| ObjectiveThe purpose of this study was to investigate and evaluate the elderly cognitive,observe the risk factors,and make a system assessment on the benifit of acupuncture on improve Alzheimer' s dementia(AD)patients' cognitive.On this basis,an animal experiment was done to study on the macanism of acupuncture improving cognition which may be relative to the "key areas of the brain",so as to provide a target for further research on the cerebral mechanism of acupuncture on cognitive.MethodsStudy is carried out in three steps.The first step was to evaluate the cognitive of older people who were from the community and university for the elderly and to find people who had Mild Cognitive Impairment(MCI)but not caused by vascular exclusion and mental factors by a series of scale including the Montreal cognitive assessment scale,activity of daily living scale,Hachinski ischemic scale and Hamilton Depression Rating Scale.Then logistic regression would be used in a correlation study on MCI and sex,age,education and continuing learning was done.The second step was a Systematic review and a meta analysis of randomized trials comparing acupuncture to medicine treatment of AD to provide a theoretical basis for clinical acupuncture improve cognition in AD patients.Finally,made AD animal model of rats by hippocampal injection of A ?,and the successful AD models would be devided into three groups randomly:the model group,the zhisanzhen group[zhisanzhen were three intelligence points,which were experience points of professor Jinrui to improve memory and intelligence,located at Shenting(GV24)and both Benshen(GB13)]and the non-point group.Then the zhisanzhen group would be given a puncturing zhisanzhen,while the non-point group would be given a puncturing non-points under both ribs.The model group was given the same interference except puncturing.After a course,FDG-PET was used to observe the brain images of these three groups.ResulisClinical investigation:The normal group showed no difference concerning sex(P>0.05)compairing with the MCI group,but statistical difference concerning age(P<0.05),education(P<0.05),and continuing learning(P<0.01).Logistic regression analysis showed education(0R2.44)and continuing learning(OR0.45)were risk factors for the incidence of MCI,while age(0R1.35)was a protective factor.Systematic review:There was no significant difference in comparison of the overall effects[OR=1.11,95%CI(0.52,2.35)]between acupuncture group and medicine group,but a statistically significant difference between the combined acupuncture and herbs group and the medicine group[OR=4.15,95%CI(2.37,7.29)].The result of compairing of MMSE score increasing before and after the treatments showed acupuncture group and medicine group had a statistical significance([WMD=-0.58,95%CI,-1.03,-0.14)]and the combined acupuncture and herbs group and the medicine group also had a statistically significant effect[WMD=2.07,95%CI(1.59,2.55)].Comparison of MMSE score before and after acupuncture,the result showed the MMSE score after acupuncture had a statisticall different with the score before acupuncture([WMD=-2.21,95%CI,-2.57,-1.84)];This statistically significant difference was also showed between the combined acupuncture and herbs group[WMD=-4.80,95%CI(-3.16,-2.53)].Animal experiment:the brain region where glucose metabolism reduced in model group included the olfactory bulb,cingulate gyrus,frontal cortex area 3,motor cortex,parietal association cortex,retrosplenial cortex,sensory cortex and the visual cortex;the brain region where glucose metabolism improved in the zhisanzhen group:the bed nucleus of stria terminalis,dorsal thalamus,hypothalamus,midbrain tegmentum,cerebral peduncle,brain pons;and the brain region where glucose metabolism improved in the non-point group:dorsal thalamus and hypothalamus.ConclusionCognitive decline was related to age,eduction and continuing learning.With the increase of age,the incidence of MCI in the elderly population increased gradually,and the upward trend was increasing;the incidence of MCI in people who had the higher level of education is lower,and continuing learning can reduce the incidence rate of MCI in elderly people.In the elderly MCI population,the delayed recall ability decreased the most obvious,and the orientation ability was almost kept.Acupuncture can improve the cognitive of AD patients.A large number of clinical trials showed the patients' MMSE scores were significantly increased after acupuncture,but in the short-term treatment,the effect of acupuncture was worse than medicine.The best treatment was combination of acupuncture and medicine,which was superior to Western medicine.However,there were few clinical research on acupuncture treatment of AD follow the evidence-based medicine,had no random control,no blind method,small sample,short course,so the results was rarely as objective.The future study needed rigorous randomized clinical trail for further verification.The results of animal experiments indicated:the zhisanzhen group activatied more brain region than the non-point group,which means the acupoints had specificity and prove the hypothesis of correlation between the acupoint and brain.On the point of function,the activated brain regions in the zhisanzhen group had a certern overlap with the brain region where glucose metabolism reduced in the model group,suggested that brain areas activated by zhisanzhen(mainly in the limbic system)may be the key target to improve cognitive function. |
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