Droux AS,Sulkava R,Kay DW,Amaducci L .The prevalence of vascular dementia in Europe: facts and fragments from 1980-1990 studies. EURODEM-Prevalence Research Group[J]. Ann Neurol, 1991,30(6):817-824
doi: 10.1002/ana.410300611
[18] Stern Y . What is cognitive reserve? Theory and research application of the reserve concept[J]. J Int Neuropsychol Soc, 2002,8(3):448-460
doi: 10.1017/S1355617702813248 pmid: 11939702
[19] Sheng T, Tian JZ, Liu H . Analysis of the correlation between cognitive impairment and traditional Chinese medicine syndromes after the onset of basal ganglia infarction[J]. Beijing Zhong Yi Yao Da Xue Xue Bao, 2003,26(3):60-62
盛彤, 田金洲, 刘峘 . 基底节梗塞后认知障碍与中医证候的相关性分析[J]. 北京中医药大学学报, 2003,26(3):60-62
[20] Liu H, Tian JZ . Correlation between cognitive level and Chinese medical syndromes in the aged people[J]. Zhongguo Lao Nian Xue Za Zhi, 2003,23(6):347-348
doi: 10.3969/j.issn.1005-9202.2003.06.010
刘峘, 田金洲 . 老年人认知水平与中医证候的相关性研究[J]. 中国老年学杂志, 2003,23(6):347-348
doi: 10.3969/j.issn.1005-9202.2003.06.010
[21] Yang CH, Wang YY, Wang XZ . Syndrome factors and Xuanfu pathogenesis of vascular dementia[J]. Beijing Zhong Yi Yao Da Xue Xue Bao, 2006,29(10):665-667
doi: 10.3321/j.issn:1006-2157.2006.10.004
杨辰华, 王永炎, 王新志 . 血管性痴呆的证候要素与玄府病机[J]. 北京中医药大学学报, 2006,29(10):665-667
doi: 10.3321/j.issn:1006-2157.2006.10.004
[22] Lü SJ, Han SF, Wang X, Wang PP, Jiang Y . Analysis of the correlation between blood lipid and traditional Chinese medicine syndromes in vascular dementia[J]. Hebei Zhong Yi Yao Xue Bao, 2006,21(4):14-15
doi: 10.3969/j.issn.1007-5615.2006.04.006
吕素君, 韩淑芬, 王霞, 王培培, 姜岩 . 血管性痴呆的血脂变化与中医证候的相关性分析[J]. 河北中医药学报, 2006,21(4):14-15
doi: 10.3969/j.issn.1007-5615.2006.04.006
[23] Sun JZ, Niu XY, Han LH, Wang ZT, Sun CJ, Zhu CL, Liu AH . Studies on the microcosic parameters of the syndrome of phlegm[J]. Henan Zhong Yi, 1996,12(2):21
孙建芝, 牛晓亚, 韩丽华, 王振涛, 孙慈君, 朱翠玲, 刘爱华 . 痰浊证微观辨证指标的实验研究[J]. 河南中医, 1996,12(2):21
[24] Lu HY, Tian GL, Wang JH, Ning XJ, Xu J . The relationship between gene polymorphism of apolipoprotein E and vascular dementia[J]. Xian Dai Shen Jing Ji Bing Za Zhi, 2003,6(3):351-354
doi: 10.3969/j.issn.1672-6731.2003.06.008
卢红艳, 田桂玲, 王景华, 宁宪嘉, 徐军 . 载脂蛋白E基因多态性与血管性痴呆的关系[J]. 现代神经疾病杂志, 2003,6(3):351-354
doi: 10.3969/j.issn.1672-6731.2003.06.008
[25] Yang SL, He BX, Liu HL, He ZY, Zhang H, Luo JP, Hong XF, Zou YC . Apolipoprotein E gene polymorphisms and risk for coronary artery disease in Chinese Xinjiang Uygur and Han population[J]. Chin Med Sci J, 2004,19(2):150-154
[26] Feng YQ, Wang JH, Guo X, Sun ZY, Liu GF, Chen JH, Gao JS, Li ZL, Qi YC, Ha ZY . The relationship between gene polymorphism of apolipoprotein E and blood lipid and vascular dementia[J]. Zhongguo Shen Jing Mian Yi Xue He Shen Jing Bing Xue Za Zhi, 2005,12(1):51-52
冯亚青, 王建华, 郭雪, 孙占用, 刘桂芳, 陈景红, 高俊淑, 李志立, 齐亚超, 哈志远 . 载脂蛋白E基因多态性及血脂与血管性痴呆的关系[J]. 中国神经免疫学和神经病学杂志, 2005,12(1):51-52
[1] Ying-chun Miao , Jin-zhou Tian , Jing Shi , Min Mao , Xiao-dong Zhao , Li-yan Fang , Chui-you Zeng , Jian-ping Liu , Zhi-liang Wang , Xiao-bin Li. Correlation between cognitive functions and syndromes of traditional Chinese medicine in amnestic mild cognitive impairment. Journal of Chinese Integrative Medicine, 2009, 7(3): 205-211.
[2] Qin Zhang, Ping Liu, Hui-fen Cheng, Liang Chen, Su-hua Cao, Ying Liu, Jian-jun Wei, Zhi-hong Fang, Ding-zhong Wu. Clinical investigation on characteristics of traditional Chinese medical syndrome of hepatocirrhosis. Journal of Chinese Integrative Medicine, 2003, 1(2): 108-112.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] Hao Li, Ming-jiang Yao, Wen-ming Zhao, Jie Guan, Lin-lin Cai, Ling Cui. A randomized, controlled, double-blind trial of Huannao Yicong capsule in senile patients with mild cognitive impairment. Journal of Chinese Integrative Medicine, 2008, 6(1): 25-31
[2] Jun Hu, Jian-ping Liu. Non-invasive physical treatments for chronic/recurrent headache. Journal of Chinese Integrative Medicine, 2008, 6(1): 31
[3] Wei Zhang, Xiang-feng Lu, Xiao-mei Zhang, Jian-jun Wu, Liang-duo Jiang. A rat model of pulmonary fibrosis induced by infusing bleomycin quickly through tracheal intubation. Journal of Chinese Integrative Medicine, 2008, 6(1): 60-67
[4] Daniel Weber, Janelle M Wheat, Geoffrey M Currie. Inflammation and cancer: Tumor initiation, progression and metastasis,and Chinese botanical medicines. Journal of Chinese Integrative Medicine, 2010, 8(11): 1006-1013
[5] Xin-jun Wang, Ling-ling Wang . A mechanism of endogenous opioid peptides for rapid onset of acupuncture effect in treatment of depression. Journal of Chinese Integrative Medicine, 2010, 8(11): 1014-1017
[6] Ya-bing Zhou, Jian-er Yu, Jie Wu, Li Bai, Li-li Huo, Xin-guang Zhang, Li-qing Li . Effects of Chinese herbal medicine Bushen Gubiao Recipe on toll-like receptor 4 and CD4 +CD25 +foxp3 +regulatory T cells in mice with recurrent respiratory tract infections. Journal of Chinese Integrative Medicine, 2010, 8(11): 1053-1059
[7] Jing-yuan Mao, Chang-xiao Liu, Heng-he Wang, Guang-li Wei , Zhen-peng Zhang, Jie Xing, Wang Xian liang , Ying-fei Bi . Effects of Shenmai Injection on serum concentration and pharmacokinetics of digoxin in dogs with heart failure. Journal of Chinese Integrative Medicine, 2010, 8(11): 1070-1074
[8] Zhao-guo Li . A discussion of English translation of 1995 and 1997 Chinese National Standards of Traditional Chinese Medical Terminologies for Clinical Diagnosis and Treatment. Journal of Chinese Integrative Medicine, 2010, 8(11): 1090-1096
[9] Zhi-mei Wang, Bin Zhang. A study on translation of ellipses in Huangdi Neijing from perspective of hermeneutic theory. Journal of Chinese Integrative Medicine, 2010, 8(11): 1097-1100
[10] Rui Jin, Bing Zhang. A complexity analysis of Chinese herbal property theory: the multiple formations of herbal property (Part 1). Journal of Chinese Integrative Medicine, 2012, 10(11): 1198-1205