A Systematic Review Of Traditional Chinese Medicine In The Treatment Of Cognitive Dysfunction In The Elderly

Objective:The aim of the study is to evaluate the effect of re-cognitive function improvement and safety on patients with vascular dementia,alzheimer's disease,or mild cognitive impairment and.Methods:This meta refered to the "Cochrane handbook of systematic review of interventions" 5.1.0.version.We searched the electronic bases(CNKI,VIP,CBMdisc,Wan Fang,PubMed,Cochrane Library,Embase)in order to obtain the RCT whose patients were diagnosed with vascular dementia,alzheimer's disease,or mild cognitive impairment.The treatment group could use Chinese medicine or combine with placebo.The control group could use western medicine,or placebo,or both.The language of the report should be Chinese or English.We extracted the trails,basic research information,research characteristics,sample size,intervention measures,results of scales index before and after treatment,and adverse reactions.The methodological quality of the trails was assessed by using the risk-of-bias scale,meta-analysis,subgroup-analysis were conducted by using Revman 5.2 software if there were more than two studies use the same scale to calculate the effect size.Results:(1)A total of 43 studies were included,and the number of patients were 3968.Literatures with the treatment traditional Chinese medicine on VaD were published in 2001?2007 and 2014,and literatures with the treatment traditional Chinese medicine on AD was published between 1995 and 2018.Literatures with the treatment traditional Chinese medicine on MCI were published in 2003?2004,2009?2010,2012,2014;(2)2100 VaD patients were included in the trails with a minimum sample size of 40 cases and a maximum sample size of 209 cases.Included patients were at ages of 41?86,16 items the study counted the education level of patients?1 trails adopted self-made traditional Chinese medicine diagnostic criteria and 1 referred to the diagnostic criteria in published articles.The Western diagnostic criteria were all provided.MMSE scale was used by 25 trails to evaluate cognitive function,ADL scale was used by 10 trails?BBS scale was used by 14 trails to evaluate daily behavioral ability.Intervention course was among 1?3 months.Three trials clearly proposed to follow up patients later.Four trails reported reasons of cases-off.15 trails observed adverse reactions and 2 patients in the treatment group and 6 in the control group were reported to have adverse reactions.(3)749 AD patients were included in the trails,401 were in intervention groups and 348 were in control groups.In the study on the treatment of AD with traditional Chinese medicine,All of the trails were reported to use the western medicine diagnostic criteria.The minimum sample size was 28 patients and the maximum was 202.The patients' age were in the rage of 49 to 90 years old.Five studies counted the education level of the patients.The MMSE scale was used by six studies.The MoCA scale was used by one study to assess cognitive function.The ADAS-Cog scale was used by four trails to assess cognitive function.The ADL scale was used by five studies to assess the daily behavioral ability.The intervention course was 2?12 months.In six trails,21 patients in the intervention group and 38 people in the control group were reported to have adverse reactions.There was no trails reported to follow up patients later.Four trails reported causes of cases-off.There were 21 intervention patients in groups and 38 in control groups were reported to have adverse reactions in four trails.(4)There were 1119 MCI patients were included,590 in the intervention group and 529 in the control group.The minimum sample size was 60 cases,and the maximum sample size was 322 cases.The patients' age were from 40 to 85 years old.There were 4 trails reported the education level of patients.To evaluate the cognitive improvement,7 trails used the MMSE scale,2 trails used the MoCA scale,2 trails used the ADAS-Cog scale.2 trails used the ADL scale to evaluate daily behavioral ability.The intervention course was 2-6 months.Three trials reported to follow up patients.Four trails reported to use both traditional Chinese medicine and western medicine diagnostic criteria.Two trails reported the causes of case expulsion.Three trails observed and reported the incidence of adverse reactions.(5)For VaD patients,the effect of MMSE improvement in control group was better than the experiment group(P<0.01).In the effect of improvement in ADL,the experiment group was better than control group in six trials and the same in three trials.In the effect of improvement in BBS,the experiment group was better than control group in five trials and the same in six trials.The experiment group had lower rate of adverse reactions than the control group(P=0.12).(6)For AD patients,the effect of the ADL improvement in Chinese medicine group was was better than the western medicine group(P<0.01).The effect of the MMSE improvement was equal between the experiment group and the control group(P=0.06).The effect of the ADAS-Cog improvement in experiment group was better than control group(P=0.02).Included trials didn't report the result of two groups on MMSE,ADL(placebo controlled)and MoCA(western medicine controlled).Due to the deficiency of trails,meta-analysis cannot be taken and the forest plot can not be given for MoCA?MMSE,ADL.The experiment group had lower rate of adverse reactions than the control group(P=0.04).Subgroups analysis showed that in the occurrence of MMSE improvement,the experiment group was equal to the control group(P=0.06,P=0.06).(7)For MCI patients,the effect of the MMSE,ADAS-Cog,ADL improvements were equal between the experiment groups and the control group(P=0.12,P=0.88,P=0.60),Chinese medicine group is better than the Western medicine group in improving MoCA(P<0.01).The experiment group had lower rate of adverse reactions than the control group(P<0.01).One trial reported the experiment group was better than the placebo group on MMSE improvement.(8)There were potential bias in publication.(9)The results of sensitive-analysis were unstable.That may related to the patients'condition,sample size or subjectivity of scale evaluating.Conclusion:(1)In generally,Chinese medicine has better effect in improving recognition than western medicine on patients with MCI?AD?VaD.And has the same effect in improving the ability of daily life on patients with MCI?AD.(2)Chinese medicine is safer than western medicine.