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      Characteristics of TCM Constitution and Related Biomarkers for Mild Cognitive Impairment

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          Abstract

          Introduction

          The incidence of Alzheimer’s disease is on the rise, early detection of cognitive impairment of the elderly is very important. In traditional Chinese medicine, constitution is related to the susceptibility of the human body to diseases. Based on the theory of constitution of traditional Chinese medicine (TCM), the human population can be classified into 9 constitutions. However, little is known about the characteristics of medical constitution and related biomarkers in subjects with mild cognitive impairment (MCI).

          Methods

          We measured the TCM Constitution of 214 subjects by using the Constitution in Chinese Medicine Questionnaire (CCMQ). MMSE and MoCA were used to assess cognitive function. The subjects were divided into mild cognitive impairment group (MCI, n = 152) and normal control group (NC, n = 62). The levels of serum Hcy and serum/urine 8-iso-PGF 2α were determined.

          Results

          1) It was found that there was a significant difference in constitution types between MCI and NC. There were significant differences in MMSE and MoCA score, serum Hcy and serum/urine 8-iso-PGF 2a levels between the two groups. 2) In logistic regression analysis, the variables with statistical significance were TCM Constitution of Yang-Deficient, Phlegm-Dampness, Blood-Stasis and abnormal increase of Hcy (OR>1). 3) The MoCA scores had a positive correlation with the MMSE. A statistically significant inverse association was found between serum Hcy, blood and urine 8-iso-PGF 2a and scores of cognitive assessment in MCI.

          Conclusion

          Constitution types (Yang-Deficient, Phlegm-Dampness and Blood-Stasis) and abnormal serum Hcy elevation can be used as risk factors for MCI. MoCA scores can serve to detect MCI at early stage. Serum/urine 8-iso-PGF 2α has a certain relationship with MCI. Higher levels of serum/urine 8-iso–PGF 2α are more likely to be associated with MCI risk.

          Most cited references63

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          The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.

          To develop a 10-minute cognitive screening tool (Montreal Cognitive Assessment, MoCA) to assist first-line physicians in detection of mild cognitive impairment (MCI), a clinical state that often progresses to dementia. Validation study. A community clinic and an academic center. Ninety-four patients meeting MCI clinical criteria supported by psychometric measures, 93 patients with mild Alzheimer's disease (AD) (Mini-Mental State Examination (MMSE) score > or =17), and 90 healthy elderly controls (NC). The MoCA and MMSE were administered to all participants, and sensitivity and specificity of both measures were assessed for detection of MCI and mild AD. Using a cutoff score 26, the MMSE had a sensitivity of 18% to detect MCI, whereas the MoCA detected 90% of MCI subjects. In the mild AD group, the MMSE had a sensitivity of 78%, whereas the MoCA detected 100%. Specificity was excellent for both MMSE and MoCA (100% and 87%, respectively). MCI as an entity is evolving and somewhat controversial. The MoCA is a brief cognitive screening tool with high sensitivity and specificity for detecting MCI as currently conceptualized in patients performing in the normal range on the MMSE.
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            The diagnosis of mild cognitive impairment due to Alzheimer's disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease

            The National Institute on Aging and the Alzheimer's Association charged a workgroup with the task of developing criteria for the symptomatic predementia phase of Alzheimer's disease (AD), referred to in this article as mild cognitive impairment due to AD. The workgroup developed the following two sets of criteria: (1) core clinical criteria that could be used by healthcare providers without access to advanced imaging techniques or cerebrospinal fluid analysis, and (2) research criteria that could be used in clinical research settings, including clinical trials. The second set of criteria incorporate the use of biomarkers based on imaging and cerebrospinal fluid measures. The final set of criteria for mild cognitive impairment due to AD has four levels of certainty, depending on the presence and nature of the biomarker findings. Considerable work is needed to validate the criteria that use biomarkers and to standardize biomarker analysis for use in community settings. Copyright © 2011 The Alzheimer's Association. All rights reserved.
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              Mild cognitive impairment as a diagnostic entity.

              The concept of cognitive impairment intervening between normal ageing and very early dementia has been in the literature for many years. Recently, the construct of mild cognitive impairment (MCI) has been proposed to designate an early, but abnormal, state of cognitive impairment. MCI has generated a great deal of research from both clinical and research perspectives. Numerous epidemiological studies have documented the accelerated rate of progression to dementia and Alzheimer's disease (AD) in MCI subjects and certain predictor variables appear valid. However, there has been controversy regarding the precise definition of the concept and its implementation in various clinical settings. Clinical subtypes of MCI have been proposed to broaden the concept and include prodromal forms of a variety of dementias. It is suggested that the diagnosis of MCI can be made in a fashion similar to the clinical diagnoses of dementia and AD. An algorithm is presented to assist the clinician in identifying subjects and subclassifying them into the various types of MCI. By refining the criteria for MCI, clinical trials can be designed with appropriate inclusion and exclusion restrictions to allow for the investigation of therapeutics tailored for specific targets and populations.
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                Author and article information

                Journal
                Neuropsychiatr Dis Treat
                Neuropsychiatr Dis Treat
                ndt
                neurodist
                Neuropsychiatric Disease and Treatment
                Dove
                1176-6328
                1178-2021
                20 April 2021
                2021
                : 17
                : 1115-1124
                Affiliations
                [1 ]Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Guangxi University of Chinese Medicine , Nanning, 530023, People’s Republic of China
                [2 ]The Xinhu Outpatient Clinic of the People’s Hospital of Guangxi Zhuang Autonomous Region , Nanning, 530021, People’s Republic of China
                [3 ]Department of Clinical Laboratory of the First Affiliated Hospital of Guangxi University of Chinese Medicine , Nanning, 530023, People’s Republic of China
                [4 ]Medical Examination Center of the First Affiliated Hospital of Guangxi University of Chinese Medicine , Nanning, 530023, People’s Republic of China
                [5 ]Renai Branch of the First Affiliated Hospital of Guangxi University of Chinese Medicine , Nanning, 530023, People’s Republic of China
                Author notes
                Correspondence: Lihua Zhao Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Guangxi University of Chinese Medicine , Dongge Road & 89-9, Nanning, 530023, People’s Republic of ChinaTel +86 130 06913108 Email zhaolh67@163.com
                Qirong Li Department of Acupuncture and Moxibustion, Renai Branch of the First Affiliated Hospital of Guangxi University of Chinese Medicine , Mingxiu East Road & 179, Nanning, 530023, People’s Republic of ChinaTel +86 136 07717755 Email 632481428@qq.com
                [*]

                These authors contributed equally to this work

                Article
                290692
                10.2147/NDT.S290692
                8068505
                33907404
                ab4118a7-95cb-4b49-9f28-186a4d810846
                © 2021 Deng et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 05 November 2020
                : 22 March 2021
                Page count
                Figures: 1, Tables: 11, References: 64, Pages: 10
                Funding
                Funded by: National Natural Science Foundation of China, open-funder-registry 10.13039/501100001809;
                This work was supported by the National Natural Science Foundation of China, (Grant No. 81360561); The Science and Technology plan of Guangxi (Gui, Grant No. 14124004-1-27), and the Science and Technology plan of Guangdong (Grant No. 2016A020215202).
                Categories
                Original Research

                Neurology
                cognitive impairment,constitutions of traditional chinese medicine,biomarkers,moca score

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