Efficacy And Mechanism Of Enhanced External Counterpulsation For Vascular Cognitive Impairment With No Dementia

Background:The aggravating trend of our aging population contributes to the rising incidence of cerebrovascular diseases and vascular dementia(VD).VD has become the second leading cause of dementia,causing a heavy mental and economic burden on the majority of families and society.Vascular cognitive impairment with no dementia(VCIND),as the early stage of VD,is widely recognized as reversible,so early detection and intervention are of great significance to the prognosis of patients.However,targeted therapeutic drugs for VCIND has not been applied clinically yet.Controlling its risk factors(such as hypertension,diabetes,etc.)to delay the progression of the disease is the main preventive method.Therefore,the search for effective interventions has become the hot spot of current research.Recently,enhanced external counterpulsation(EECP)has been increasingly used in the rehabilitation of ischemic heart disease.Furthermore,It also has a significant effect on partial ischemic cerebrovascular disease.However,its efficacy is unclear for VCIND.Purpose:This article aims to explore the effect of EECP on patients with VCIND,and to investigate the possible underlying mechanism.Methods:We planned to select 70 patients diagnosed with VCIND by senior neurologists in our hospital and randomize them either a control group(n=35)or therapy group(n=35).Record their clinical and biochemical characteristics.All patients follow a drug treatment regimen for VCIND-related risk factors,and the patients in the therapy group receive EECP therapy additionally(once a day for 60 minutes for a total of 35 times).Before and after the study,record the following information of the two group:the score of Boston Naming Test(BNT),Digit Span Test(DST),Stroop Color Word Test(ST),Draw Clock Test(CDT),memory part of Montreal Cognitive Assessment Scale(MoCA),24-hour average systolic blood pressure,24-hour average diastolic Pressure,24-hour mean arterial pressure,blood viscosity,bilateral cerebrovascular reactivity(CVR).The differences in the above-mentioned indexes before and after treatment were compared to evaluate clinical efficacy.Results:During the course of this subject,2 cases were dropped,no case was eliminated and suspended in the therapy group,while 1 case was dropped,1 case eliminated and no case suspended in the control group.Finally,66 cases have completed the test(33 cases in the therapy group and 33 cases in the control group).No statistically significant differences were observed in age,gender,education level,height,weight,BMI,CRP,glycosylated hemoglobin,fasting blood glucose,liver and kidney function,blood lipid,stroke history,hypertension history,coronary heart disease history,diabetes history,hyperlipidemia history,smoking history,alcohol abuse history,medication usage,MMSE,MoCA,ADL and Hachinski scores(P>0.05).After the test,BNT scores did not change significantly in the two groups of patients(P>0.05).The scores of DST,ST,CDT and the memory part of MoCA were improved in the therapy group and the change has the statistical meaning(P<0.05),while have no significant change in the control group(P>0.05).There was no statistical difference between the two groups of patients in the 24-hour average systolic blood pressure after the test(P>0.05).After EECP therapy,the 24-hour average diastolic blood pressure and 24-hour mean arterial pressure were increased and the change has the statistical meaning(P<0.05),while there were no changes in the control group(P>0.05).After EECP therapy,the low-shear viscosity of whole blood、high-shear viscosity of whole blood and plasma viscosity were all decreased and the change has the statistical meaning(P<0.05),while there were no changes in the control group(P>0.05).In the therapy grouup,CVR of both side increased and the change has the statistical meaning(P<0.05),while have no significant change in the control group after the test(P>0.05).Conclusion:EECP can improve the cognitive function of patients with VCIND.And the possible underlying mechanism may involve increasing mean arterial pressure、reducing blood viscosity and improving cerebrovascular reactivity.In conclusion,EECP may be an effective therapy for patients in the early stage of VD.