The Study Of The Simvastatin's Effects On The Mild Vascular Cognitive Impairment

In pace with the acceleration of the aging population,it has become a problem in the public health area that elderly people are facing a cognitive decline,which has drawn massive attention as the only preventable cognitive disorder that can also be intervened in an early stage.Simvastatin,as the clinical blood-lipid regulator,has been widely used in the primary and secondary prevention and treatment of cardiovascular diseases.Besides regulating lipids by lowering triglycerides and low-density lipoprotein,etc.Statins also have many other effects: anti-inflammation,anti-oxidation,improving endothelial function,anti thrombus,stabilizing atheroscle-rotic plaques and so on.These effects are one of the main reasons why statins are believed as one kind of medicine that can delay the development of vascular cognitive impairment.Currently,it is partially agreed that statins can control the blood lipid level,protect the veins,reduce the risk of cerebral apoplexy and may protect cognition.Nonetheless,in some references,statins interfere with the cholesterol metabolism and lead to a cognitive decline.So the effects of statins remain unclear among patients who suffer mild vascular cognitive impairment.Objectives:To observe the efficacy of different doses of simvastatin(20 m simvastatin,40 mg simvastatin)on patients with vascular mild cognitive impairment.Methods:Patients,aged from 60 to 75 years old,who suffered VaMCI,were enrolled.They had been out patient and in-patient in the Internal Medicine Department in Yongxiu County TCM Hospital in Jiangxi Province.Their general information has been recorded: age,gender,level of education,smoking history,drinking history,hypertension history,diabetes history,past history of stroke,blood lipid before medication,scores of MMSE and MoCA.There were a total of 180 patients are devided into three groups based on the Blood Lipid Management Guide 2016 and Hazard stratification: Control Group,20 mg Simvastatin Group,40 mg Simvastatin Group.After one year of treatment,those patients were assessed the score MMSEand MoCA.And their blood lipid,stroke occurrence,dementia occurrence were recordedThe patients were all given a general treatment,such as blood sugar control,blood pressure control,platelet aggregation,quitting smoking and drinking,lifestyle modifications.Results:There was no significant difference in age,sex,education level,diabetes mellitus,hypertension,stroke,smoking and drinking among the three groups before treatment.Compared with before treatment,MoCA and MMSE in patients in control group and simvastatin 20 mg group decreased after one-year treatment(p < 0.01).The scores of MMSE and MoCA in simvastatin 40 mg group were higher than those before treatment(p < 0.01).There was no significant difference in blood lipids before and after one-year treatment in the patients in control group(p > 0.05).Compared with before treatment,the levels of blood lipids in patients in simvastatin 20 mg group and simvastatin 40 mg group decreased after one-year of treatment(p < 0.05),while the levels of blood lipids in simvastatin 40 mg group were lower than those in 20 mg group(p < 0.05).After one year follow-up,some patients in the control group,20 mg simvastatin group and 40 mg simvastatin group developed dementia,and the incidence of dementia in the 40 mg simvastatin group was lower than that in the other two groups(p < 0.05).After one-year treatment,the patients were divided into stroke group and non-stroke group according to whether there was recurrence of stroke.In those patients with stroke recurrence,the scores of MMSE and MoCA in the control group and simvastatin 20 mg group were lower than those before treatment(p < 0.01);in the simvastatin 40 mg group,the scores of MMSE and MoCA in the stroke group were higher than those before treatment,but there was no statistical significance(p >0.05).In those patients with non-stroke recurrence,the scores of MMSE and MoCA in control group and simvastatin 20 mg group were lower than those before treatment(p < 0.01),while those in simvastatin 40 mg group were higher than those before treatment(p < 0.01).Conclusion:After one year of simvastatin 20 mg treatment,it could not prevent stroke and dementia,and not improve the cognitive function of patients with mild vascular cognitive function.40 mg simvastatin can improve the cognitive function of patients with mild vascular cognitive impairment,reduce the recurrence of stroke,and delay the transformation from mild impairment to dementia.