Study on the Therapeutic Effects of External Counterpaulsation on Alzheheimer-Type Senile Dementia
Wei-ping Li, MS; Zhi-bin Yao, MD; Yi-ci Chen, MD Brain Research Office, Sun Yat-sen University of Medical Sciences, Guangzhou (510089)
Wen-jun Yang, MD Department of Neurology, Nanfang Hospital, First Military Medical University
Wu-he Peng, MD Department of Nuclear Medicine, Nanfang Hospital, First Military Medical University
Ping Hu, MD Department of Nuclear Medicine, First Affiliated Hospital of Sun Yat-sen University of Medical Sciences
Compiled and edited by Dr. Gong (usecp.com)
Abstract
Objective: To investigate the therapeutic effects of External Counterpulsation (ECP) on patients with Alzheimer-type senile dementia (SDAT).
Methods: Ten patients with mild-to-moderate SDAT underwent ECP therapy for 8 weeks. Clinical symptoms, Hasegawa Dementia Scale (HDS) scores, Single-Photon Emission Computed Tomography (SPECT) brain perfusion, and biochemical markers in blood and cerebrospinal fluid (CSF) were evaluated before and after treatment.
Results: SPECT imaging showed a significant increase in the cortex/cerebellum uptake ratio in the temporal, parietal, and frontal lobes (P<.05). Superoxide dismutase (SOD) activity and Somatostatin (SS) levels in the CSF increased significantly post-treatment (P<.01).
Conclusion: ECP improves cerebral blood flow and modulates neuroendocrine substances, suggesting a potential comprehensive therapeutic role in managing SDAT.
Introduction
External Counterpulsation (ECP) is a non-invasive circulatory support device that increases diastolic arterial pressure, thereby improving perfusion to vital organs such as the heart and brain. While traditionally used for ischemic cardiovascular diseases, ECP has shown promise in treating neurological conditions including cerebral thrombosis, vascular dementia, and Parkinson’s syndrome.
Recent hypotheses suggest that ECP’s efficacy may extend beyond hemodynamics to include complex neuroendocrine regulation. Alzheimer-type senile dementia (SDAT) is a degenerative neuronal disease with increasing prevalence and limited effective treatments. This study evaluates the clinical and biochemical impact of ECP on 10 SDAT patients.
Materials and Methods
Patient Population
Ten patients (3 male, 7 female; mean age 74.5±10.5 years) diagnosed with SDAT per DSM-II-R criteria were enrolled. Disease duration ranged from 1 to 5 years. Baseline HDS scores averaged 11.9±9.6. All patients exhibited brain atrophy on CT and increased slow waves on EEG.
ECP Protocol
Patients were treated using the MCI-type ECP device (Sun Yat-sen University and Foshan Analytical Instrument Factory). Treatment consisted of 1-hour sessions, 6 days per week, for 8 consecutive weeks. Counterpulsation pressure was maintained at 0.35 to 0.45 kg/cm2 with a Diastolic/Systolic (D/S) ratio >1.2.
Observation Indicators
HDS Scores: Assessed pre- and post-treatment.
SPECT Imaging: 99mTc-ECD perfusion tomography was performed using a TOSHIBA GCA901A/SA system. Regional interest zones (ROI) included superior frontal (SF), inferior frontal (IF), temporal (T), parietal (P), and occipital (O) regions.
Biochemical Analysis: SOD activity, Malondialdehyde (MDA), Somatostatin (SS), and Dynorphin A1-13 (DynA1−13) were measured in blood and CSF via RIA and TBA methods.
Amino Acids: CSF free amino acid concentrations were determined using High-Performance Liquid Chromatography (HPLC).
Statistical Analysis
Data are expressed as mean ± standard deviation (xˉ±s). Comparisons were performed using the Student’s t-test.
Results
Clinical Findings and HDS Scores
All patients completed the 8-week course without adverse effects. Clinical improvements included better mental status and increased attention span. HDS scores trended upward (11.9 to 13.8±6.9), though the change was not statistically significant (P>.05).
SPECT Perfusion Results
Post-treatment SPECT showed a significant increase in radioactive uptake across several brain regions, particularly the temporal and parietal lobes (Table 1).
Table 1. SPECT Cortex/Cerebellum Uptake Ratios Pre- and Post-ECP (n=6, xˉ±s)
∗P<.05, ∗∗P<.01
Biochemical Markers
ECP treatment significantly increased SOD activity in both serum and CSF. SS levels in the CSF and plasma DynA1−13 also showed significant elevation (Table 2).
Table 2. Effects of ECP on Bioactive Substances in Blood and CSF (n=10, xˉ±s)
∗P<.05, ∗∗P<.01
CSF Free Amino Acids
Proline and Methionine levels decreased significantly post-treatment. Trends toward increased Glutamate and GABA were observed but did not reach statistical significance (Table 3).
Table 3. CSF Free Amino Acid Levels Pre- and Post-ECP (nmol/ml, n=10, xˉ±s)
∗P<.05, ∗∗P<.01
Discussion
SDAT is characterized by reduced cerebral blood flow and impaired glucose metabolism. This study demonstrates that ECP significantly improves cerebral perfusion, as evidenced by increased SPECT uptake ratios in the temporal and parietal lobes. Furthermore, the increase in SOD activity suggests that ECP enhances the body's antioxidant capacity, potentially mitigating free-radical damage common in aging and neurodegeneration.
The significant rise in CSF Somatostatin (SS) is particularly noteworthy, as SS levels are typically diminished in SDAT and correlate with cognitive function. The increase in plasma DynA1−13 likely represents a systemic stress response to ECP therapy, while the stability of CSF DynA1−13 indicates the blood-brain barrier's role in localizing these effects.
While HDS scores showed only a modest trend toward improvement, the physiological and biochemical changes suggest that ECP provides a comprehensive benefit by combining hemodynamic improvement with neuroendocrine modulation.
Conclusion
ECP represents a promising, non-invasive therapeutic modality for SDAT. It effectively increases cerebral blood flow and positively influences the levels of key bioactive substances in the CSF and blood. Future studies with larger sample sizes and longer treatment durations are warranted to further establish its clinical utility.
