麻黃附子細辛湯與智愛湯治療失智患者冬季憂鬱及冷漠症狀

Treatment of Depressive and Cold Symptoms of Dementia Patients with Ma- Huang-Fu-Zi-Xi-Xin-Tang and Zhi-Ai-Tang

前言：憂鬱及冷漠是失智症患者常見精神症狀，尤以寒冷且光照較少的冬天更易出現。本研究探討併用麻黃附子細辛湯與智愛湯，對於失智症患者在冬季時的憂鬱及冷漠等症狀的療效。方法：招募2014年11月至2015年3月間，因失智症伴有明顯憂鬱或冷漠，而希望接受中醫治療的患者，用追蹤觀察法研究26名自願參與者的精神與神經學症狀進展。試驗前四週每位患者接受每日早晨服用中藥智愛湯一包（100ml），及一日兩次每次4克麻黃附子細辛湯濃縮中藥粉劑。治療後八週我們繼續使用智愛湯作維持治療，療效指標包含簡短版神經精神量表（NPI-Q）、簡易心智量表（MMSE）、工具性日常生活活動能力量表（IADL）與日常生活活動功能量表（ADL）。測量時間為治療開始前與治療後各作一次測量。結果：研究結束時共有24位參與者完成研究，參與者的NPI-Q總分及憂鬱、冷漠兩項分數明顯下降且達統計意義，ADL與IADL分數均顯著上升且達統計意義。在兩個月後續維持治療時，IADL、MMSE、NPI-Q總分與治療前差異不明顯，顯示治療效果在兩個月內能繼續維持。結論：本研究發現服用智愛湯合併麻黃附子細辛湯可減緩失智症患者的憂鬱及冷漠症狀，並能改善日常活動能力，但對於認知能力無顯著影響，建議未來可在失智症臨床照護上推廣使用。

Background: Depression and indifference are common psychiatric symptoms in people with dementia, especially in the cold and less sunny days are more likely to occur. This study explored the effects of combined use of Ma-Huang- Fu-Zi-Xi-Xin-Tang and Zhi-Ai-Tang on mental and behavioral symptoms such as depression and indifference during dementia in winter. Methods: We recruited patients with dementia associated with marked depression or indifference from November 2014 to March 2015, who were expecting to receive Chinese medicine treatment. The follow-up observation was used to study the status of medication and symptom progression in 26 volunteers. During the experiment, each patient received a package（100ml）of traditional Chinese medicine, Zhi-Ai-Tang, every morning, and four grams of Ma-Huang-Fu-Zi-Xi- Xin-Tang powder for four consecutive weeks. After treatment, we continued to use Chi Ai Tang for two months of maintenance therapy; curative effect indicators include a short version of neuropsychiatric scale（NPI-Q）, simple mental scale （MMSE）, instrumental activities of daily living scale IADL）and daily life function scale（ADL）. We Measured before and after the three-month treatment. Results: At the end of the study, a total of 24 participants completed the study, the participants of the NPI-Q score and depression, apathy two scores decreased significantly and statistical significance, ADL and IADL scores were significantly increased and reached statistical significance. In two months follow-up maintenance therapy, IADL、MMSE、NPI-Q score and the difference between the treatment is not apparent, showing that treatment can continue to maintain within two months. Conclusions: The study found that taking traditional Chinese medicine Ma- Huang-Fu-Zi-Xi-Xin-Tang and Zhi-Ai-Tang could slow dementia patients with depression and apathy symptoms and can improve the ability of daily activities, but no significant impact on cognitive ability, it is recommended to the future clinical dementia Care to promote the use.