中醫對失智患者認知功能與行為症狀的影響：臨床觀察性研究

The Effects of Traditional Chinese Medicine on Cognitive Function and Behavioral Symptoms in Dementia Patients: A Clinical Observational Study

失智症是一種進行性神經退行性疾病，以認知功能逐漸退化為特徵，常伴隨顯著的行為心理症狀（BPSD），如焦慮、躁動及抑鬱，對患者生活品質及照護者心理健康造成挑戰。目前，傳統西醫療法雖能控制症狀，但長期使用可能引發副作用。中醫療法以其整體治療特性和低副作用逐漸應用於失智症患者的綜合治療。然而，其對認知功能、行為症狀及生活品質的具體影響仍需更多研究驗證。本研究採用單臂開放標籤觀察性設計，納入548名失智症患者（65至90歲），包括不同類型及嚴重程度的失智症患者，接受9個月中醫綜合治療。干預措施包括個性化中藥方劑（以補腎益智為主）、針灸及耳穴敷貼。使用簡易精神狀態檢查（Mini-Mental State Examination，MMSE），神經精神症狀量表（Neuropsychiatric Inventory，NPI），阿茲海默症行為病徵評估量表（Behavioral Pathology in Alzheimer's Disease Rating Scale，BEHAVE-AD），歐洲生活品質視覺類比量表（EuroQol Visual Analogue Scale，EQ-VAS）等量表評估患者的認知功能、行為心理症狀及生活品質，並記錄照護者負擔的變化。數據分析採用重複測量變異數分析。
治療後，患者神經精神症狀量表（NPI）分數從49.8下降至39.9（P < 0.0001），焦慮、幻覺、躁動及攻擊性行為顯著改善（P < 0.01）。生活品質視覺類比量表（EQ-VAS）分數從49.3提升至52.5（P < 0.0001），且在治療結束後持續穩定。MMSE評分從15.7下降至14.2。此外，照護者負擔顯著減輕，患者睡眠質量及情緒穩定性均提升。未記錄嚴重不良事件，顯示治療安全性良好。中醫綜合治療能有效改善失智症患者的行為心理症狀及生活品質，並減輕照護者負擔，但在提升認知功能方面的效果有限。本研究支持中醫療法在失智症患者照護中的價值，尤其是針灸和中藥的聯合應用，可能通過調節神經炎症和改善腦部血流發揮作用。未來需進一步進行多中心隨機對照試驗以驗證其療效及作用機制。

Dementia is a progressive neurodegenerative disease characterized by cognitive decline and often accompanied by significant behavioral and psychological symptoms of dementia (BPSD), such as anxiety, agitation, and depression, posing challenges to patients' quality of life and the mental health of their caregivers. While conventional Western medicine can manage symptoms, long-term use may lead to notable side effects. Traditional Chinese medicine (TCM), with its holistic approach and low side effects, has increasingly been applied to the comprehensive treatment of dementia. However, further studies are needed to verify its specific effects on cognitive function, behavioral symptoms, and quality of life.
This study employed a single-arm, open-label observational design, enrolling 548 dementia patients aged 65 to 90 years, including various types and severities of dementia. Patients underwent nine months of comprehensive TCM treatment, including personalized herbal prescriptions (primarily focusing on kidney-tonifying and cognition-enhancing effects), acupuncture, and auricular acupressure. Standardized scales such as the Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), and EuroQol Visual Analogue Scale (EQ-VAS) were used to evaluate cognitive function, behavioral and psychological symptoms, and quality of life. Changes in caregiver burden were also recorded. Statistical analysis was performed using repeated-measures ANOVA.
After treatment, NPI scores significantly decreased from 49.8 to 39.9 (P < 0.0001), with notable improvements in anxiety, hallucinations, agitation, and aggressive behavior (P < 0.01). EQ-VAS scores increased from 49.3 to 52.5 (P < 0.0001) and remained stable after treatment. MMSE scores declined from 15.7 to 14.2. Additionally, caregiver burden was significantly reduced, with improvements in patients' sleep quality and emotional stability. No severe adverse events were reported, demonstrating good safety and tolerability.
Comprehensive TCM treatment effectively alleviates behavioral and psychological symptoms and improves the quality of life for dementia patients, while its effects on cognitive function are limited. This study highlights the value of TCM, especially the combined use of acupuncture and herbal medicine, which may exert effects by modulating neuroinflammation and improving cerebral blood flow. Further multi-center randomized controlled trials are needed to validate its efficacy and explore underlying mechanisms.