血管性痴呆患者证候学研究

目的探讨血管性痴呆(vascular dementia,VaD)患者证候特征,研究VaD发病机制。方法应用Bristol最新神经心理量表中文版(BMDC-NPTB-CR)和B lessed行为量表(BBS)筛选VaD患者(n=66)和无认知损害的脑梗塞患者(卒中组,n=51)。VaD诊断基于《精神疾病诊断和统计手册》第4版(DSM-Ⅳ)、美国国立神经系统疾病与卒中研究所和瑞士神经科学研究国际协会(NINDS-AIREN)的标准及临床痴呆量表(CDR);Hachinski缺血量表和Cornell抑郁量表(CSDD)用于鉴别诊断。定式表格调查证候,《血管性痴呆的中医辨证量表》(SDSVD)诊断证候。结果VaD组比卒中组的肾精亏虚证、痰浊阻窍证单证阳性率增高;SDSVD证候总分以及肾精亏虚证、痰浊阻窍证、热毒内盛证积分显著性增高。结论肾精亏虚证、痰浊阻窍证、热毒内盛证在VaD患者中出现频率高、表现严重,是VaD发病的重要因素。

Study on syndrome manifestations in patients with vascular dementia

Objective To investigate the characteristics of syndrome manifestations and pathogenesis in patients with vascular dementia(VaD).Mehtods To select VaD patients(n=66) and the patients with cerebral infarction(without cognitive lesion as the stroke group,n=51)by the New Psychometric Test Battery used in Bristol Memory Disorders Clinic Revised(BMDC-NPTB-CR,Chinese edition) and the Blessed Behavior Scale(BBS).VaD diagnosis was made based on the Diagnostic and Statistical Manual of Mental Disorders,4th edition(DSM-IV),the standards of the National Institute of Neurological Disorders and Stroke of USA and Association of International Research of Neuroscience of Switz.(NINDS-AIREN) and Clinic Dementia Rating(CDR).The Hachinski Ischemia Scale and the Cornell Scale of Depression Disease(CSDD) were used for differential diagnosis.The questionnaire was used for the investigation of syndrome manifestations and the Syndrome Differentiation Scale of Vascular Dementia(SDSVD) was used for diagnosis of syndrome manifestations.Results The positive rate of single-syndrome increased in the syndromes of asthenia of kidney essence and turbid phlegm clouding orifices of the VaD group compared with that of the stroke group.The total integral of SDSVD increased obviously,and the integrals in the syndromes of kidney essence asthenia,turbid phlegm clouding orifices and internal excessive heat increased too.Conclusion The syndromes of asthenia of kidney essence,turbid phlegm clouding orifices and internal excessive heat have a higher morbidity and more serious manifestations in VaD patients.These syndromes are important nosogenic factors of vascular dementia.