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JKM > Volume 40(1); 2019 > Article
Kim, Jo, Kang, Choi, Song, Sul, and Leem: Proposal of Evidence-based East-West Integrative Medicine Manual for Vascular Dementia

Abstract

Objectives

This study was made by Chung Yeon Korean Medicine Hospital in order to perform appropriate East-West integrative medicine. The purpose of this manual is to support decision-making and communication in the implementation of the East-West cooperative treatment of vascular dementia.

Methods

In order to carry out this study, it is based on search terms such as ‘vascular dementia’, ‘acupuncture’, ‘herbal medicine’, ‘integrative medicine’, ‘chinese traditional medicine’, and ‘cognitive function’ in databases such as MEDLINE, EMBASE, OASIS and CNKI We collected references.
The drafting proceeded with the collaboration of two specialists of the Korean medicine, and the disagreement on the basis of the quotation was determined through a two person agreement. After, The draft was reviewed by a western medical doctor(rehabilitation specialist). Then, The opinions of the entire medical staff of the committee were reflected in the draft and finalized the agreement.

Results

Through this study, manuals for diagnosis, treatment, and other considerations in the process of applying East-West integrative medicine to vascular dementia were derived.

Conclusions

This study has significance in that it provides manual information about the decision structure, treatment contents, role distribution, etc. of East-West integrative medicine within the medical institution that conducts the vascular dementia consultation. In order for this study to function as a generalized medical guideline, it is necessary to improve the research methodology and carry out professional consensus procedures.

Fig. 1
Clinical Pathway of East-West Integrative Medicine for Vascular Dementia
jkm-40-1-46f1.gif
Table 1
NINDS-AIREN Criteria for the Diagnosis of Probable Vascular Dementia
The criteria for the clinical diagnosis of probable vascular dementia include all of the following
1. Dementia The diagnosis of dementia should be based on a decline in cognitive function from a prior baseline and a deficit in performance in 2 or more cognitive domains (orientation, attention, language, visuospatial functions, executive functions, motor control, and praxis) that are of sufficient severity to affect the subject’s activities of daily living.
Those having disturbances of consciousness, delirium, psychosis, severe aphasia, or major sensorimotor impairment precluding neuropsychological testing are excluded.
Also excluded are systemic disorders or other brain diseases (such as Alzheimer’s disease) that in and of themselves could account for deficits in memory and cognition.
2. Cerebrovascular disease Defined by the presence of focal signs on neurologic examination, such as hemiparesis, lower facial weakness, Babinski sign, sensory deficit, hemianopia, and dysarthria consistent with stroke (with or without history of stroke), and evidence of relevant CVD by brain imaging (CT or MRI)
3. A relationship between the above two disorders Manifested or inferred by the presence of one or more of the following: (a) onset of dementia within 3 months following a recognized stroke; (b) abrupt deterioration in cognitive functions; or fluctuating, stepwise progression of cognitive deficits.
Table 2
Characteristics of the Respondents
Subtypes Imaging and pathological change
Multi-infarct dementia (cortical vascular dementia) Multiple cortical infarct
Small vessel dementia (subcortical vascular dementia) Lacunes, extensive white matter lesions; pathologically, infarcts, demyelination, and gliosis
Strategic infarct dementia Infarct in strategic location (e.g. thalamus)
Hypoperfusion dementia Watershed infarcts, white matter lesions; pathologically, incompleted infarcts in white matter
Haemorrhagic dementia Haemorrhagic changes, may be associated with amyloid angiopathy
Hereditary vascular dementia (CADASIL) Multiple lacunes and white matter lesions, temporal lobe white matter affected
Alzheimer’s disease with cardiovascular disease Combination of vascular changes and atrophy, especially medial temporal lobe; pathologically, mixture of vascular and degenerative (plaque and tangle) pathology
Table 3
Role Table of East-West Integrative Medicine for Vascular Dementia
Korean medicine Western medicine
Diagnosis 1)history taking, physical examination, neurological examination, screening test (including MMSE)
2)evaluation for patients who screen positive (including CDR, GDS, KDSQ, ADL, HIS)
3)Imaging test consult for differential diagnosis
4)examination for pattern identification (including pulse diagnosis, abdominal palpation)
3)Imaging test for differential diagnosis
Treatment 1)acupuncture (including manual acupuncture, electroacupuncture, scalp acupuncture, pharmacopuncture), cupping (including dry cupping, wet cupping), moxibustion.
2)herbal medication (including decoction, capsule, pill, tablet, granule, powder, concentrate extract)
3)Korean medicine psychotherapy such as Yijeongbyunqi(移精變氣) therapy, family therapy etc.
1)cognitive training and cognitive rehabilitation
2)Cognitive-behavioural therapy
3)Oral medication, Injection treatment
Management 1)management and monitoring of coexistence risk factor (including stroke, hypertension, hyperlipidemia, diabetes mellitus, alcohol dependence, obesity)
2)education and adjustment of the patient’s lifestyle
3)patient carer consultation

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