Clinical study on TCM pattern differentiation and treatment of brain function change in patients with severe Alzheimer's disease based on resting-state functional magnetic resonance imaging.

Objective To explore the effects of TCM pattern differentiation and treatment on brain function of patients with severe Alzheimer's disease (AD) using resting-state functional magnetic resonance imaging (fMRI). Methods According to the internationally recognized NINCDS-ADRDA Alzheimer's Criteria, fifty patients with severe AD were enrolled in the study and were randomly divided into Chinese medicine group (CMG) (n = 25) and Western medicine group (WMG) (n = 25). Patients in the CMG were given TCM treatment based on pattern differentiation: patients with heart-qi deficiency received Tiaoxin Fang (Heart-regulating Formula), patients with kidney-essence insufficiency Bushen Fang (Kidney-supplementing Formula) and patients with patterns complicated by phlegm and blood stasis were additionally given Mengshi Guntan Wan (Chlorite Phlegm-Removing Pill) and Xuefu Zhuyu Jiaonang (Blood Mansion Stasis-Expelling Capsule) respectively. Patients in the WMG were treated with donepezil 5 mg once daily. The course of treatment lasted 48 weeks for both groups. Therapeutic effects were observed and compared using Mini-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR). Changes in brain function of the AD patients before and after treatment were also examined and compared with resting-state fMRI. Results After 48 weeks of treatment, 45.00% and 38.89% patients scored higher in MMSE and 30.00% and 22.22% scored higher in CDR in the CMG and the WMG respectively. The results of fMRI demonstrated better connectivity between posterior cingulate gyrus and other brain regions in both groups of patients. In CMG, the improved regions involved primarily the left frontal and parietal lobes, left temporal lobe and occipital lobe, while in WMG, the improved regions included primarily the right hippocampus, the left frontal lobe and the temporal lobes. Conclusion The heart-regulating and kidney-supplementing TCM treatment based on pattern differentiation is effective in improving cognitive function and reducing disease severity of patients with severe AD and enhancing their brain function by increasing connectivity between posterior cingulate gyrus and specific regions in the brain. [ABSTRACT FROM AUTHOR]