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viernes, 24 de junio de 2011

Acupuncture treatment for vascular dementia

By JlNZHOU TlAN
Department of Geriatrics, Beijing University of Chinese Medicine and Pharmacology, Beijing Dongzhimen Hospital, 5 Haiyuncang Street Beijing 100700, China. Fax: (+86) 10 6401 0817

Acupuncture begins with a diagnosis of the individual's energy imbalance. The energy of the body, mind and spirit is distributed through 12 main energy pathways (sometimes called meridians). Each pathway is associated with an organ. The chronic over- or underactivity
of any of these pathways will cause organs, including the brain, to work less effectively, resulting in disease. Each organ also has a pulse associated with it that informs the practitioner about the energy of that organ. These signs, together with others, such as focal neuropsychiatric symptoms and signs, form the basis of diagnosis. Treatment is the process of re-establishing the energy balance through the insertion of needles into acupuncture points located on the pathways. As the balance improves, health improves [20].
A study at Shanghai Medical University investigated the effects of acupuncture on 21 elderly subjects with vascular dementia. These all met the DSM-HI-R criteria, and scored >7 on the Hachinski ischaemia scale, <295 HDS-R and >5 on the Functional Activities Questionnaire [21]. They all had evidence of vascular damage on a brain computed tomography or magnetic resonance imaging. In 10 cases the dementia was considered to be mild (22-29.5 on die HDS-R), in seven it was thought to be moderate (10.5-21.5 on the HDS-R) and in four cases the dementia was severe (0-10 on the HDS-R).
The main acupuncture points employed in this study were baihui, qiangjia, naohu, shuigo and shengmen, but at the same time the researchers injected other acupuncture points, including yamen, ganyu, shengyu, dajui, fengchi and zhusanli, using 1 ml of acetyl glutamine, injecting two points at the same time every other day, with longitudinal comparison. Three months later improvement on the HDS-R scale of > 5 -10 was noted. Similarly, statistically significant results were reported for improvement on the Functional Activities Questionnaire. The intelligence disturbance rate dropped from 3946 % before treatment to 22.52%, with high density lipoprotein-c notably raised to normal level.
Another trial was undertaken at Helongjiang College of Chinese Medicine Hospital with 18 inpatients with vascular dementia, diagnosed using the DSM-HIR criteria, the HDS-R and the Hachinski ischaemia scale, together with evidence of infarcts on computed tomography. All patients underwent acupuncture, using shengting, baihui, fengchi, shemen and dazhong as the main points, once daily, for 30 successive days, again with longitudinal assessment. The authors report an improvement in intellectual function in 15 of the 18 subjects, including memory function as measured by the Clinical Memory Questionnaire [22].
There was also evidence of an improvement in the electroencephalogram, especially the a wave pattern [6].
It is considered that the acupuncture points described above are associated with pathways that
penetrate the brain, and the authors of these reports believe that the efficacy of acupuncture is associated with an increasing provision of oxygen to the brain brought about by an improvement in cerebral blood flow [6, 12].
A number of factors make it difficult to evaluate accurately the reliability of the results described above. For example, different criteria were used when evaluating the outcome and some of the trials were not conducted in a randomized double-blind controlled fashion. The findings do, however, indicate that traditional Chinese medicine, especially acupuncture, has something to offer people with vascular dementia. The mechanism by which these improvements are obtained is uncertain, and warrants further investigation.

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