Zhiling Decoction for Vascular Dementia: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

YUE Jirong ¹ , WU Taixiang ² , DONG Birong ³

1.Department of Gerontology; West China Hospital; Sichuan University; Chengdu 610041; China2.Evidence-Based Medicine and Clinical Epidemiology Center; China;

Corresponding author：

Keywords：

Zhiling decoction; Vascular dementia; Randomized controlled trials; Systematic review

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Objective 　To assess the efficacy and safety of Zhiling decoction for vascular dementia.
Methods 　The Specialized Register of the Cochrane Dementia and Cognitive Improvement Group was searched in Feb. 2004 using the term Zhiling. In addition, we handsearched 83 traditional Chinese medicine journals （1993 to 2004 ）. We included all randomized controlled trials（RCTs）of Zhiling decoction treating people with vascular dementia. We also evaluated the internal validity of the RCTs . If all included RCTs were of high quality and homogeneity, then the meta-analysis was conducted.
Results　 Only one RCT was identified. The outcomes were listed as the followings ： ① The Hasegawa＇ s dementia scale scoring （ HDS ） scores of the patients in Zhiling decoction group were improved significantly from baseline after 8 weeks course of treatment and there was no significant difference in the control group. The HDS scores improvement was greater than control group（P 〈0.01 ）o ② The latency of P3 was shorter in both groups after treatment, and there was a significant treatment effect in Zhiling group （t = -52. 09, 95% CI -69.79 to -34.39, P 〈0. 000 01 ）. The amplitude of 173 increased in both groups after treatment, and there was a non-sigmficant treatment effect in Zhiling group for change from baseline （t =1.40, 95% CI -0.02 to 2.82, P =0.05）. ③ Brain electrical activity monitoring （BEAM） showed that benefits in those treated by Zhiling decoction were higher than those treated by Naofukang with OR9.90 （ 95% CI 3.34 to 29.38）. ④In the Zhiling group serum cholesterol （P 〈0.01 ） , serum triglyceride （P 〈0.01 ） and LPO（P 〉0. 01 ） decreased after treatment. There was an increase in the level of high density lipoprotein （HDL） and superoxide dismutase （SOD） in red blood cells compared with baseline for Zhiling groups （P 〈0.01 ）. ⑤ The cerebral blood flow decreased in both groups after treatment, and there was a significant treatment effect in favour of Zhiling （treatment effect t = -1.03, 95% CI -1.26 to -0.80, P 〈0. 00001 ）.⑥ No side effects on heart, liver or renal function were reported in Zhiling decoction group.
Conclusions 　The currendy available evidence is insufficient to assess the potential efficacy for Zhiling decoction in the treatment of vascular dementia. Just one RCT concerning the management of Zhifing decoction versus Naofukang suggests that Zhiling decoction may be effective in treating vascular dementia. Further randomised, double-blind, placebo-controlled trials are urgendy needed .

Citation： YUE Jirong,WU Taixiang,DONG Birong. Zhiling Decoction for Vascular Dementia: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2005, 05(9): 692-695. doi: Copy

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1. 阎乐法, 刘百波, 李光宗, 孙鲁妍, 崔华勤, 王梅, 郭文君, 高汉义, 李义清. 智灵汤治疗老年血管性痴呆临床研究[J]. 中国中西医结合杂志, 1998; 18(7): 388～391.
2. World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical description and diagnostic guidelines[Z]. Geneva: World Health Organisation, Division of Mental Health, 1992.
3. Hebert R, Brayne C. Epidemiology of vascular dementia[J]. Neuroepidemiology, 1995;14(5):240-257.
4. Liu L, Guo XE, Zhou YQ, Xia JL. Prevalence of dementia in China[J]. Dement Geriatr Cogn Disord, 2003;15(4):226-230.
5. Kannayiram Alagiakrishnan, Kamal Masaki. Vascular Dementia[OB]. Available from http://www.emedicine.com/med/topic3150.htm. 2004.
6. Skoog I. Status of risk factors for vascular dementia[J]. Neuroepidemiology, 1998;17(1):2-9.
7. Williams PS, Rands G, Orrel M, Spector A. Aspirin for vascular dementia[M/CD]. The Cochrane Database of Systematic Reviews 2003, Issue 3. Oxford: Update Software.
8. Schneider LS, Olin JT. Overview of clinical trials of hydergine in dementia[J]. Archives of Neurology, 1994; 51(8): 787-798.
9. European Dementia Study. European Pentoxifylline Multi-Infarct Dementia Study[J]. European Neurology, 1996; 36(5): 312-321.
10. Fulder S. The Handbook of Alternative and Complementary Medicine[M]. Oxford: Oxford University Press, 1996.
11. Yan LF, Zheng NZ, Liu BB, Guo WJ, Gao HY. Clinical study of the effect of Zhiling Decoction in treating senile vascular dementia[J]. International Journal of Oriental Medicine, 1999; 24(2): 98-103.
12. Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials[J]. JAMA, 1995; 273(5): 408-412.
13. Jadad A, Moore R, Carroll D, Jenkinson C, Reynolds J, Gavaghan D, McQuay H. Assessing the quality of reports of randomised clinical trials: Is blinding necessary[J]? Controlled Clinical Trials, 1996; 17: 1-12.
14. Yan LF, Liu BB, Li GZ, Sun LY, Cui HQ, Wang M, Guo WJ, Gao HY, Li YQ. Clinical study on effects of Zhiling decoction in treating senile vascular dementia[J]. Chinese Journal of Integrated Traditional and Western Medicine, 1998; 18(7): 388-391.

Chinese Journal of Evidence-Based Medicine

Zhiling Decoction for Vascular Dementia: A Systematic Review

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