| Vascular dementia(VaD)is a neurological disorder that is age-related and primarily characterized by cognitive impairment.Traditional Chinese medicine considers VaD to be a type of "Chidai" disease,which was previously referred to as "yuchi","wenchi","shanwang",and so on.In recent years,traditional Chinese medicine has achieved good therapeutic effects in the treatment of VaD using the theory of "Dusunnaoluo" and the method of "huoxuejiedu".However,there is currently a significant difference in the diagnostic criteria for the syndrome of "yuduhujie" in VaD research,and clinical differentiation relies heavily on the physician’s personal judgment,which lacks objectivity,unity,and standardization.Based on the previous diagnostic criteria for the syndrome of "yuduhujie" in cardiovascular and cerebrovascular diseases,this study conducted a retrospective survey of VaD patients,investigated the influencing factors and clinical characteristics of the syndrome of "yuduhujie" in VaD,and provided a basis for the clinical identification of the syndrome of "yuduhujie" in VaD,which is of great research significance.Objectives:Study 1:To establish a clinical database for dementia using database technology,providing support for future research.Study 2:To explore the influencing factors and clinical characteristics of the syndrome of "yuduhujie" in VaD,providing a theoretical basis for clinical differentiation of the syndrome of "yuduhujie" in VaD and supporting the establishment of diagnostic criteria for the syndrome of "yuduhujie" in VaD.Methods:Study 1:For research one,we collected inpatient cases from Xiyuan Hospital and data from our team’s previous studies.We used software such as Access,Visual Studio,and Navicat for MySQL to build the database.The collected information is divided into eight major categories:patient basic information,medical history,family history,history of dementia medication,TCM syndrome information,auxiliary examination results,scale score data,and follow-up information,with a total of 197 field names.The database functions include importing,exporting,batch Excel interaction,querying,modifying,deleting,and more.Study 2:Based on the dementia clinical database established in Study 1,we extracted VaD patients who met the study criteria,diagnosed them according to the dialectical criteria of stasis-toxin mutual blockage syndrome in past cardiovascular and cerebrovascular diseases,and divided them into VaD stasis-toxin mutual blockage syndrome group and non-stasis-toxin mutual blockage syndrome group.We analyzed the differences in general conditions,traditional Chinese medicine syndrome information,scale score data,and auxiliary examination results between the two groups,exploring the main clinical characteristics of VaD stasis-toxin mutual blockage syndrome.SPSS 26.0 software was used for statistical analysis.Metric data conforming to normal distribution(such as age,BMI,blood pressure,heart rate,etc.)were expressed as mean ± standard deviation(X±S)and analyzed using t-test for inter-group differences.Count data were expressed as frequency and percentage(n(%))and analyzed using Pearson chi-square test(if the sample size<40 or expected<5,Fisher’s exact test was used).Differences were considered statistically significant when P<0.05.Logistic regression analysis was used to screen for clinical characteristic indicators with high correlation among the indicators with significant differences,which were then selected as the main clinical characteristics of VaD stasis-toxin mutual blockage syndrome.Results:Study 1:The clinical database ultimately included a total of 2966 patients with 20762 clinical data records,including 682 patients with Alzheimer’s disease,983 with VaD,275 with mild cognitive impairment,603 with mild vascular cognitive impairment,as well as 205 patients with other types of dementia and 218 cognitively normal individuals.The data mainly included demographic information,medical history,auxiliary examination,TCM syndrome differentiation,and dementia rating scale information.All data were standardized and some unstructured data were transformed into structured data for storage.All functions of the database were tested and operated normally,and the clinical dementia database was successfully established.Study 2:1.A total of 864 VaD patients were included in the study,including 235 patients in the VaD blood stasis and phlegm turbidity syndrome group and 629 patients in the non-blood stasis and phlegm turbidity syndrome group.Compared with the non-blood stasis and phlegm turbidity syndrome group,the blood stasis and phlegm turbidity syndrome group showed statistically significant differences in gender and age distribution,as well as in the history of hypertension,diabetes,smoking,and other aspects(P<0.05).The logistic regression results showed that advanced age(OR=1.98,95%CI=[1.44,2.72]),male gender(OR=1.02,95%CI=[1.01,1.04]),history of hypertension(OR=2.08,95%CI=[1.44,3.00]),and history of diabetes(OR=2.20,95%CI=[1.51,3.20])were all risk factors for VaD blood stasis and phlegm turbidity syndrome.2.In terms of TCM syndrome differentiation,compared with the non-stasis-intermingled group,the stasis-intermingled group showed significant differences in the following symptoms:dizziness,headache,chest tightness,palpitations,bitter taste in the mouth,halitosis,bluish-purple lips,dull complexion,dry and cracked skin,bluish-purple nails,numbness of limbs,constipation,bluish-purple spots or points on the tongue,bluish-purple or purplish-red tongue veins,old-looking tongue,yellow greasy tongue coating,wiry pulse,rough pulse,slippery pulse,sunken pulse,and knotted pulse.Further logistic regression analysis showed that dull complexion,chest tightness,headache,bitter taste in the mouth,dry and cracked skin,bluish-purple spots or points on the tongue,yellow greasy tongue coating,bluish-purple or purplish-red tongue veins,old-looking tongue,and wiry pulse were more strongly associated with stasis-intermingled VaD(P<0.05),while slippery pulse(OR=0.23,95%CI=[0.07,0.75])was significantly negatively correlated with VaD.After adjusting for differences in patient source,age,and gender,the correlation between headache and stasis-intermingled VaD was no longer significant(P=0.06),while the significance of the other variables remained unchanged.3.In comparing the data from various scales,except for the language ability measured by the MMSE score(P=0.003),there were no significant statistical differences in the scores of the other scales(P>0.05).The comparison of auxiliary examinations showed that there was a correlation between MPV(P=0.003),LDL-C(P=0.013)and the VaD blood stasis syndrome.Conclusion:The main clinical features of VaD blood stasis syndrome are dull complexion,chest tightness,headache,bitter taste in the mouth,dry and scaly skin,purple or dark tongue,purple or red sublingual veins,yellow greasy tongue coating,stiff tongue,and string-like pulse.Advanced age,male gender,and risk factors such as hypertension and diabetes are considered to be risk factors for VaD blood stasis syndrome.Preliminary investigation found that there were differences in the LDL-C and MPV levels between the VaD blood stasis syndrome group and non-VaD blood stasis syndrome group,suggesting that they may serve as specific indicators for VaD blood stasis syndrome.There were no significant statistical differences in the scores of the MMSE,MoCA,HIS,HAMD,and CDR scales between the VaD blood stasis syndrome group and the non-VaD blood stasis syndrome group. |
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