The Interaction Between Cognitive Impairment And Depression In Wilson’s Disease And The Correlative Study Of Traditional Chinese Medicine Syndromes With Cognitive Impairment In Wilson’s Disease

ObjectiveWe aim to probe the level of cognitive impairment and depression in Wilson’s disease(WD),explore the interaction of cognitive impairment and depression in WD and analyze the correlation between Traditional Chinese Medicine syndrome(TCM) elements and cognitive impairment in WD,so as to provide demonstrations for treatment in WD with cognitive impairment.Methods108 patients with WD were selected from Neurology Department of the First Hospital affiliated to Anhui University of Traditional Chinese Medicine.Neuropsychological scales were used to investigate the level of cognitive impairment and depression.And the data of TCM elements were also collected.According to the diagnostic criteria,the participants were divided into two groups:non-cognitive impairment group(WDNCI),cognitive impairment group(WD-CI);Depending on the clinical syndromes and the Hamilton’s Depression Scale(HAMD),the participants were divided into depression group and non-depression group. The interaction of cognitive impairment and depression was analyzed using Analysis of Covariance(ANCOVA) and Analysis of Logistic Regression was used to analyze the correlation between TCM elements and cognitive impairment in WD.Results1. 108 patients were evaluated,in which 46 patients presented cognitive deficit(42.59%),and another 62 patients presented non-cognitive form(57.41%).In WD-CI group, all 46 patients accord with diagnosis of Mild Cognitive impairment.The result of MMSE was less than 24 in 2 male cases,and another 44 cases performed score from 24 to 27.The result ofGeriatric Depression scale(GDS) was 2 or 3 and Clinical Dementia Rating(CDR) was 0.5.2. 108 patients were evaluated,in which 70 patients presented depression(64.81%),in which 62 cases performed mild depressive symptoms(88.57%),5 cases performed moderate depressive symptoms(7.14%),3 cases performed severe depressive symptoms(4.29%).38 patients(35.19%) were non-depression.3. In 46 WD cases with cognitive deficit, males were 22 and females were 24,and the incidences respectively are 44.89% and 40.67%.There is no significant difference in sex and education. Cognitive impairment is affected by progress of disease, the incidences of WD less than 5 years, from 5 to 10 years and over 10 years respectively are 32.26%,34.15% and 61.11%.Longer progress perform higher incidence of cognitive impairment in WD and the difference is significant(P<0.05).4. In analysis of two-sample t-test, there is no significant in most of the Mo CA subscales between WD-NCI and WD-MCI, but only in attention and memory subscales.5. In 70 WD cases performed depression, males were 27 and females were 43,and the incidences respectively are 55.10% and 72.88%,females were apparently more than males, but the difference is no significant. Depressive symptoms are affected by education.Junior and senior high school patients(80.00%,81.48%) have higher incidences than academicians(38.89%),and there is apparently significant difference(P<0.01).Depressive symptoms are affected by progress of disease, the incidence of WD less than 5 years, from 5 to 10 years and over 10 years respectively are 40.63%,65.22% and 90.00%.Longer progress perform higher incidence of cognitive impairment in WD, the difference is apparently significant(P<0.01).6. In analysis of ANCOVA,the main effect of cognitive impairment was significant in all the Montreal Cognitive Assessment Scale(Mo CA) subscales, in stead of the major function of depression in most of the Mo CA.Depression was only significant in direction(F=4.518,P=0.040).The interaction of cognitive impairment and depression was significant only in nomenclature(F=5.325,P=0.027),attention(F=6.550,P=0.015)and direction(F=5.485,P=0.025).7. Collect TCM syndrome elements from 46 cases who met the diagnostic criteria of MCI,11 cases with single syndrome(23.91%),35 cases with concurrent syndromes(76.09%):19 cases with both syndromes(41.30%),13 cases with three syndromes(28.26%),3 cases with four syndromes(6.52%), and the top syndromes are both phlegm and intrinsic-heat syndromes(respectively 32 cases,69.57%).The following is qi-depression(19 cases,41.30%),blood-stasis(14 cases,30.43%) and yangdeficiency(3 cases,6.52%) and none with yin-deficiency syndrome.8. In analysis of correlation: both intrinsic-heat and phlegm syndromes linked with attention, verbal intelligence and memory(P<0.05),bloodstasis syndrome linked with verbal intelligence and memory(P<0.05,and qi-depression syndrome linked with verbal intelligence(P<0.05).9. In analysis of logistic regression, intrinsic-heat, phlegm and bloodstasis syndromes were selected( P <0.05, β > 0,Exp > 1),which may predispose cognitive impairment in WD.Conclusion1.WD patients have higher incidence of cognitive impairment, which needs urgent attention.2. WD patients have higher incidence of depression, which needs urgent attention.3. In this study, WD cases present milder cognitive impairment, according with diagnosis criteria of MCI. Long-term therapy may lead to this situation. The incidence has no relationship with sex and education, but with progress of disease in stead. The longer progress, the greater risk of cognitive impairment.4.In this study, most of WD cases present milder depressive syndromes, according with diagnosis criteria of mild depression. The incidence has no relationship with sex, but negative correlation to education and positive correlation to progress of disease. Lesser education and longer progress may result in the greater risk of depression.5.WD with MCI present in two domains of cognitive function, including attention and memory, which hints deficits of above-mentioned domains may emerge more early.6.In early stage of cognitive impairment in WD, the main effect of cognitive impairment is independent and depression makes no difference in cognition. Cognitive impairment and depression show interactions in attention, memory and direction.7.Some subscales in Mo CA have close relationship with TCM syndrome elements. Both intrinsic-heat and phlegm syndromes link with attention, verbal intelligence and memory, blood-stasis syndrome links with verbal intelligence and memory, and qi-depression syndrome links with verbal intelligence.8. The TCM syndrome elements which relate closely to WD with MCI are intrinsic-heat, phlegm and blood-stasis syndromes. These syndromes may lead to greater risk of cognitive impairment in WD.