To evaluate the efficacy and safety of Compound Danshen Injection combined with Western medicine in the treatment of vascular dementia. Databases of Cochrane Library, PubMed, EMbase, CNKI, SinoMed, VIP, Wanfang Data were electronically retrieved for collecting randomized controlled trial(RCT)about vascular dementia treated with Western medicine alone or combined with Compound Danshen Injection from the year of database establishment to January 2020. Two researchers independently screened out li-teratures, extracted data, and evaluated the risk of bias for inclusion in the study. Meta-analysis was conducted using RevMan 5.3 software. A total of 5 RCTs were included, involving 588 patients, with 299 in treatment group and 289 in control group. Meta-analysis results showed that compared with Western medicine alone, Compound Danshen Injection combined with Western medicine was better in the effective rate(RR=1.23,95%CI[1.14,1.33],P<0.000 01), MMSE score(MD=3.54,95%CI[3.01,4.06],P<0.000 01), ADL score(MD=11.49,95%CI[8.05,14.93],P<0.000 01), the level of CRP(MD=-0.72,95%CI[-1.25,-0.20],P=0.007) and the level of IL-6(MD=-7.64,95%CI[-9.65,-5.63],P<0.000 01). Adverse reactions mainly included rash and skin prick, which did not affect the treatment effect. Based on the findings, the combination of Compound Danshen Injection in the treatment of vascular dementia could improve the effective rates, relieve the mental state damage and improve the daily living ability, with mild adverse reactions and a low incidence. However, due to the low quality of the included literatures, high-quality and large-scale randomized controlled trials are needed for further verification.
Dementia, Vascular/drug therapy* ; Drugs, Chinese Herbal/adverse effects* ; Humans ; Injections ; Medicine ; Salvia miltiorrhiza

Vascular dementia(VD) is a condition of cognitive impairment due to acute and chronic cerebral hypoperfusion. The available therapies for VD mainly focus on mitigating cerebral ischemia, improving cognitive function, and controlling mental behavior. Achievements have been made in the basic and clinical research on the treatment of VD with traditional Chinese medicine(TCM) active components, including Ginkgo leaf extract, puerarin, epimedium, tanshinone, and ginsenoside. Most of these components have anti-inflammatory, anti-apoptotic, anti-oxidant, and neuroprotective effects, and puerarin demonstrates excellent performance in mitigating cholinergic nervous system disorders and improving synaptic plasticity. Puerarin, ginkgetin, and epimedium are all flavonoids, while tanshinone is a diterpenoid. Puerariae Lobatae Radix, pungent in nature, can induce clear Yang to reach the cerebral orifices and has the wind medicine functions of ascending, dispersing, moving, and scurrying. Puerariae Lobatae Radix entering collaterals will dredge blood vessels to promote blood flow, and that entering the sweat pore will open the mind, which is in line with the TCM pathogenesis characteristics of VD. This study reviews the progress in the mechanism of puerarin, the main active component of Puerariae Lobatae Radix, in treating VD. Puerarin can ameliorate cholinergic nervous system disorders, reduce excitotoxicity, anti-inflammation, inhibit apoptosis, alleviate oxidative stress injury, enhance synaptic plasticity, up-regulate neuroprotective factor expression, promote cerebral circulation metabolism, and mitigate Aβ injury. The pathways of action include activating nuclear factor erythroid 2-related factor 2(Nrf2)/antioxidant response element(ARE), vascular endothelial growth factor(VEGF), extracellular regulated protein kinases(ERK), phosphatidylinositol-3-kinase(PI3K)/protein kinase B(Akt), Janus-activating kinase 2(JAK2)/signal transducer and activator of transcription 3(STAT3), AMP-activated protein kinase(AMPK), as well as inhibiting the tumor necrosis factor α(TNF-α), transient receptor potential melastatin 2(TRPM2)/N-methyl-D-aspartate receptor(NMDAR), p38 mitogen-activated protein kinase(p38 MAPK), Toll-like receptor 4(TLR4)/nuclear factor-kappaB(NF-κB), early growth response 1(Egr-1), and matrix metalloproteinase 9(MMP-9). By reviewing the papers about the treatment of VD by puerarin published by CNKI, Wanfang, VIP, PubMed, and Web of Science in the last 10 years, this study aims to support the treatment and drug development for VD.
Humans ; Dementia, Vascular/drug therapy* ; Vascular Endothelial Growth Factor A ; NF-kappa B/metabolism* ; Antioxidants ; Brain Ischemia ; Cholinergic Agents

Aged ; Cerebrovascular Circulation ; drug effects ; Dementia, Vascular ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Phytotherapy

OBJECTIVETo provide reliable evidence for acupuncture treatment of vascular dementia (VD).

METHODSMulti-central randomized controlled trial method was adopted and 270 cases enrolled were randomly assigned to an acupuncture-medicine group, an electroacupuncture group and a medication group. The acupuncture-medicine group were treated by scalp electroacupuncture on Sishencong (EX-HN 1), Baihui (GV 20), Shenting (GV 24), Fengchi (GB 20) and oral administration of Nimodipine; the electroacupuncture group were treated with scalp electroacupuncture; the medication group were treated with simple oral administration of Nimodipine. They were treated for 6 weeks. Mini-mental state scale (MMSE), ability of daily life-rating scale (ADL-R) and P300 were detected before and after treatment.

RESULTSThe total effective rate for cognition improvement was 86.59% in the acupuncture-medicine group, 82.05% in the electroacupuncture group and 43.21% in the medication group, the electroacupuncture group and the acupuncture-medicine group being better than the medication group; and their total effective rates for improvement of ability of daily life were 59.76%, 65.38% and 32.10%, respectively, the electroacupuncture group and the acupuncture-medicine group being better than the medication group. Scores for MMSE and ADL-R and P300 examination indicated that there were significant differences as the acupuncture-medicine group and the electroacupuncture group compared with the medication group (P < 0.01).

CONCLUSIONScalp electroacupuncture or scalp electroacupuncture combined with oral administration of Nimodipine has a better therapeutic effect in improvement of recognition function and the ability of life activity than simple oral administration of Nimodipine with a higher safety.

Acupuncture Points ; Aged ; Dementia, Vascular ; drug therapy ; physiopathology ; therapy ; Electroacupuncture ; Female ; Humans ; Male ; Middle Aged ; Nimodipine ; therapeutic use

OBJECTIVETo investigate the therapeutic effects of modified Sanjiasan decoction (MSD) on vascular dementia (VD).

METHODSThirty-seven patients in the treated group were given MSD, one dosage each day, and 31 patients in the control group were administered orally Naofukang 0.8 g three times a day. The treatment course for both groups was three months. The indices as Hasegawa dementia scale (HDS), mini mental state examination (MMSE) and its subentries, intelligence quotient (IQ) and memory quotient (MQ) were examined.

RESULTSMSD could improve the scores of HDS, MMSE and its subentries (P<0.05 or P<0.01), ameliorate dementia state and enhance IQ (P<0.05) and MQ (P<0.01) in patients with VD.

CONCLUSIONMSD has a certain effect on intelligence benefiting and dementia antagonizing.

Aged ; Dementia, Vascular ; drug therapy ; Female ; Humans ; Intelligence ; drug effects ; Intelligence Tests ; Male ; Materia Medica ; therapeutic use ; Middle Aged ; Nootropic Agents ; therapeutic use ; Phytotherapy

Animals ; Dementia, Vascular ; drug therapy ; physiopathology ; Hippocampus ; physiopathology ; Isoflavones ; pharmacology ; therapeutic use ; Long-Term Potentiation ; physiology ; Male ; Memory ; drug effects ; Rats ; Rats, Sprague-Dawley ; Synaptic Transmission ; physiology

There are about sixty to seventy diseases which develop dementia until now. These include degenerative disease, vascular disease, infectious disease, hydrocephalus, toxic condition, head trauma, tumor , metabolic disease, and demyelinating disease etc. 20% of dementing illness is reversible to treatment. Treatment strategies of dementia can be classified as disease-specific treatment, pharmacotherapy with neurocognitive activators or psychopharmacologic agents, and nonpharmacologic intervention such as neurocognitive rehabilitation, reminiscence therapy, occupational or physical therapy, and psychosocial approach. But medical approach is necessary to prevent disability stemming from pneumonia, dehydration, malnutrition, decubitus ulcer, and other complication. These treatment strategies must be administered comprehensibly due to characteristics of the dementia patients.
Alzheimer Disease* ; Communicable Diseases ; Craniocerebral Trauma ; Dehydration ; Dementia ; Demyelinating Diseases ; Drug Therapy ; Humans ; Hydrocephalus ; Malnutrition ; Metabolic Diseases ; Occupational Therapy ; Pneumonia ; Pressure Ulcer ; Rehabilitation ; Vascular Diseases

Although many drugs are currently available in the treatment of vascular dementia, there are no licensed drugs for it with proven efficacy. The major treatment efforts are therefore focused on the management of the underlying causes and control of risk factors. Antiplatelet agents or anticoagulants such as a low dose of aspirin or warfarin should be used in all patients where there is no contraindication. Hypertension should be properly controlled not to make the patient hypotensive. Blood cholesterol and triglyceride, especially LDL cholesterol, should be assessed and, if raised, treated using diet or drugs. And if the patient is diabetic, it should be controlled also. If the patient is a smoker, they should be encouraged to stop smoking. Supportive measures such as gait retraining, prophylaxis against limb contractures, and speech therapy are indicated in selected patients. Pathophysiological processes common to both vascular dementia and dementia of Alzheimer's type may include microglial activation, increased production of cytokines, free radicals and glutamate. Propentofylline, a neuroprotective glial cell modulator, has been shown to be effective in the management of the patients with Alzheimer's disease or vascular dementia. Other therapies such as estrogen, non-steroid anti-inflammatory drugs and anti-oxidants such as vitamin E/selegiline (MAO-B inhibitor), Gingko biloba are sometimes used and show promise in delaying the progression of dementia. But several further clinical trials are needed to determine whether these new therapies can be successfully used in patients with vascular dementia or dementia of Alzheimer's type.
Alzheimer Disease ; Anticoagulants ; Aspirin ; Cholesterol ; Cholesterol, LDL ; Contracture ; Cytokines ; Dementia ; Dementia, Vascular* ; Diet ; Drug Therapy* ; Estrogens ; Extremities ; Free Radicals ; Gait ; Ginkgo biloba ; Glutamic Acid ; Humans ; Hypertension ; Neuroglia ; Platelet Aggregation Inhibitors ; Risk Factors ; Smoke ; Smoking ; Speech Therapy ; Triglycerides ; Vitamins ; Warfarin

OBJECTIVETo determine the effects of Jiji decoction (Traditional Chinese Medicine) on the cognitive function and oxidative stress in mice with vascular dementia (VD) induced by cerebral ischemia/reperfusion.

METHODSThirty-two mice were randomly divided into nonnal group (n = 8), sham group (operation, but no cerebral ischemia/reperfusi6n, n = 8), model group (vascular dementia model induced by cerebral ischemia/reperfusion, n = 8), and Jiji decoction-treated group (vascular dementia model plus treatment with Jiji decoction, n = 8). Fourteen days of treatment after operation, the cognitive behavior was measured in step-through test, spatial probe test and platform test. Afterwards, to assess the levels of oxidative stress, the activity of superoxide dismutase(SOD) and content of malonaldehyde (MDA) in brain of these mice were measured.

RESULTSData from step-through test indicated that the escaping latency of Jiji decoction-treated group was prolonged and the error counts were decreased significantly ( P <0.01) compared with those of model group. Data from spatial probe test indicated that the time of entering darkroom, the time of climbing height and the time of entering bright room in Jiji decoction-treated group were shortened and the counts of climbing height were increased (P < 0.05-0.01) significantly compared with those of model group. Data from platform test showed that the escaping latency of Jiji decoction-treated group was prolonged significantly (P < 0.01) compared with that of model group. Compared with normal and sham group, the activity of SOD was decreased and the content of MDA was increased in model group significantly (P < 0.01). Compared with those of model group, the levels of SOD and MDA in Jiji decoction-treated group were improved significantly (P < 0.01).

CONCLUSIONJiji decoction could improve cognitive function of VD mice. Its mechanism might be related with the inhibition of oxidative stiess in the brain.

Animals ; Brain ; drug effects ; metabolism ; Cerebral Infarction ; physiopathology ; Cognition ; drug effects ; Dementia, Vascular ; drug therapy ; Drugs, Chinese Herbal ; pharmacology ; Malondialdehyde ; metabolism ; Medicine, Chinese Traditional ; Mice ; Oxidative Stress ; drug effects ; Reperfusion Injury ; drug therapy ; Superoxide Dismutase ; metabolism

OBJECTIVETo observe clinical curative effect of Shenxiong Bushen Capsule for the treatment of mild vascular dementia (VaD), and probe the partial mechanism.

METHODSWith a block random, double-blinded and controled clinical research method adopted, seventy patients with VaD were randomly assigned to two groups in a ratio of 5:2, including 50 cases in the trial group and 20 cases in the control group. The patients in the trial group were given the Shenxiong Bushen Capsule (5 tablets, thrice a day), while those in the control group were given Piracetam (5 tablets, twice a day). All patients of the two groups were treated for 2 months, and one third cases were follow-up surveyed for 1 month. The cognitive ability, the activities of daily living, Chinese medicine syndrome of VaD, and the quality of life were measured respectively before and after the treatment.

RESULTSAccording to the Mini-Mental State Examination, the clinical effects of patients showed that there was insignificant difference between the trial group (total effective rate was 74.46% and 80.85%, respectively) and the control group (total effective rate was 68.42% and 78.95%, respectively) on the cognitive ability and the activities of daily living (P > 0.05), while the curative effect of the trial group (total effective rate was 85.11%) was superior to that of the control group (total effective rate was 63.16%) on Chinese medicine syndrome of VaD, and had significant difference between the two groups (P < 0.05). The results measured by WHOQOL-SF36 indicated that the total scores and the scores of each field in both the trial group and the control group after treatment increased more than those of before treatment (P < 0.01, P < 0.05), except physical function (PF) field and role physical (RP) field of the control group (P > 0.05). The scores of the trial group about total body, PF field, RP field and vitality (VT) field increased more than those of the control group (P < 0.05); while no difference was shown between the trial group and control group in the scores of bodily pain field, role emotional field, general health field, social function field and mental health field (P > 0.05).

CONCLUSIONShenxiong Bushen Capsule has a definite curative effect on mild VaD, and it can improve the quality of life of patients. Adopting the SF36 Scale to evalute the quality of life of patients with VaD has significance and avaibility to some extent.

Aged ; Aged, 80 and over ; Capsules ; Dementia, Vascular ; drug therapy ; Double-Blind Method ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Phytotherapy ; Quality of Life