Original Article Effects of Butylphthalide Combined With
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Int J Clin Exp Med 2020;13(10):7773-7779 www.ijcem.com /ISSN:1940-5901/IJCEM0112554 Original Article Effects of butylphthalide combined with Naofukang on cognitive function and the expression of serum neurotrophic factor in patients with vascular dementia Yonghua Chen1*, Jinlong Zhao2*, Hao Wu3, Xiaoyi Li4, Mingjun Zhang5 1Department of Psychiatry, Zhoushan Second People’s Hospital, Zhoushan 316000, Zhejiang, China; 2Depart- ment of Psychology, Armed Police Corps Hospital, Jiaxing 314000, Zhejiang, China; 3Department of Psychiatry, Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang, China; 4Department of Psychiatry, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China; 5Depart- ment of General Medicine, Zhoushan Second People’s Hospital, Zhoushan 316000, Zhejiang, China. *Co-first authors. Received April 14, 2020; Accepted June 2, 2020; Epub October 15, 2020; Published October 30, 2020 Abstract: Objective: This study aimd to determine the effect of butylphthalide combined with Naofukang on cogni- tive function and serum neurotrophic factor level in patients with vascular dementia. Methods: A total of 172 pa- tients with vascular dementia were randomly enrolled and equally divided into an observation group and a control group. Patients in the control group received Naofukang orally besides routine treatment, while the observation group was treated with Butylphthalide Soft Capsules in addition to Naofukang for 12 weeks. Simple Mental State Examination (MMSE) and Clinical Dementia Degree Scale (CDR) were used to assess cognitive function. Activity of Daily Life Scale (ADL) and Barthel Index were used to evaluate the self-care ability of patients. Adverse drug reac- tions were recorded while serum neurotrophic factor (BDNF) level was detected by ELISA. Results: The therapeutic effect of the observation group (86.05%) was significantly higher than that of the control group (70.93%) (P<0.05). MMSE and CDR scores showed no significant difference between two groups before treatment (P>0.05). After treatment, the MMSE score in observation group was significantly increased and the CDR score was statistically reduced compared to those in the control group (P<0.05). In addition, MMSE scores were significantly elevated and CDR scores were markedly decreased after treatment (P<0.05). Butylphthalide combined with Naofukang sig- nificantly improved the Barthel index score, whereas it markedly decreased the ADL score compared to single use of Naofukang (P<0.05). After treatment, serum BDNF level was significantly increased in both groups and it was further up regulated in the observation group compared to control group (P<0.05). Adverse reaction rates showed no significant difference between the two groups (P>0.05). Conclusion: Butylphthalide combined with Naofukang can improve cognitive function and patients’ self-care ability, which maybe implicated to the changes in BDNF levels. Keywords: Butylphthalide, Naofukang, vascular dementia, cognitive function, serum neurotrophic factor Introduction tant types of Alzheimer’s related diseases. In recent years, as the aging population increas- Vascular dementia (VaD) is caused by brain es, the prevalence of VaD is rising rapidly. The damage owing to cerebral hypoperfusion and incidence of VaD in males is clearly higher lesions such as multiple stroke or chronic ce- than that in females [5]. At present, the treat- rebral ischemia [1-3]. Cognitive dysfunction is ment of VaD mostly depends on drug inter- an important clinical symptom of VaD patients. vention, but the clinical effects vary in multi- The patients frequently present with dysfunc- ple types of medicine. Therefore, how to effec- tion of language, memory, orientation, beha- tively improve the cognitive impairment and vior and so on, which seriously affects cogni- patient’s quality life remains to be settled [6]. tive function, social activities and quality of life. The disease even causes great psychologi- Butylphthalide is a new kind of lipid-soluble cal pressure and economic burden to patients drug, which can directly exert anti-cerebral is- and their families [4]. VaD is one of the impor- chemia functions and protect neurons against Effects of butylphthalide in patients with vascular dementia injury through the blood-brain barrier [7, 8]. equally assigned into a control group and an Therefore, in 2002, butylphthalide was official- observation group by a double blind method. ly approved by China’s Food and Drug Admi- nistration as a new drug for the treatment of Therapeutic methods acute ischemic stroke. Many animal experi- ments and pharmacodynamic studies have Patients from both groups received basic confirmed that butylphthalide has protective treatment such as routine control of blood effects on nerve cells, and its structure as well pressure, blood sugar, blood lipids, anticoagu- lation, regulation of cerebral circulation and as clinical safety has been determined [9, 10]. brain metabolism. The control group was given Naofukang, also known as piracetam, is a cy- Naofukang (piracetam tablet, Tianjin Jinshi clic derivative of alpha-aminolevulinic acid. It Pharmaceutical Co., Ltd., the Chinese medi- has the function of activating, protecting and cine standard H12020667, specifications: 0.4 repairing neuronss and can be used for the g*100 tablets), orally 0.8 g/3 times/d, along treatment of memory impairment and cognitive with the routine treatment. The observation dysfunction caused by cerebrovascular diseas- group received Butylphthalide Soft Capsules es, brain trauma and various toxic encephalop- (Enbipu, produced by Enbipu Pharmaceuti- athy [11, 12]. This study explored the thera- cal Co., Ltd. of Stone Pharmaceutical Group, peutic effect of Butylphthalide combined with the Chinese medicine standard H20050299, Naofukang on VaD and analyzed their effects specifications: 0.1 g*24 capsules) orally 0.2 on brain-derived neurotrophic factor (BDNF), g/3 times/d for 12 weeks. which is expected to provide ideas and evi- dence for the clinical treatment of VaD. Observation Indicators Materials and methods Cognitive function was assessed by MMSE and CDR: Among them, the MMSE scale includes General information 30 questions with a total score of 30. If the score is lower than 23, a cognitive impairment A total of 172 patients with VaD from June is implicated. The score is negatively corre- 2017 to June 2018 were enrolled. The diagno- lated to the severity of cognitive impairment. sis was performed according to the diagnostic CDR scale mainly includes memory, orienta- criteria of VaD based on American Psychiatric tion, judgment and question-solving ability, Association’s Diagnostic and Statistical Man- work and social communication ability, family ual for Psychiatry (DSMIV) 5th edition. life and personal hobbies, and self-care ability for an independent life. Each aspect is as- Inclusion criteria [13]: 1) patients diagnosed sessed by five grades from harmlessness to with ischemic stroke previously by brain CT or/ severe damage. However, the scores of each or MRI; 2) patients with dementia occurring aspect are not superimposed. Instead, the six within 3 months after stroke and lasting for aspects are assessed as a total score. The more than 6 months; 3) Hachonski ischemic comprehensive results are expressed as 0, score ≥7; 4) MMSE score was between 12-23 0.5, 1, 2 and 3 points. A higher score indicates points. Exclusion criteria: 1) patients with se- more serious cognitive dysfunction. vere heart, liver, kidney dysfunction or hema- tological diseases, malignant tumors and ca- The ADL and Barthel index were used to asse- chexia; 2) patients with other nervous system ss the self-care ability of the patients: Among diseases or psychiatric diseases, depression, them, there are 14 items in the ADL scale, etc.; 3) patients with dementia before stroke; 4) including self-care, exercise, housework and patients who have incomplete clinical data, or communication. The total score ranges from took drugs which affected cognitive function 14 to 56, and the lowest is 14, which indica- recently, or stopped treatment due to intoler- tes completely normal. When the ADL score is ance or severe adverse reactions of drugs in more than 14, it denotes that there are differ- this study. The study was approved by the Eth- ent degrees of functional decline. The critical ics Committee of Zhoushan Second People’s value is 20. A high score suggests poor prog- Hospital. All participants were aware of the nosis. The Barthel index has 10 items, includ- contents of this study and signed the informed ing eating, bathing, decorating, dressing, defe- consent. The 172 patients were randomly and cation control, toilet use, bed and chair trans- 7774 Int J Clin Exp Med 2020;13(10):7773-7779 Effects of butylphthalide in patients with vascular dementia Statistical analysis The data were input into SPSS 15.0 for result analysis and statistical processing. The count- ing data were displayed as mean ± standard deviation. The comparison between the two groups and the comparison before and after treatment were analyzed by t-test. The mea- surement data were displayed as percentage or number of cases, and the comparison bet- ween the two groups was analyzed by chi- square test. P<0.05 indicates a significant difference. Result Basic characteristics of participants The control group consisted of 44 males and 42 females, aged 55-74 years (average age: 62.58+4.73), and disease course ranged from 7 to 23 months (average: 5.36+4.08 mon- ths). The observation group included 43 males Figure 1. Comparison of efficiency. and 43 females, aged 57-75 years (average: 63.42±4.88) with a course of disease of 7-25 fer, walking and stairs up and down. A full score months (average: 16.14±4.72 months). Gene- of 100 means that patients have good activi- ral data were comparable and no significant ties of daily life, while a score below 60 indi- difference was found between the two groups cates that patients have moderate to severe (P>0.05). dysfunction of activities and need care from others in daily life.