I. Definition 
The acquired and persistent damage of intelligence, including the changes of memory, thinking, orientation, calculation, learning ability, language, judging function, emotions or personality, occurs in the aged people over 60 years.

II. Social value 
In accordance with the various investigation data, it is showed that among the population over 60 years of age, the incidence is rising with the increase of age.

In pace with the development of society, the prolongation of human life span, and the active or passive control to the increase of population, the society is under the quickened aging process. The large cities e.g. Shanghai and Beijing have developed into the aging society. It is estimated that up to the year of 2030, the total population in China will reach the number of one thousand and five hundred millions (1,500,000,000), and at that time there will be approximately two hundred millions (200,000,000) of aged people, among whom a million of patients with this disease will cause heavy pressure on their families and the society. It is of vital importance to conduct vigorously the research, treatment, and prevention of this disease as soon as possible.

III. Etiology 
There could be various etiological factors, and as the situation in China is concerned, the causes are listed in the following: 
1). Vascular dementia: multiple infarctional dementia, and extensive cerebroinfarctional dementia. 
2). Degenerative dementia: Ad dementia, Parkinson’s disease dementia, and hepatolenticular degeneration dementia. 
3).  Infective dementia: caused by the bacterial, mycotic, and virus meningitis and encephalitis. 
4).  Toxic dementia: due to the alcoholism and heavy metal poisoning. 
5).  Others: craniocerebral injury, tumors, etc.

In traditional Chinese medicine, it is understood that there are many causative factors for this disease: since the heart houses mind, so when the heart orifice is misted, the mind can not function kidney houses the will, and when the will is harmed, the previous speech might be easily forgotten up to the age of eighty, the Po(corporeal soul) is away, so the person can not speak and behave in a proper way. Generally speaking there are mainly such causes as:

1).  Insufficiency of kidney essence.
2).  Dysfunction of mind.
3).  Obstruction by phlegm.
4).  Blood stagnation blocking meridians and collaterals.

IV.  Diagnosis 
In western medicine, 3 types of examinations are integrated to determine the diagnosis, i.e.
1).  Intelligence e.g. the dementia measuring table of 
2).  Neuroelectro-physiological examination: electroencephalography
3).  Image examinations: CT, MRI, cerebroangiography.

In both multiple infarction dementia and extensive infarction dementia, there are complications of hypertension, atherosclerosis, apoplexy, or transient cerebral ischemia. But the former is characterized by progressiveness, recurrence, and gradual aggravation, associated with the functional impairment corresponding to the loci of the infarction,  while the later is featured by the abrupt but critical onset, often leading to the residual of neuropsychic abnormalities even after the survival. AD (Alzheimer’s disease) dementia, known as presenile dementia, is marked by the insidious and persistent intelligence disturbance which is unable to be improved. In the early stage, there are damage of remote and recent memory, disturbance of language and spatial orientation. EEG and CT examinations found nothing abnormal. In mid stage, all the manifestations mentioned above are aggravated, and there is slow rhythm of background in EEC examination. In late stage, there is diffuse slow wave in EEC examination, and enlarged ventricles and widened brain grooves revealed by CT examination, and there appear paramyotonia and incontinence of urine and stool. In Parkinson’s disease dementia, there are such manifestations as: tremor (aggravated by excitation and strain), loss of sleep, paramyotonia, lead-pipe rigidity, road-sign motoring slowness, initiation difficulty, festinating gait, inflexibility of fine movement, and  micrographia.

In alcoholism dementia: there are manifestations of hallucination, tremor, emotional disturbance, history of long-term abuse of alcohol, and alcoholic hepatic lesion.

The Diagnosis and Differentiation of Traditional Chinese Medicine
1). Insufficiency of kidney essence: overstrain, or overindulgence in sexual activities have consumed the kidney essence, thus the sea of marrow  becomes empty, so there could appear such manifestations as bent back, premature loss of teeth and hair, dizziness, tinnitus, blurred vision, poor memory, incontinence of urine and stool, slow and awkward actions and deep, weak pulse, especially in Chi pulse.

2). Deficient heart and disabled mind: over-thinking exhausts the energy, and the heart and mind are undermined, then the spirit and thinking become dull, the consciousness is not very clear, the speech is slurring to be even worse, involuntary cry and laugh, irregularity of sleep, self-murmuring, inability to answer questions, pale tongue, deep, thready, and forceless "Cun" pulse.

3). Misting by turbid-phlegm: obese build, sluggishness and reluctance to move, preference for rich food or hot-temper, depression, gradually developing to reluctance to speak, dull expression, unclear mind, inability to distinguish the family members from strangers, the beauty from ugliness, the good from the bad, etc., thick and sticky tongue coating, and rolling-forceful pulse.

4). Blood stagnation blocking meridians: there used to be the history of sudden falling-down, associated with paralysis of limbs, deviation of mouth and eyes, slurring of speech, slow reaction or even worse, there was attack of stroke associated with unconsciousness, mental derangement even after the recovery, dark-purple tongue or with stasis spots, and wiry, hesitant, and unharmonious pulse.

V. Treatment

In regard of western medicine, the treatment is offered accordingly on the basis of clarified diagnosis. Treatment of traditional Chinese medicine
To insufficiency of kidney essence: to replenish the kidney essence, and to reinforce the functions of brain.

Pilose Antler 3g, Human Placenta 10,Epimedium 15g, Morinda Root 10g,

Eucommia Bark (stir-fried) 10g, Sesame Seed 15g, Mulberry 15g, Grass-leaved Sweetflag Rhizome 10g, and Licorice Root 5g

To the deficiency of heart and disabled mind: to tonify the heart, nourish the mind, and cultivate the intelligence.

Ginseng 3g, Milkvetch (astragalus) Root 15g, Asparagus Root 10g,Rehmannia Root 15g, Milkwort Root 10g, Chuanxiong 10g, Lotus Seed 15g,Grass-leaved Sweetflag Rhizome 15g, and Licorice Root 5g.

To the obstruction and misting by turbid phlegm: to resolve the phlegm from the orifices, and to vitalize the brain to cultivate the intelligence.

Tangerine Peel 10g, Pinellia Tuber 10g, Poria 15g, Milkwort Root 10g, Grass-leaved Sweetflag Rhizome 15g, Bezoar 0.3g, and Musk 0.15g.

To the blood stagnation blocking meridians: to disperse the stagnation to reopen the meridians, and to vitalize the brain to recover the intelligence.

Chinese Angelica 10g, Rehmannia Root 15g, Red Peony Root 15g, Safflower 10g, Chuanxiong 10g, Peach Kernel 15g, and Musk 0.3g.

In clinic, it is difficult to distinguish one syndrome from another, both heart and kidney could be coincidentally deficient, or phlegm and stagnation could coexist. The key point of syndrome differentiation is: to grasp the principle and use it flexibly to ensure the syndrome by ascertaining the etiology and to make changes on the ground of patients conditions. In general, the treatment aims to cure the disease.

The Zhang Jingyue’s opinion on dementia 
In those without constitutional phlegm, due to various factors e.g. depression, frustration, anxiety or over-thinking, suspicion, fright and fear, the dementia is progressing with so many strange manifestations as ambiguous speech, insensible behaviors, profuse perspiration, worries and sadness etc, the pulse could also vary as being wiry, rapid, big, small, etc. It’s all because of the reversal of impure qi in heart or in liver and gallbladder. However, the patients are looking strong in build, and normal in appetite, and no any deficient syndromes are present. So most appropriate treatment is to be given with drastic decoctions.

For this disease, some cases could be cured, and some couldn’t, for it is also dependent on the vitality of stomach qi and primordial qi. So the treatment could be long-lasting, because it takes time for the recovery of both types of qi, hence the patience is required.

by Prof. Kong Lingxu