A Study On The Correlation Between The Mental And Behavioral Symptoms Of Dementia, The Level Of Homocysteine And TCM Syndrome Elements

Objective:To explore the distribution of homocysteine levels,TCM syndromes and psycho-behavioral symptoms in dementia patients with psycho-behavioral symptoms,and to further analyze the correlation between psycho-behavioral symptoms,homocysteine levels and TCM syndromes in dementia patients.Methods:This study was a cross-sectional study.A total of 60 patients diagnosed with dementia who were admitted to Dongzhimen Hospital from June 2019 to January 2021 were selected according to the discharge criteria.The general data of the patients,such as gender,age,course of disease,history of tobacco and alcohol,and previous medical history,were collected,and the level of homocysteine(Hcy)was measured and recorded,and scores of related scales were collected.The scales used included the MMSE,the Clinical Dementia Rating Scale(CDR),the Neuropsychiatric Symptoms Questionnaire(NPI),and the Dementia Syndrome Elements Scale(PES-D/11).The survey data were checked and sorted out,and then input into the database.SPSS 26.0 software was used for statistical analysis of the data.Chi-square test,Shapiro-Wilk(S-W)test,one-way analysis of variance,nonparametric test,correlation analysis and linear analysis were used to explore the correlation between psychosodic symptoms,homocysteine levels and TCM syndromes in dementia patients.Results:1.Results of general data:A total of 60 patients with dementia were included in this study,among whom the youngest was 50 years old and the largest was 97 years old.There were 28 male patients with an average age of 75.57±10.97 years old.There were 32 female patients with an average age of 77.62±7.13 years,and the male to female ratio was about 1:1.14.Among the 60 dementia patients,20 were Alzheimer’s disease patients,23 were vascular dementia patients,15 were mixed dementia patients,and 2 were other dementia patients.Compared with vascular dementia and mixed dementia,delusion,apathy,and rigid movement were more common in Alzheimer’s disease patients(P<0.05).Among the 60 dementia patients,there were 12 patients with mild dementia,33 patients with moderate dementia and 15 patients with severe dementia.Patients with severe dementia had significantly higher overall NPI scores than those with mild dementia(P=0.03)and were more likely to have hallucinations(P=0.02).Among the patients,42 had a history of hypertension,30 had a history of cerebrovascular disease,26 had a history of hyperlipidemia,25 had a history of diabetes,and 17 had a history of coronary heart disease.Patients with diabetes may have a lower Hcy level(P=0.02)and a lower incidence of agitated aggression symptoms(P=0.03).There was no significant correlation between age,sex,history of smoking and drinking,duration of disease and psychosocial symptoms and Hcy level.2.Analysis of the relationship between homocysteine levels and psycho-behavioral symptoms:In this study,there were 12 items of psycho-behavioral symptoms,including delusion,hallucination,agitated aggression,depression,anxiety,euphoria,apathy,disinhibition,irritability,routine movement,nocturnal behavior,and eating disorders.12 points for each item,for a total of 144 points.453/5000 Correlation analysis and linear regression analysis between Hcy level and total NPI score indicated that the higher the Hcy level was,the higher the NPI score was,and this positive effect was more closely related to patients with dementia accompanied by psycho-behavioral symptoms.Among the 12 symptom items,dementia patients with apathy symptoms had higher Hcy levels,and the two were positively correlated(P=0.03).3.Analysis of the relationship between homocysteine and TCM syndromes:a total of 11 TCM syndromes were included in this study,including Yang hyperactivity,toxic excess,Yin deficiency,spleen deficiency,Yang deficiency,medullary degeneration,blood deficiency,kidney deficiency,qi deficiency,blood stasis,and phlegm turbidity.The dementia patients with hyperthyroidism syndrome had higher Hcy level(P=0.01).4.Psychobehavioral symptoms and TCM syndromes:By analyzing the total score distribution of TCM syndromes and NPI,it was found that patients with hyperthyroidism syndrome had higher NPI score(P<0.01),and more symptoms would appear(P<0.01).Among the specific symptom items,the patients with spleen deficiency syndrome were more likely to have eating disorder symptoms(P=0.02).The patients with blood deficiency syndrome were more likely to have nocturnal behavioral symptoms(P=0.01).The patients with Yin deficiency syndrome were more likely to have delusional symptoms(P=0.01).Patients with hyperthyroidism syndrome were more likely to have agitated aggression symptoms(P=0.01)and irritability symptoms(P=0.01).Nocturnal behavioral symptoms were more likely to occur in patients with virulent overdose syndrome(P=0.03).Conclusion:1.The occurrence and aggravation of psychosocial symptoms in dementia patients may be related to their Hcy level.2.Dementia patients with apathy symptoms may have higher Hcy level,and the degree of apathy may be positively correlated with Hcy level.3.Dementia patients with hyperthyroidism syndrome may have higher Hcy level,more types of psycho-behavioral symptoms and more severe psycho-behavioral symptoms.4.There is a correlation between TCM syndromes and psycho-behavioral symptoms in patients with dementia:patients with spleen deficiency syndrome are more likely to have eating disorder symptoms;Patients with blood deficiency and toxin deficiency syndrome were more likely to have nocturnal behavioral symptoms.Patients with Yin deficiency syndrome were more likely to have delusional symptoms.Patients with hyperthyroidism are more likely to have agitated aggression and irritability.