Association of traditional Chinese medicine therapy and the risk of dementia in patients with hypertension: a nationwide population-based cohort study

Kuen-Hau Chen, Ming-Hsien Yeh, Hanoch Livneh, Bor-Chyuan Chen, I-Hsin Lin, Ming-Chi Lu, Tzung-Yi Tsai, Chia-Chou Yeh, Kuen-Hau Chen, Ming-Hsien Yeh, Hanoch Livneh, Bor-Chyuan Chen, I-Hsin Lin, Ming-Chi Lu, Tzung-Yi Tsai, Chia-Chou Yeh

Abstract

Background: Patients with hypertension (HTN) reportedly have a higher risk of developing dementia. However, it remains unclear if use of Traditional Chinese Medicine (TCM), the most common form of complementary and alternative medicine, can help lower the risk of dementia for these patients. So the aim of the study was to investigate the effects of TCM on dementia risk among patients with hypertension.

Methods: This longitudinal cohort study used the Taiwanese National Health Insurance Research Database (NHIRD) to identify 143,382 newly diagnosed hypertension patients aged 20-90 years who received treatment between 1998 and 2007. Among them, 52,365 (36.52%) had received TCM after the onset of hypertension (TCM users), and the remaining 91,017 patients (63.48%) were designated as a control group (non-TCM users). All enrollees were followed until the end of 2012 to record the incidence of dementia. A Cox proportional hazards regression model was used to compute the hazard ratio (HR) of dementia in patients who received TCM.

Results: During the 15-year follow-up, 3933 TCM users and 10,316 non-TCM users developed dementia, representing an incidence rate of 8.41 and 11.55%, respectively, per 1000 person-years. TCM users had a significantly reduced risk of dementia compared to non-TCM users (adjusted HR = 0.76; 95% confidence interval [CI] = 0.74-0.81). The predominant effect was observed among those treated with TCM longer than 180 days (adjusted HR = 0.65; 95% CI = 0.62-0.69). Among the commonly used TCM products, Tian-Ma-Gou-Teng-Yin, Dan-Shen (Radix Salviae Miltiorrhizae), Chuan-Niu-Xi (Radix Cyathulae), Ge-Gen (Radix Puerariae), Jia-Wei-Xiao-Yao-San, and Jue-Ming-Zi (Semen Cassiae) were significantly associated with a lower risk of dementia.

Conclusions: Results from this population-based study support the effects of TCM on reducing dementia risk, which may provide a reference for dementia prevention strategies.

Keywords: Cohort study; Dementia; Hypertension; Traditional Chinese medicine.

Figures

Fig. 1
Fig. 1
A flowchart about the selection and follow-up of study subjects

References

    1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. 5. Washington, DC: Author; 2013.
    1. Alzheimer’s Disease International. World Alzheimer Report. In.; 2015.
    1. Raina P, Santaguida P, Ismaila A, Patterson C, Cowan D, Levine M, et al. Effectiveness of cholinesterase inhibitors and memantine for treating dementia: evidence review for a clinical practice guideline. Ann Intern Med. 2008;148:379–377. doi: 10.7326/0003-4819-148-5-200803040-00009.
    1. Hsu PC, Tsai YT, Lai JN, Wu CT, Lin SK, Huang CY. Integrating traditional Chinese medicine healthcare into diabetes care by reducing the risk of developing kidney failure among type 2 diabetic patients: a population-based case control study. J Ethnopharmacol. 2014;156:358–364. doi: 10.1016/j.jep.2014.08.029.
    1. Chen YC, Lin YH, Hu S, Chen HY. Characteristics of traditional Chinese medicine users and prescription analysis for pediatric atopic dermatitis: a population-based study. BMC Complement Altern Med. 2016;16:173. doi: 10.1186/s12906-016-1158-1.
    1. Fleischer T, Chang TT, Chiang JH, Hsieh CY, Sun MF, Yen HR. Integration of Chinese herbal medicine therapy improves survival of patients with chronic lymphocytic leukemia: a nationwide population-based cohort study. Medicine. 2016;95:e3788. doi: 10.1097/MD.0000000000003788.
    1. Liao HH, Yeh CC, Lin CC, Chen BC, Yeh MH, Chang KM, et al. Prescription patterns of Chinese herbal products for patients with fractures in Taiwan: a nationwide population-based study. J Ethnopharmacol. 2015;173:11–19. doi: 10.1016/j.jep.2015.07.014.
    1. Tsai TY, Li CY, Livneh H, Lin IH, Lu MC, Yeh CC. Decreased risk of stroke in patients receiving traditional Chinese medicine for vertigo: a population-based cohort study. J Ethnopharmacol. 2016;184:138–143. doi: 10.1016/j.jep.2016.03.008.
    1. Lin Z, Gu J, Xiu J, Mi T, Dong J, Tiwari JK. Traditional chinese medicine for senile dementia. Evid Based Complement Alternat Med. 2012;2012:692621.
    1. Gottesman RF, Schneider AL, Albert M, Alonso A, Bandeen-Roche K, Coker L, et al. Midlife hypertension and 20-year cognitive change: the atherosclerosis risk in communities neurocognitive study. JAMA Neurol. 2014;71:1218–1227. doi: 10.1001/jamaneurol.2014.1646.
    1. Norton S, Matthews FE, Barnes DE, Yaffe K, Brayne C. Potential for primary prevention of Alzheimer's disease: an analysis of population-based data. Lancet Neurol. 2014;13:788–794. doi: 10.1016/S1474-4422(14)70136-X.
    1. Freitag MH, Peila R, Masaki K, Petrovitch H, Ross GW, White LR, et al. Midlife pulse pressure and incidence of dementia: the honolulu-Asia aging study. Stroke 2006;37:33-7.
    1. Xiong X, Wang P, Zhang Y, Li X. Effects of traditional Chinese patent medicine on essential hypertension: a systematic review. Medicine. 2015;94:e442. doi: 10.1097/MD.0000000000000442.
    1. Zhang G, Yang G, Deng Y, Zhao X, Yang Y, Rao J, et al. Ameliorative effects of Xue-Fu-Zhu-Yu decoction. Tian-Ma-Gou-Teng-Yin and Wen-Dan decoction on myocardial fibrosis in a hypertensive rat mode BMC Complement Altern Med. 2016;16:56.
    1. Alonso A, Mosley TH, Jr, Gottesman RF, Catellier D, Sharrett AR, Coresh J. Risk of dementia hospitalisation associated with cardiovascular risk factors in midlife and older age: the Atherosclerosis Risk in Communities (ARIC) study. J Neurol Neurosurg Psychiatry. 2009;80:1194–1201. doi: 10.1136/jnnp.2009.176818.
    1. Debette S, Seshadri S, Beiser A, Au R, Himali JJ, Palumbo C, et al. Midlife vascular risk factor exposure accelerates structural brain aging and cognitive decline. Neurology. 2011;77:461–468. doi: 10.1212/WNL.0b013e318227b227.
    1. National Health Research Institute . Longitudinal Health Insurance Research Database. 2011.
    1. Liu CY, Hung YT, Chuang YL, Chen YJ, Weng WS, Liu JS, et al. Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey. J Health Manag. 2006;4:1–22.
    1. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–619. doi: 10.1016/0895-4356(92)90133-8.
    1. Shih CC, Liao CC, Su YC, Tsai CC, Lin JG. Gender differences in traditional Chinese medicine use among adults in Taiwan. PLoS One. 2012;7:e32540. doi: 10.1371/journal.pone.0032540.
    1. Moroney JT, Tang MX, Berglund L, Small S, Merchant C, Bell K, et al. Low-density lipoprotein cholesterol and the risk of dementia with stroke. JAMA. 1999;282:254–260. doi: 10.1001/jama.282.3.254.
    1. Ritchie K, Lovestone S. The dementias. Lancet. 2002;360:1759–1766. doi: 10.1016/S0140-6736(02)11667-9.
    1. Lloret A, Badia MC, Giraldo E, Ermak G, Alonso MD, Pallardo FV, et al. Amyloid-beta toxicity and tau hyperphosphorylation are linked via RCAN1 in Alzheimer's disease. J Alzheimers Dis. 2011;27:701–709.
    1. Xian YF, Mao QQ, Wu JC, Su ZR, Chen JN, Lai XP, et al. Isorhynchophylline treatment improves the amyloid-beta-induced cognitive impairment in rats via inhibition of neuronal apoptosis and tau protein hyperphosphorylation. J Alzheimers Dis. 2014;39:331–346.
    1. Liu LF, Song JX, Lu JH, Huang YY, Zeng Y, Chen LL, et al. Tianma Gouteng Yin, a traditional Chinese medicine decoction, exerts neuroprotective effects in animal and cellular models of Parkinson's disease. Sci Rep. 2015;5:16862. doi: 10.1038/srep16862.
    1. Chik SC, Or TC, Luo D, Yang CL, Lau AS. Pharmacological effects of active compounds on neurodegenerative disease with gastrodia and uncaria decoction, a commonly used poststroke decoction. ScientificWorldJournal. 2013;2013:896873. doi: 10.1155/2013/896873.
    1. Huang GB, Zhao T, Muna SS, Jin HM, Park JI, Jo KS, et al. Therapeutic potential of Gastrodia elata Blume for the treatment of Alzheimer's disease. Neural Regen Res. 2013;8:1061–1070.
    1. Fujiwara H, Iwasaki K, Furukawa K, Seki T, He M, Maruyama M, et al. Uncaria rhynchophylla, a Chinese medicinal herb, has potent antiaggregation effects on Alzheimer's beta-amyloid proteins. J Neurosci Res. 2006;84:427–433. doi: 10.1002/jnr.20891.
    1. Tam WY, Chook P, Qiao M, Chan LT, Chan TY, Poon YK, et al. The efficacy and tolerability of adjunctive alternative herbal medicine (Salvia miltiorrhiza and Pueraria lobata) on vascular function and structure in coronary patients. J Altern Complement Med. 2009;15:415–421. doi: 10.1089/acm.2008.0400.
    1. Mei Z, Zhang F, Tao L, Zheng W, Cao Y, Wang Z, et al. Cryptotanshinone, a compound from Salvia miltiorrhiza modulates amyloid precursor protein metabolism and attenuates beta-amyloid deposition through upregulating alpha-secretase in vivo and in vitro. Neurosci Lett. 2009;452:90–95. doi: 10.1016/j.neulet.2009.01.013.
    1. Zhou Y, Li W, Xu L, Chen L. In Salvia miltiorrhiza, phenolic acids possess protective properties against amyloid beta-induced cytotoxicity, and tanshinones act as acetylcholinesterase inhibitors. Environ Toxicol Pharmacol. 2011;31:443–452. doi: 10.1016/j.etap.2011.02.006.
    1. Park CH, Kim DH, Park MH, Kim MK, Kim ND, Kim CM, et al. Chinese prescription kangen-karyu and salviae miltiorrhizae radix improve age-related oxidative stress and inflammatory response through the PI3K/Akt or MAPK pathways. Am J Chin Med. 2014;42:987–1005. doi: 10.1142/S0192415X14500621.
    1. Yang GD, Zhang H, Lin R, Wang WR, Shi XL, Liu Y, et al. Down-regulation of CD40 gene expression and inhibition of apoptosis with Danshensu in endothelial cells. Basic Clin Pharmacol Toxicol. 2009;104:87–92. doi: 10.1111/j.1742-7843.2008.00342.x.
    1. Wong KH, Li GQ, Li KM, Razmovski-Naumovski V, Chan K. Kudzu root: traditional uses and potential medicinal benefits in diabetes and cardiovascular diseases. J Ethnopharmacol. 2011;134:584–607. doi: 10.1016/j.jep.2011.02.001.
    1. Sun K, Fan J, Han J. Ameliorating effects of traditional Chinese medicine preparation, Chinese materia medica and active compounds on ischemia/reperfusion-induced cerebral microcirculatory disturbances and neuron damage. Acta Pharm Sin B. 2015;5:8–24. doi: 10.1016/j.apsb.2014.11.002.
    1. Dong XH, Gao WJ, Kong WN, Xie HL, Peng Y, Shao TM, et al. Neuroprotective effect of the active components of three Chinese herbs on brain iron load in a mouse model of Alzheimer's disease. Exp Ther Med. 2015;9:1319–1327.
    1. Anukulthanakorn K, Parhar IS, Jaroenporn S, Kitahashi T, Watanbe G, Malaivijitnond S. Neurotherapeutic effects of pueraria mirifica extract in early- and late-stage cognitive impaired rats. Phytother Res. 2016;30:929–939. doi: 10.1002/ptr.5595.
    1. Zhang H, Liu Y, Lao M, Ma Z, Yi X. Puerarin protects Alzheimer’s disease neuronal cybrids from oxidant-stress induced apoptosis by inhibiting pro-death signaling pathways. Exp Gerontol. 2011;46:30–37. doi: 10.1016/j.exger.2010.09.013.
    1. Han X, Shen S, Liu T, Du X, Cao X, Feng H, et al. Characterization and antioxidant activities of the polysaccharides from radix cyathulae officinalis kuan. Int J Biol Macromol. 2015;72:544–552. doi: 10.1016/j.ijbiomac.2014.09.007.
    1. Tanaka M, Satou T, Koike K. Anxiolytic-like effect of Shigyakusan extract with low side effects in mice. J Nat Med. 2013;67:862–866. doi: 10.1007/s11418-013-0746-3.
    1. Lee JG, Shin BS, Lee YC, Park SW, Kim YH. Clinical effectiveness of the Kampo medicine kamishoyosan for adjunctive treatment of tardive dyskinesia in patients with schizophrenia: a 16-week open trial. Psychiatry Clin Neurosci. 2007;61:509–514. doi: 10.1111/j.1440-1819.2007.01700.x.
    1. Ishikawa T, Funahashi T, Kudo J. Effectiveness of the Kampo kami-shoyo-san (TJ-24) for tremor of antipsychotic-induced parkinsonism. Psychiatry Clin Neurosci. 2000;54:579–582. doi: 10.1046/j.1440-1819.2000.00756.x.
    1. Chang YY, Tsai YT, Lai JN, Yeh CH, Lin SK. The traditional Chinese medicine prescription patterns for migraine patients in Taiwan: a population-based study. J Ethnopharmacol. 2014;151:1209–1217. doi: 10.1016/j.jep.2013.12.040.
    1. Lin YJ, Ho TJ, Yeh YC, Cheng CF, Shiao YT, Wang CB, et al. Chinese herbal medicine treatment improves the overall survival rate of individuals with hypertension among type 2 diabetes patients and modulates in vitro smooth muscle cell contractility. PLoS One. 2015;10 doi: 10.1371/journal.pone.0145109.
    1. Lee TH, Park SH, You MH, Lim JH, Min SH, Kim BM: A potential therapeutic effect of Saikosaponin C as a novel dual-target anti-Alzheimer agent. J Neurochem 2015. [Epub ahead of print].
    1. Zhang Z, Zhao R, Qi J, Wen S, Tang Y, Wang D. Inhibition of glycogen synthase kinase-3beta by angelica sinensis extract decreases beta-amyloid-induced neurotoxicity and tau phosphorylation in cultured cortical neurons. J Neurosci Res. 2011;89:437–447. doi: 10.1002/jnr.22563.
    1. Ju MS, Kim HG, Choi JG, Ryu JH, Hur J, Kim YJ, et al. Cassiae semen, a seed of Cassia obtusifolia, has neuroprotective effects in Parkinson’s disease models. Food Chem Toxicol. 2010;48:2037–2044. doi: 10.1016/j.fct.2010.05.002.
    1. Yi JH, Park HJ, Lee S, Jung JW, Kim BC, Lee YC, et al. Cassia obtusifolia seed ameliorates amyloid beta-induced synaptic dysfunction through anti-inflammatory and Akt/GSK-3beta pathways. J Ethnopharmacol. 2016;178:50–57. doi: 10.1016/j.jep.2015.12.007.
    1. Lai MN, Wang SM, Chen PC, Chen YY, Wang JD. Population-based case-control study of Chinese herbal products containing aristolochic acid and urinary tract cancer risk. J Natl Cancer Inst. 2010;102:179–186. doi: 10.1093/jnci/djp467.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel