遗忘型轻度认知损害患者认知功能与中医证候的相关性

目的：探讨遗忘型轻度认知损害（amnestic mild cognitive impairment，aMCI）的认知功能和中医证候的相关性，为中医药干预治疗aMCI提供辨证依据。方法：招募了600例在北京东直门医院老年病科就诊的患者及北京7个社区的居民，年龄在40～85岁。对该600例受试者进行神经心理学、影像学、生化学检查和中医证候辨别，筛选出aMCI患者159例，认知正常对照（normal control，NC）者213例，阿尔茨海默病（Alzheimer’s dementia，AD）者171例。用偏相关分析法分析aMCI患者的认知功能和中医证候的相关性。结果：aMCI患者简易精神状态检查（Mini Mental State Examnation，MMSE）总分与肾精亏虚证和气血不足证呈负相关，偏相关系数r分别为-0．11，-0．11，P值分别为0．003，0．015。aMCI患者的词语延迟回忆得分与肾精亏虚证呈负相关，偏相关系数r=-0．20，P=-0．020。患者的即刻故事回忆得分和延迟故事回忆得分均与痰浊蒙窍证呈负相关，偏相关系数r分别为～0．11，～0．27，P值分别为0．021，0．000。aMCI患者的语言能力与肾精亏虚证和气血不足证呈负相关，偏相关系数分别为-0．11、-0．13，P值分别为0．042、0．007。患者的注意力／计算力也与肾精亏虚证和气血不足证呈负相关，偏相关系数r分别为-0．10、-0．21，P值分别为0．039、0．010。患者的注意力与热毒内盛证呈负相关，偏相关系数，r=-0．29，P=-0．026。结论：肾精亏虚、痰浊蒙窍与aMCI患者记忆力下降相关，其中，痰浊蒙窍与患者情景记忆损害密切相关，痰浊蒙窍证与患者进展为AD的危险性有关。虽然aMCI患者的其他认知功能相对保持完整。但是，随着肾精亏虚、气血不足、痰浊、热毒等病理程度的加重，患者的语言能力、注意力/计算力以及总体认知功能有可能会下降，最终出现多个认知领域的损害，甚或转化为痴呆。

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

Objective:To explore the correlation between lhe cognitive functions and syndromes of traditional Chinese medicine(TCM)in amnestic mild cognitive impai rment(aMCI),and to provide evidence for cIinicaI syndrome differentiatiOn treatment.Methods:Six hundred subjects from Dongzhimen Hospital and seven communities in Beijing.aged between 40 and 85 years,accepted neuropsychoIogical assessments.imaging and biochemical examinations,and syndrome differentiation,from whom 159 aMCl patients,213 normal control(NC)subjects and 171 Aizheimer's dementia(AD)patients were screened out.Correlation between the cognitive functions and TCM syndromes in aMCI patients was analyzed.Results:Mini-Mental State Examination(MMSE)score in aMCl patients was closely correlated with kidney essence vacuity and deficiency of blood and qi(r=-0.11,r=-0.11;P=0.003,P=0.015).Delayed Word RecalI(DWR)score was correlated with kidney essence vacuity(r=-0.20,P=0.020).Instanl Story Recall(ISR)and Delayed Story Recall(DSR)scores were respectively correlated with tu rbid phlegm blocking upper orifices(r=-0.1l,r=-0.27;P=0.021,P=0.000).Language function was correlated with kidney essence vacuity and deficiency of blood and qi(r=-0.11,r=-0.13;P=0.042,P=0.007).AtlentiOn/calcuIation was also closely correlated with kidney essence vacuity and deficiency of blood and qi(r=-O.10,r=-0.2l;P=0.039,P=0.010).Attention score of aMCI patients was correlated with excess of heat toxin syndrome(r=-0.29,P=0.026).Conclusion:The memory decline of aMCIis correlated with kidney essence vacuity and tu rbid phlegm blocking upper orifices.Fu rthermore.turbid phlegm blocking upper orifices is correlated with episodic memory decline,which is closely related to AD.The aMCI patients with phlegm have the risk to prog ress into AD.Although other cognitive functions of aMCI remain relatively intact,lhe patients'language function,attention/calculation and the whole cognilive function may be worsen as lhe aggravation of kidney essence vacuilv.deficiency of blood and qi,phlegm and heat toxin,and may eventually lead to multiple cognitive domains impai rment,even dementia.