| Objective:To investigate the differences in the characteristics of cognitive impairment and the distribution of TCM syndromes between AD and VaD,and preliminarily analyze the changes of AD and VaD in serum biomarkers.Methods:The project used case-control research scheme.Patients with Normal cognitive and Vascular disease(VaD)were compared with Alzheimer's disease(AD).Diagnostic criteria for AD used NIN-AA diagnostic criteria,VaD diagnostic criteria adopted NINDS-AIREN diagnostic criteria,and TCM syndrome standards adopted the "Guidelines for the clinical research of new Chinese medicines for the treatment of senile dementia" promulgated by the Ministry of Health of the People's Republic of China(2002),the second series of diagnostic criteria for senile dementia and vascular dementia as well as the diagnosis of vascular dementia set by Tian Jinzhou etc.The MMSE and MoCA were used to the assessment of cognitive function in patients with AD and VaD,and observe blood lipid levels in the AD and VaD patients.The biomarkers levels of A?42,Ach,Tau,HCY,and Hs-CRP in serum in the AD,VaD,and the NC groups were determined by ELISA.According to the TCM syndrome scale,three groups of TCM syndromes were investigated and divided into different TCM syndromes types,and the distribution of TCM syndromes in each group was observed.Used Excel spreadsheet to establish database,record all data,and SPSS20.0 software for statistical analysis.The independent sample T-test was used to obey the normal distribution.The non-parametric test(Wilcoxon Rank sum test)was used if it did not conform to the normal distribution.Results:1.Comparison of neuropsychological scale.(1)Overall comparison of scale scores:there was no significant difference between the AD and VaD group in MMSE,CDR and HMED score(P>0.05);The score of MoCA in the VaD group was lower than the AD group(P<0.05).The ADL score of VaD group was higher than the AD group(P<0.01).(2)Comparison of scores of each item:There was no significant difference between the AD and VaD group in spatial orientation ability,memory ability,calculation ability,language ability and execution ability(P>0.05).The time orientation ability of the VaD group was lower than that of the AD group(P<0.05),and the attention of the AD group was lower than that of the VaD group(P<0.01).(3)Comparison of age stratification:between 50?59 years old:the time orientation ability and the total score of MoCA of the VaD group were lower than that of the AD group(P<0.01,P<0.05).Between 60?69 years old:The time orientation ability of the VaD group was lower than that of the AD group(P<0.05),the attention and object naming ability of AD group was lower than that of VaD group,(P<0.01,P<0.05).There was no statistical difference between the two groups in the age group of 70-79 years old(P>0.05).2.Comparison of serum biomarkers.(1)Overall comparison:compared with the VaD group,the level of Serum A?42 in the AD group was lower than the VaD group(P<0.05).Compared with the NC group,the levels of serum A?42 in the AD group and the VaD group were higher than the NC group,and the level of serum Ach was lower than that of the NC group(P<0.01).There was no significant difference in serum Tau protein between three groups(P>0.05).(2)Age stratification comparison:between 50~59 years old:the level of serum A?42 in the VaD group was higher than the NC group(P<0.05).The level of serum Ach in the AD and VaD group was lower than the NC group(P<0.05).Between 60-69 years old:The levels of serum A?42 and HCY in the AD and VaD group were higher than the NC group(P<0.05).The level of serum Ach in the AD and VaD group was lower than that in the NC group(P<0.05).Between 70?79 years old:The levels of serum A?42,hs-CRP and HCY in the AD group were higher than that in the NC group(P<0.05),and the serum Ach level was lower than the NC group(P<0.05).In the VaD group,serum A?42 was higher than the NC group(P<0.05),and the level of serum Ach in the VaD group was lower than that in the NC group(P<0.05).There was no statistically significant difference between the AD group and VaD group in each age group(P>0.05).3.Distribution of TCM syndromes.(1)The single syndromes in the AD and VaD group were kidney deficiency,blood stasis,obstruction of phlegm,deficiency of heart and spleen,deficiency of qi and blood.The AD group also founded syndromes of deficiency of spleen and kidney.The heart and liver Yin deficiency syndrome and qi stagnation blood stasis syndrome were founded in VaD.But the syndrome of deficiency of kidney was more common in the AD group,and blood stasis obstruction of collaterals syndrome is the majority in the VaD group.(2)In the AD and VaD group,the syndromes of kidney deficiency,blood stasis and collaterals obstruction,phlegm turbid obstruction of resuscitation were the main combined syndromes.In addition,in the AD group,the syndromes of kidney deficiency with deficiency of heart and spleen were founded.In the VaD group,the syndromes of blood stasis with deficiency of heart and spleen,kidney deficiency with deficiency of qi and blood,blood stasis with deficiency of heart and spleen were also founded.(3)In the scores of TCM syndromes,the AD and VaD group were higher than the NC group in kidney deficiency(P<0.05),and there was no significant difference between AD and VaD group(P>0.05).In the AD group,the scores of the two deficiency syndromes of qi and blood,phlegm obstruction,and the heart and spleen were all higher than that of the VaD group(P<0.05),and the scores of blood stasis in VaD group was higher than the AD group(P<0.05).Conclusion:1.Simple AD patients with VaD early according to risk factors to identify more easily,but with the dementia deterioration,and patients with a variety of diseases,the difference on the pathological changes and clinical manifestations of the two gradually decreased;2.Specific diagnostic markers for the AD are also present in patients with VaD,and whether the increased of A? is related to the cerebral microvascular disease remains to be further studied. |
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