Study On The Influencing Factors Of Behavioral And Psychiatric Symptoms In Patients With Acute Ischemic Stroke And Its Correlation With Caregiver Burden

ObjectiveTo analyze the influencing factors of behavioral and psychiatric symptoms in patients with acute ischemic stroke,to explore the clinical characteristics and changes of BPS,and to analyze the correlation between BPS and caregiver burden.MethodsFrom January 2018 to May 2019,280 patients with acute cerebral infarction were enrolled in the Department of Neurology,the Northern Jiangsu People's Hospital.Detailed data collection,behavioral and psychiatric symptoms and cognitive function evaluation were conducted within 2 weeks(baseline period)and 6 months after stroke.We collected the patients' sex,age,years of education,BMI index,NIHSS score,m RS score,hypertension,diabetes,hyperlipidemia,heart disease,stroke history,smoking history,drinking history,neutrophils,lymphocytes,platelets,calculated the neutrophil lymphocyte ratio(NLR)and platelet lymphocyte ratio(PLR).The cognitive function of the patients was evaluated by Montreal cognitive assessment(Mo CA)and Cognition-12(Cog-12).The activities of daily living of the patients were evaluated by Activity of daily living scale(ADL).The behavioral and psychiatric symptoms of the patients were assessed by the neuropsychiatric inventory(NPI).The patients who completed the followup(180 ± 7)days were divided into BPS group and non-BPS group.All the caregivers completed the Caregiver Burden Inventory(CBI)to evaluate the nursing burden.ResultsA total of 280 patients with AIS were followed up for(180 ±7)days,20 patients had severe aphasia and dysarthria,21 patients had limb muscle strength of superior side less than grade 3,10 patients had cognitive disorder,severe depression,anxiety or mental symptoms,19 patients were in serious condition with conscious disorder,52 patients died or refused to complete the follow-up evaluation,and finally entered group 158 AIS patients.There were 70 cases in the BPS group(45 men and 25 women)and 88 cases in the non-BPS group(55 men and 33 women).Univariate analysis showed that there were significant differences in the years of education,NIHSS score,Mo CA score,ADL score,Cog12 score,NLR,and PLR between the BPS group and the non-BPS group at 6 months after stroke(P<0.05),while there was no significant difference in sex,age,BMI index,hypertension,diabetes,hyperlipidemia,heart disease,stroke history,smoking history,drinking history,m RS score,CBI score(baseline period),infarction location and infarction location between the two groups(P>0.05).Multivariate logistic regression analysis showed that Mo CA score(OR:0.752;95%CI:0.631-0.896),ADL score(OR:0.950;95%CI:0.905-0.997),NLR(OR:1.397;95%CI:1.006-1.939),PLR(OR:1.015;95%CI:1.001-1.029)were independent influencing factors of BPS in AIS patients six months after stroke.High Mo CA score and high ADL score are protective factors for BPS,while high NLR and high PLR levels are risk factors for BPS.Six months after stroke,the incidence of each BPS was different in different infarction sites.The common BPS in the frontal lobe were depression(23.8%),anxiety(19.0%)and apathy(19.0%),in the temporal lobe were anxiety(29.4%),agitation/aggression(23.5%),apathy(23.5%)and sleep and nocturnal behavior disorder(23.5%),in basal ganglia was anxiety(18.6%),agitation/aggression(16.3%)and irritability(14.0%),in thalamus was apathy(31.8%),sleep and nocturnal behavior disorder(22.7%),hallucination(18.2%)and depression(18.2%),in brainstem was depression(16.1%).Six months after stroke,the incidence of agitation/aggression and depression in BPS increased(11.4%vs9.5%,13.3%vs9.5%)compared with the baseline period,and the incidence of other items decreased compared with the baseline period,with no significant difference(P>0.05).The total score of NPI in AIS patients at 6 months after stroke was positively correlated with the total score of time-dependent burden,emotional dependent burden and CBI,and the difference was statistically significant(P < 0.05);the degree of distress of NPI caregivers was positively correlated with the total score of time-dependent burden,social burden,emotional dependent burden and CBI score,and the difference was statistically significant(P<0.05).Conclusion1.Low educational level,cognitive impairment,severe neurological impairment and higher inflammatory factors are closely related to the occurrence of BPS in AIS patients.Therefore,such patients are recommended to control the risk factors at an early stage to reduce the incidence of BPS.2.Inflammation indexes NLR and PLR have a certain predictive value for the occurrence of BPS in patients 6 months after stroke.3.Early infarction classification can be performed on AIS patients to prevent the occurrence of BPS.4.Reducing or improving BPS can reduce the burden on caregivers.