针刺对主观认知下降人群认知功能的调节作用
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摘要
目的观察"调和气血,补心益智"针刺法对主观认知下降(SCD)人群认知功能的调节作用。方法纳入2017年12月至2018年9月期间首都医科大学附属北京中医医院公众号广告平台以及北京地区多个社区义诊招募的SCD者26例,按就诊顺序分为针刺组(n=14)和空白对照组(n=12)。2组受试者在治疗期间均予内科常规治疗,针刺组在常规治疗基础上采用"调和气血,补心益智"针刺法进行为期3个月的针刺治疗,空白对照组进行为期3个月的等待治疗。观察2组受试者治疗前和治疗结束后主观认知下降量表(SCD-Q)、简易智能精神状态量表(MMSE)、动物词语流畅性量表(AFT)、听觉词语学习测验量表(AVLT-H)、形状连线测验A和B量表(TMT A-B)评分以及神经心理学量表综合Z分数的变化情况。采用SPSS 22.0软件进行数据处理。依据数据类型,组间比较分别采用t检验或秩和检验或χ~2检验。结果与治疗前相比,针刺组SCD-Q[(7.35±1.32)vs(3.46±1.63)分]、MMSE[(27.00±1.66)vs(28.32±1.56)分]、AVLT-H即刻回忆[(14.85±2.03)vs(19.14±2.31)分]、AVLT-H短延时回忆[(4.28±1.58)vs(6.64±1.15)分]、AVLT-H长延时回忆[(4.14±1.56)vs(6.57±1.08)分]、AFT[(15.64±4.19)vs(19.36±3.75)分]和综合Z分数[0.03(-0.22,0.24)vs 0.04(-0.30,0.49)分]评分均有显著改善(P<0.05);对照组MMSE评分[(27.16±1.40)vs(26.16±1.52)分]有下降趋势(P<0.05)。与对照组比较,针刺组的SCD-Q[(3.46±1.63)vs(7.20±1.33)分]、MMSE[(28.32±1.56)vs(26.16±1.52)分]、AFT[(19.36±3.75)vs(15.33±5.17)分]、综合Z分数[0.04(-0.30,0.49)vs-0.06(-0.37,0.30)分]评分改善更为明显(P<0.05)。结论 "调和气血,补心益智"针刺法能够明显减少SCD人群对自身认知功能的抱怨,对SCD人群的记忆和言语功能具有较好的调节作用,但对执行功能未见明显影响。
Objective To observe the effect of acupuncture maneuver featuring "harmonizing qi and blood and nourishing mind" on cognitive function of people with subjective cognitive decline(SCD).Methods A total of 26 SCD patients were recruited for the study via the online bulletin board of Beijing Chinese Medicine Hospital affiliated to Capital Medical University or at gratuitous medical consultation in multiple communities in Beijing from December 2017 to September 2018.They were divided into acupuncture group(n=14) and control group(n=12).For a period of 3 months,both groups received conventional medical therapy,with acupuncture maneuver featuring "harmonizing qi and blood and nourishing mind" being added to the acupuncture group but not to the control group.A comparison was made between the two groups before and after the treatment for subjective cognitive decline questionnaire(SCD-Q),mini-mental state examination(MMSE),animal fluency test(AFT),auditory verbal learning test-Huashan version(AVLT-H),trail-making test A-B(TMT A-B) and Z-composite score.SPSS statistics 22.0 was used for data processing.Depending on the data type,comparison between groups was conducted by Student′s t test or Chi-square test.Results Acupuncture group scored significantly better after the treatment than before the treatment in SCD-Q [(7.35±1.32) vs(3.46±1.63)],MMSE [(27.00±1.66) vs(28.32±1.56)],AVLT-H immediate recall [(14.85±2.03) vs(19.14±2.31)],AVLT-H short delay recall [(4.28±1.58) vs(6.64±1.15)],AVLT-H long delay recall [(4.14±1.56) vs(6.57±1.08) ],AFT[(15.64±4.19) vs(19.36±3.75),P < 0.05]and Z-composite score [0.03(-0.22,0.24) vs 0.04(-0.30,0.49) ] and the control group showed declining MMSE scores [(27.16 ± 1.40) vs(26.16±1.52) ](P < 0.05).Improvement in the acupuncture group was more significant than the control group in SCD-Q[(3.46±1.63) vs(7.20±1.33) score],MMSE[(28.32±1.56) vs(26.16±1.52) score],AFT[(19.36±3.75) vs(15.33±5.17)score] and Z-composite score [0.04(-0.03,0.49) vs-0.06(-0.37,0.30) ](P < 0.05).Conclusion Acupuncture maneuver featuring"harmonizing qi and blood and nourishing mind"can significantly reduce the complaints in the SCD patients,exerting positive effects on their memory function and speech function but no obvious effects on their executive function.
Objective To observe the effect of acupuncture maneuver featuring "harmonizing qi and blood and nourishing mind" on cognitive function of people with subjective cognitive decline(SCD).Methods A total of 26 SCD patients were recruited for the study via the online bulletin board of Beijing Chinese Medicine Hospital affiliated to Capital Medical University or at gratuitous medical consultation in multiple communities in Beijing from December 2017 to September 2018.They were divided into acupuncture group(n=14) and control group(n=12).For a period of 3 months,both groups received conventional medical therapy,with acupuncture maneuver featuring "harmonizing qi and blood and nourishing mind" being added to the acupuncture group but not to the control group.A comparison was made between the two groups before and after the treatment for subjective cognitive decline questionnaire(SCD-Q),mini-mental state examination(MMSE),animal fluency test(AFT),auditory verbal learning test-Huashan version(AVLT-H),trail-making test A-B(TMT A-B) and Z-composite score.SPSS statistics 22.0 was used for data processing.Depending on the data type,comparison between groups was conducted by Student′s t test or Chi-square test.Results Acupuncture group scored significantly better after the treatment than before the treatment in SCD-Q [(7.35±1.32) vs(3.46±1.63)],MMSE [(27.00±1.66) vs(28.32±1.56)],AVLT-H immediate recall [(14.85±2.03) vs(19.14±2.31)],AVLT-H short delay recall [(4.28±1.58) vs(6.64±1.15)],AVLT-H long delay recall [(4.14±1.56) vs(6.57±1.08) ],AFT[(15.64±4.19) vs(19.36±3.75),P < 0.05]and Z-composite score [0.03(-0.22,0.24) vs 0.04(-0.30,0.49) ] and the control group showed declining MMSE scores [(27.16 ± 1.40) vs(26.16±1.52) ](P < 0.05).Improvement in the acupuncture group was more significant than the control group in SCD-Q[(3.46±1.63) vs(7.20±1.33) score],MMSE[(28.32±1.56) vs(26.16±1.52) score],AFT[(19.36±3.75) vs(15.33±5.17)score] and Z-composite score [0.04(-0.03,0.49) vs-0.06(-0.37,0.30) ](P < 0.05).Conclusion Acupuncture maneuver featuring"harmonizing qi and blood and nourishing mind"can significantly reduce the complaints in the SCD patients,exerting positive effects on their memory function and speech function but no obvious effects on their executive function.
引文
[1] Jessen F, Amariglio RE, van Boxtel M, et al. A conceptual framework for research on subjective cognitive decline in pre-clinical Alzheimer′s disease[J]. Alzheimers Dement, 2014, 10(6): 844-852. DOI: 10.1016/j.jalz.2014.01.001.
[2] Mewton L, Sachdev P, Erson T, et al. Demographic, clinical, and life style correlates of subjective memory complaints in the Australian population[J]. Am J Geriatr Psychiatry, 2014, 22(11): 1222-1232. DOI: 10.1016/j.jagp.2013.04.004.
[3] Luck T, Luppa M, Matschinger H, et al. Incident subjective memory complaints and the risk of subsequent dementia[J]. Acta Psychiatr Scand, 2015, 131(4): 290-296. DOI: 10.1111/acps.12328.
[4] Luck T, Roehr S, Jessen F, et al. Mortality in individuals with subjective cognitive decline: results of the Leipzig Longitudinal Study of the Aged (LEILA75+)[J]. J Alzheimers Dis, 2015, 48 (Suppl 1): S33-S42. DOI: 10.3233/JAD-150090.
[5] 闫超群, 张帅, 周平, 等. 阿尔茨海默病相关概念研究进展[J]. 中华老年多器官疾病杂志, 2018, 17(4): 305-308. DOI: 10.11915/j.issn.1671-5403.2018.04.067. Yan CQ, Zhang S, Zhou P, et al. Research progress on related concepts of Alzheimer′s disease[J]. Chin J Mult Organ Dis Elderly, 2018, 17(4): 305-308. DOI: 10.11915/j.issn.1671-5403.2018.04.067.
[6] Mitchell AJ, Beaumont H, Ferguson D, et al. Risk of dementia and mild cognitive impairment in older people with subjective memory complaints: meta-analysis[J]. Acta Psychiatr Scand, 2014, 130(6): 439-451. DOI: 10.1111/acps.12336.
[7] Deng M, Wang XF. Acupuncture for amnestic mild cognitive impairment: a meta-analysis of randomised controlled trials[J]. Acupunct Med, 2016, 34(5): 342-348. DOI: 10.1136/acupmed-2015-010989.
[8] 赵吉平, 李瑛. 针灸学[M]. 北京: 人民卫生出版社, 2016:
275. Zhao JP, Li Y. Acupuncture[M]. Beijing: People′s Health Publishing House, 2016: 275.
[9] Gifford KA, Liu D, Romano RR, et al. Development of a subjective cognitive decline questionnaire using itemresponse theory: a pilot study[J]. Alzheimers Dement (Amst), 2015, 1(4): 429-439.
[10] Hao L, Wang X, Zhang L, et al. Prevalence, risk factors, and complaints screening tool exploration of subjective cognitive decline in a large cohort of the Chinese population[J]. J Alzheimers Dis, 2017, 60(2): 371-388. DOI: 10.3233/JAD-170347.
[11] Sayers J. The world health report 2001. Mental health: new understanding, new hope[J]. Bull World Health Organ, 2001, 79(11): 1085.
[12] Kwon CY, Lee B, Suh HW. Efficacy and safety of auricular acupuncture for cognitive impairment and dementia: a systematic review[J]. Evid Based Complement Alternat Med, 2018, 2018: 3426078. DOI: 10.1155/2018/3426078.
[13] Bondi MW, Edmonds EC, Jak AJ, et al. Neuropsychological criteria for mild cognitive impairment improves diagnostic precision, biomarker associations, and progression rates[J]. J Alzheimers Dis, 2014, 42(1): 275-289. DOI: 10.3233/JAD-140276.
[14] Edmonds EC, Delano-Wood L, Galasko DR, et al. Subtle cognitive decline and biomarker staging in preclinical Alzheimer′s disease[J]. J Alzheimers Dis, 2015, 47(1): 231-242. DOI: 10.3233/JAD-150128.
[2] Mewton L, Sachdev P, Erson T, et al. Demographic, clinical, and life style correlates of subjective memory complaints in the Australian population[J]. Am J Geriatr Psychiatry, 2014, 22(11): 1222-1232. DOI: 10.1016/j.jagp.2013.04.004.
[3] Luck T, Luppa M, Matschinger H, et al. Incident subjective memory complaints and the risk of subsequent dementia[J]. Acta Psychiatr Scand, 2015, 131(4): 290-296. DOI: 10.1111/acps.12328.
[4] Luck T, Roehr S, Jessen F, et al. Mortality in individuals with subjective cognitive decline: results of the Leipzig Longitudinal Study of the Aged (LEILA75+)[J]. J Alzheimers Dis, 2015, 48 (Suppl 1): S33-S42. DOI: 10.3233/JAD-150090.
[5] 闫超群, 张帅, 周平, 等. 阿尔茨海默病相关概念研究进展[J]. 中华老年多器官疾病杂志, 2018, 17(4): 305-308. DOI: 10.11915/j.issn.1671-5403.2018.04.067. Yan CQ, Zhang S, Zhou P, et al. Research progress on related concepts of Alzheimer′s disease[J]. Chin J Mult Organ Dis Elderly, 2018, 17(4): 305-308. DOI: 10.11915/j.issn.1671-5403.2018.04.067.
[6] Mitchell AJ, Beaumont H, Ferguson D, et al. Risk of dementia and mild cognitive impairment in older people with subjective memory complaints: meta-analysis[J]. Acta Psychiatr Scand, 2014, 130(6): 439-451. DOI: 10.1111/acps.12336.
[7] Deng M, Wang XF. Acupuncture for amnestic mild cognitive impairment: a meta-analysis of randomised controlled trials[J]. Acupunct Med, 2016, 34(5): 342-348. DOI: 10.1136/acupmed-2015-010989.
[8] 赵吉平, 李瑛. 针灸学[M]. 北京: 人民卫生出版社, 2016:
275. Zhao JP, Li Y. Acupuncture[M]. Beijing: People′s Health Publishing House, 2016: 275.
[9] Gifford KA, Liu D, Romano RR, et al. Development of a subjective cognitive decline questionnaire using itemresponse theory: a pilot study[J]. Alzheimers Dement (Amst), 2015, 1(4): 429-439.
[10] Hao L, Wang X, Zhang L, et al. Prevalence, risk factors, and complaints screening tool exploration of subjective cognitive decline in a large cohort of the Chinese population[J]. J Alzheimers Dis, 2017, 60(2): 371-388. DOI: 10.3233/JAD-170347.
[11] Sayers J. The world health report 2001. Mental health: new understanding, new hope[J]. Bull World Health Organ, 2001, 79(11): 1085.
[12] Kwon CY, Lee B, Suh HW. Efficacy and safety of auricular acupuncture for cognitive impairment and dementia: a systematic review[J]. Evid Based Complement Alternat Med, 2018, 2018: 3426078. DOI: 10.1155/2018/3426078.
[13] Bondi MW, Edmonds EC, Jak AJ, et al. Neuropsychological criteria for mild cognitive impairment improves diagnostic precision, biomarker associations, and progression rates[J]. J Alzheimers Dis, 2014, 42(1): 275-289. DOI: 10.3233/JAD-140276.
[14] Edmonds EC, Delano-Wood L, Galasko DR, et al. Subtle cognitive decline and biomarker staging in preclinical Alzheimer′s disease[J]. J Alzheimers Dis, 2015, 47(1): 231-242. DOI: 10.3233/JAD-150128.