| Objectives(1)Screening of high risk factors for cognitive impairment in WD patients,to provide basis for clinical intervention(2)To explore the characteristics of cognitive impairment in patients with WD cognitive impairment through the neuropsychological scale.(3)To explore the correlation between serum alpha-synuclein and WD cognitive impairment,serum copper,copper zinc ratio,modified Young scale score and Barthel index score,so as to provide theoretical basis for early diagnosis and clinical intervention of WD patients with cognitive impairment.(4)To explore the correlation between WD cognitive impairment characteristics and TCM syndromes,and provides a theoretical basis for the clinical syndrome differentiation and treatment of TCM.Methods(1)72 cases of WD patients hospitalized in our hospital from December 2017 to December 2017 were selected,according to ACE-III scale score,the enrolled patients were divided into cognitive impairment group and non cognitive impairment group.The risk factors of cognitive impairment in WD patients were screened out by multiple linear stepwise regression analysis.at the same time,the difference between the two groups of ACE-III total score and ACE-III scale in each sub cognitive domain(including five aspects of attention,memory,language fluency,language and visual space)and the difference between the two groups were compared.(2)Detecting the level of alpha-synuclein in serum of seventy-two patients with WD through the ELISA Kit,to compare the difference between the levels of alpha-synuclein in the serum of the subjects of the cognitive impairment group and the non cognitive impairment group;The correlation between alpha-synuclein and ACE-III scale score,serum copper,copper zinc ratio,modified Young scale score and Barthel index score were analyzed by multiple linear regression.(3)According to TCM dialectical analysis method,dividing the 43 patients with WD cognitive impairment into four groups:Damp-heat mixed syndrome,Phlegm and Mongolia clear syndrome,Gan-Shen yin deficiency syndrome and Qi-b Iood defi ciency syndrome,to analyze the correlation between the TCM Syndrome Types and the ACE-III gauge score and the cognitive specific scale score.Results(1)According to the ACE-III scale,43 of the 72 patients had cognitive impairment,and the incidence of cognitive dysfunction in WD patients was 59.7%.(2)Multiple linear stepwise regression analysis showed that the scores of modified Young scale(B=-0.842,p=0.001),serum copper(B=1.896,p=0.01)and Barthel scale(B=0.244,p=0.024)had an effect on the score of ACE-III scale.(3)The total score of ACE-III scale and attention,memory,language fluency and visual spatial score in the cognitive impairment group were significantly lower than those in the non cognitive impairment group(p<0.05);the scores between the two groups were basically similar,and the difference was not statistically significant(p>0.05).(4)The evaluation results of NCT-A,NCT-B,LTT and SDT in the cognitive impairment group were significantly higher than those in the non cognitive impairment group,the difference was statistically significant(p<0.05);the DST score in the cognitive impairment group was significantly higher than that in the non cognitive impairment group(p<0.05).(5)The serum alpha-synuclein in the cognitive impairment group was(3.66±0.850)ng/ml,and the serum alpha-synuclein in the non cognitive impairment group was (3.10±0.683)ng/ml;the level of serum alpha-syn in the cognitive impairment group was significantly higher than that in the non cognitive impairment group(p<0.05).Correlation analysis showed that alpha-syn and ACE-III score was negatively correlated(r=-0.514,p=0.000),and negatively correlated with serum copper(r=-0.340,p=0.002),and copper zinc ratio(r=-164,p=0.085),Young score(r=0.179,p=0.066)and Barthel index score(r=-0.142,p=0.116)no significant correlation.(6)The proportion of TCM syndrome types:A total of 43 cases of WD combined with cognitive impairment,18 cases of damp-heat mixed syndrome,accounting for 41.90%,13 cases of phlegm-nongolia clear syndrome,accounting for 30.20%;7 cases of liverkidney yin deficiency syndrome,accounting for 16.30%;5 cases of 5 cases of Qi-b Iood deficiency syndrome,accounting for 11.60%.(7)The correlation of TCM syndrome type with the score of ACE-III scale and the score of each cognitive specific scale:the difference of ACE-III score between between dampheat mixed syndrome,Phlegm-Mongolia clear syndrome,liver-kidney yin deficiency syndrome and Qi-blood two deficiency syndrome was statistically significant(p<0.05);among them,ACE-III score of damp-heat mixed syndrome was significantly higher than that of Phlegm-Mongolia clear syndrome and Qi-blood two deficiency syndrome,the difference was statistically significant(p=0.000,p=0.000);ACE-III score of liver-kidney yin deficiency syndrome was significantly higher than that of PhlegmMongolia clear syndrome and Qi-blood two deficiency syndrome,the difference was statistically significant(p=0.000,p=0.000).In the special cognitive assessment,there was a significant difference in NCT-A,NCT-B and SDT between damp-heat mixed syndrome,Phlegm-Mongolia clear syndrome,liver-kidney yin deficiency syndrome and Qi-blood two deficiency syndrome(p<0.05);there was no significant difference between DST and LTT(p>0.05);among them,in the aspect of NCT-A,the time of NCT-A in damp-heat mixed syndrome was significantly lower than that of Phlegm-Mongolia clear syndrome and Qi-blood two deficiency syndrome,the difference was statistically significant(p=0.006,p=0.011).In terms of NCT-B,the time of NCT-B in damp-heat mixed syndrome was significantly lower than that of Phlegm-Mongolia clear syndrome and Qi-blood two deficiency syndrome,and the difference was statistically significant(p=0.001,p=0.000).the time of NCT-B in liver-kidney yin deficiency syndrome was significantly lower than that of Phlegm-Mongolia clear syndrome and Qi-blood two deficiency syndrome,the difference was statistically significant(p=0.015,p=0.002).In the SDT aspect,the time of SDT in liver-kidney yin deficiency syndrome was significantly lower than that of damp-heat mixed syndrome,Phlegm-Mongolia clear syndrome and Qi-blood two deficiency syndrome(p=0.008,p=0.001,p=0.000);the time of SDT in damp-heat mixed syndrome was significantly lower than that of Qi-blood two deficiency syndrome,and the difference was statistically significant(p=0.029).Conclusions(1)WD cognitive impairment is related to serum copper,nervous system symptoms and daily living ability.WD patients with cognitive impairment showed multiple cognitive impairment,including memory,attention,language fluency,and visual space processing.WD patients with cognitive impairment have different degrees of damage in visual scanning ability,attention switching ability,visual attention ability,thinking flexibility,perception discrimination ability,speed and accuracy.(2)The level of serum alpha-synuclein is related to the cognitive impairment of WD,which can be used as a serum marker to evaluate the cognitive function of WD patients.(3)The overall cognition level,visual scanning ability,attention switching and movement speed and accuracy of WD in patients with damp-heat mixed syndrome and liver-kidney yin deficiency syndrome were relatively severe compared with those of two cases of Phlegm-Mongolia clear syndrome and Qi-blood two deficiency syndrome. |
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