Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
J Alzheimers Dis. 2018;62(1):429-456. doi: 10.3233/JAD-170856.
Vascular dementia (VaD) is the second common form of dementia and Chinese herbal medicine (CHM) has been used for aging-related disorders for thousands of years. However, there is still a lack of scientific evidence using CHM for VaD.
To conduct a systematic review to assess the current evidence available for the effectiveness and safety of CHM for VaD.
Six databases were searched for high-quality randomized-controlled clinical trials that met the requirements of at least 4 of the 7 domains of the Cochrane risk of bias tool from their inception to February 2017. RevMan 5.3 was applied for data analysis.
Forty studies with 42 comparisons and 3,572 individuals were included. The studies investigated the CHM versus placebo (n = 4), CHM versus western conventional treatment (WCT) (n = 36), and CHM plus WCT versus WCT (n = 2). Meta-analysis showed that CHM for VaD could improve Mini-Mental State Examination (MMSE), the Activities of Daily Living, Hasegawa's dementia scale, and clinical effective rate but had statistically similar effect based on Blessed Behavior Scale (BBS) outcome when compared with WCTs. When compared with placebo, CHMs were more beneficial in improving MMSE but showed no significant difference in BBS scores. CHM as adjuvant therapy exerted an additive anti-VaD benefit on MMSE scores. The participants of CHM group had fewer adverse events than that of the placebo group or WCT group.
The findings of the present study support, at least to an extent, that CHM can be recommended for routine use for treatment of VaD.
血管性痴呆（VaD）是第二常见的痴呆症类型，中药（CHM）已被用于治疗与衰老相关的疾病已有数千年的历史。然而，目前仍然缺乏使用 CHM 治疗 VaD 的科学证据。
进行系统评价，评估 CHM 治疗 VaD 的有效性和安全性的现有证据。
从建库至 2017 年 2 月，检索 6 个数据库，以获取符合 Cochrane 偏倚风险工具至少 4 个领域要求的高质量随机对照临床试验。采用 RevMan 5.3 进行数据分析。
纳入 40 项研究，共 42 项比较，3572 例患者。研究涉及 CHM 与安慰剂（n=4）、CHM 与西药常规治疗（WCT）（n=36）以及 CHM+WCT 与 WCT（n=2）的比较。Meta 分析显示，与 WCT 相比，CHM 治疗 VaD 可改善简易精神状态检查（MMSE）、日常生活活动、长谷川痴呆量表和临床有效率，但基于Blessed 行为量表（BBS）结局，其疗效无统计学差异。与安慰剂相比，CHM 更有益于改善 MMSE，但 BBS 评分无显著差异。CHM 作为辅助治疗对 MMSE 评分有附加的抗 VaD 益处。CHM 组的不良反应发生率低于安慰剂组或 WCT 组。
本研究的结果至少在一定程度上支持 CHM 可常规用于治疗 VaD。
