Effects And Mechanism Of Levoamlodipine On Vascular Cognitive Impairment

Objective:To observe cognitive impairment controlling effects and study the mechanismof levoamlodipine in patients with vascular cognitive impairment by detect the changesof endothelin(ET) and vascular endothelial growth factor(VEGF).Methods:95patients with vascular cognitive impairment combined with essential hypertension in the department of neurology,The Second Affiliated Hospital of Shanxi MedicalUniversity from September2011to December2013were selected. The95patients grouped according to the time sequence were randomly divided into A group47cases andB group48cases.The patients in the A group was administrated orally with levoamlodipine,B group received conventional therapy,except antihypertensive drug categories of calcium-channel blocker,both at month6,to control blood pressure140-110/90-60mmHg.Werecorded the age,sex,the time of study,systolic pressure, diastolic pressure and improving cognitive function drugs.The score of mini-Mental State Examination(MMSE) were applied to evaluate of patients before and after treatment.we collected the elbow vein blood before and after treatment in all patients at7in the morning.Euzymelinked immunosorbent assay was used to detect the concentration of ET and VEGF.The indice of plasmaendothelin(ET),vascular endothelial growth factor(VEGF),and the score of mini-Mental State Examination(MMSE) were compared respectively between the groups before and after treatment,and at month6.Results:(1)Age,sex,the time of study,systolic pressure,diastolic pressure and improving cognitive function drugs in the two groups had no significantly statistical difference(P>0.05).(2)Before treatment,the Pearson correlation analyses revealed that the plasma of ET and the score of MMSE were negative correlation（r=-0.454,P<0.01),the plasma of VEGFand the score of MMSE were positive correlation（r=0.418,P<0.01).(3)MMSE in A group and B group before treatment were respectively21.9±2.8and21.3±2.4.There were no significantly statistical difference (P>0.05).The plasma of ET in A group and B groupbefore treatment were respectively96.1±9.1pg/ml and93.2±9.2pg/ml.There were no significantly statistical difference (P>0.05).The plasma of VEGF in A group and B group before treatment were respectively194.3±5.3pg/ml and196.2±4.9pg/ml.There were no significantly statistical difference (P>0.05).The score of MMSE before and after treatment inthe A group was no statistically different(P>0.05),while in the B group was statisticallysignificantly different(P<0.05).The level of ET and VEGF before and after treatment inthe A group was statistically significantly different(P<0.05),but B group was not(P>0.0 5).(4)The decline in scores on the MMSE for the A group was significantly less than the B group,the ET was significantly more;The increase of VEGF for the A group wassignificantly less than the B group.(5)Patients of A groups were divided into≥24groupand <24group by baseline MMSE score.In≥24group,after treatment the score of MMSE was significantly higher than baseline(P<0.05). In the <24group there was no significantly statistical different before and after treatment.The increase in scores on the MMSE for the≥24group was significantly more than the <24group.The change of ET before and after treatment in the two subgroup was statistically significantly different(P<0.05),but the VEGF was not.Conclusion:Levoamlodipine compaired with antihypertensive drugs categories ofnon-calcuimchannnel drugs in favor of delay the progress of vvascular cognitiveimpairment.This phenomenon is more significant at Vascular cognitive impairment nodementia.The machanism of Levoamlodipine on VCI may depend on the lowing of ET and theincreasing of VEGF.