| ObjectiveTo study the syndrome characteristics of patients with post-stroke cognitive impairment(PSCI)and the correlation with white matter lesions,the characteristics of TCM syndromes in patients with PSCI and the relationship with the severity of cognitive dysfunction after stroke,then to provide laboratory evidence for the prevention and treatment of PSCI by TCM.MethodsFrom May 2019 to January 2021,301 cases of stroke patients who were diagnosed with the first onset within 1 to 6 months at the Memory Clinic of the Department of Brain Diseases of Guangdong Provincial Hospital of Traditional Chinese Medicine were continuously included.The patients were divided into 144 patients with post-stroke cognitive impairment and 157 patients without cognitive impairment after stroke through neuropsychological evaluation.We would record the past medical history of all patients who meet the criteria,including age,gender,education level,and whether they have hyperglycemia,hypertension,hyperlipidemia,osteoporosis,etc.All patients were evaluated by TCM syndrome type,and the white matter of the patients was evaluated by Fazekas Scale.And we would do as following:1.Analyze the difference in general data,TCM syndrome distribution,Fazekas total score representing the degree of white matter lesions between the PSCI group and the post-stroke group without cognitive impairment.2.Analyze the correlation between the degree of white matter lesions in PSCI patients and cognitive dysfunction after stroke.3.Analyze the distribution characteristics of TCM syndromes in PSCI patients and their relationship with the severity of cognitive dysfunction after stroke.4.Analyze TCM syndromes in PSCI patients The correlation between the distribution and the degree of white matter lesions.Result1.Regarding the total Fazekas score,the number of PSCI components is higher than that of the post-stroke group without cognitive impairment(P<0.01).And in the PSCI group,the results of the correlation analysis showed that MMSE and Fazekas scores and MoCA total scores were negatively correlated with Fazekas scores.2.In the TCM syndromes of the PSCI group,the distribution ratios of the syndromes of deficiency of kidney essence and deficiency of Qi and blood were greater than those of the post-stroke group without cognitive impairment(70.83%VS 24.2%,75.69%VS 26.11%),and there were relatively few.The difference(P<0.01,P<0.01),and the distribution of phlegm turbidity blocking orifice syndrome and blood stasis blocking collateral syndrome in the PSCI group was less than that of the post-stroke group without cognitive impairment(25.69%VS 59.87%,26.39%VS 59.24%),There is a difference(P<0.05,P<0.01).And in the PSCI group,the results of correlation analysis showed that the total scores of MMSE and MoCA were positively correlated with the syndrome of deficiency of kidney essence and deficiency of Qi and blood.3.In the TCM syndromes of the white matter disease group,the distribution of the syndromes of deficiency of kidney essence and deficiency of Qi and blood is greater than that of the post-stroke group without cognitive impairment(93.57%VS 6.43%,86.0%VS 14.0%).There are differences(P<0.01,P<0.01).And in the white matter lesion group,the correlation analysis results suggested that the total score of Fazekas was positively correlated with the syndrome of deficiency of kidney essence and deficiency of Qi and blood.Conclusion1.Compared with patients without cognitive impairment after stroke,PSCI patients are more likely to have white matter lesions.As the cognitive ability of PSCI patients decreases,white matter lesions are more likely to occur.2.TCM syndromes without cognitive impairment after stroke are mainly phlegm turbidity obstructing orifice syndrome and blood stasis blocking collaterals syndrome,PSCI TCM syndromes are mainly kidney essence deficiency syndrome and Qi and blood deficiency syndrome,and PSCI patients show a lower level of cognitive function,and are more likely to have the syndrome of deficiency of kidney essence or deficiency of Qi and blood.3.The TCM syndromes of white matter lesions are mainly based on the syndrome of deficiency of kidney essence and deficiency of Qi and blood.With the aggravation of white matter lesions in patients with white matter lesions,it is more likely to manifest as syndrome of deficiency of kidney essence or deficiency of Qi and blood.That is,the main pathogenesis of white matter lesions is kidney deficiency and Qi and blood deficiency.To sum up,the pathogenesis of PSCI is mainly the deficiency of kidney essence,Qi and blood,supplemented by turbid phlegm and blood stasis as the standard.As the cognitive level of PSCI patients decreases,white matter lesions are more likely to occur,and at the same time,it is more likely to show the pathogenesis of deficiency of kidney essence or deficiency of Qi and blood.ObjectiveThis study observed the clinical efficacy of Yi-Nao-Kang capsules combined with donepezil hydrochloride tablets in the treatment of PSCI,then to explore the mechanism of Yi-Nao-Kang capsules on post-stroke cognitive impairment.MethodsContinuously included patients with post-stroke cognitive impairment who had a definite diagnosis of the first onset within 1 to 6 months at the encephalopathy specialist memory clinic of Guangdong Provincial Hospital of Traditional Chinese Medicine from May 2019 to January 2021.Record all patients’ information including age,gender,education level,whether they have hyperglycemia,hypertension,hyperlipidemia,osteoporosis,etc.,and use the MMSE score and the MoCA score to assess the patient’s cognitive level.Patients will be divided into the experimental group or the control group according to the different treatment options.The experimental group will receive Yi-Nao-Kang capsule with Donepezil hydrochloride tablets,and the control group will receive Donepezil hydrochloride tablets.After 6 months of intervention treatment,the MMSE score and the MoCA score will be evaluated again.By comparing the changes of cognitive function between the two groups of patients before and after treatment and the changes of cognitive function between the groups,the clinical efficacy of Yi-Nao-Kang capsules in patients with PSCI and the possible mechanism of white matter lesions were studied.Result1.1.Regarding the MMSE score and the MoCA score,the test group and the control group increased after treatment compared with before treatment,and the difference before and after treatment was statistically significant(P<0.05,P<0.05);and the MMSE score and the MoCA score treatment between the two groups.The difference between before and after was statistically significant(P<0.05).2.Regarding the visual space and executive function scores,language ability scores and memory scores of the MoCA score sub-items,the test group and the control group increased after treatment compared with before treatment,and the difference was statistically significant(P<0.05);and memory capacity between the two groups.The difference between the scores before and after treatment was statistically significant(P<0.05).3.Regarding the ADL score,after treatment,the two groups of patients increased compared with before treatment(P>0.05),and there was no statistically significant difference in the difference of ADL score before and after treatment between the two groups(P>0.05).Conclusion1.Both Yi-Nao-Kang capsules combined with donepezil hydrochloride tablets and simple use of donepezil hydrochloride tablets can improve the cognitive function of patients;While compared with simple use of donepezil hydrochloride tablets,Yi-Nao-Kang capsule combined with donepezil hydrochloride tablets can improve the cognitive function more significantly.2.Both Yi-Nao-Kang capsules combined with donepezil hydrochloride tablets and simple use of donepezil hydrochloride tablets can improve the visual space and executive function,language ability and memory ability of patients;compared to the patients.compared with simple use of donepezil hydrochloride tablets,Yi-Nao-Kang capsule combined with donepezil hydrochloride tablets can improve the memory and attention of patients more significantly;for visual space and executive function,language ability,the two groups have significant differences.The curative effect of the two groups was similar.3.Yi-Nao-Kang capsules combined with donepezil hydrochloride tablets and simple use of donepezil hydrochloride tablets can improve the daily life function of patients;but the two groups have the same effect on daily life functions.In summary,the combination of Yi-Nao-Kang Capsules and Donepezil Hydrochloride Tablets have a better effect on the overall cognitive function of patients than the simple use of Donepezil Hydrochloride Tablets,and can improve the concentration and memory of patients.Combined with the results of the previous test,patients with PSCI often have white matter lesions.The main pathogenesis of white matter lesions in PSCI patients is the lack of kidney essence and deficiency of Qi and blood.So We can speculate that Yi-Nao-Kang Capsules,which have the effects of nourishing kidney essence and nourishing Qi and blood,can target the main pathogenesis of white matter lesions in patients with PSCI,and play an effect on white matter lesions.That is,the improvement effect of Yi-Nao-Kang Capsules combined with donepezil hydrochlorides on PSCI patients may be through the mechanism of delaying the further development of white matter lesions. |
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