Study On The Relationship Between The Concentration Of Serum Hcy,Folic Acid And VitB12 And Cognitive Function And Behavioral And Psychological Symptoms Of Alzheimer’s Disease

Objective:To study the correlation of serum homocysteine(Hcy),folic acid and vitamin B12(Vit B12)levels with cognitive function and behavioral and psychological symptoms of dementia(BPSD)in patients with Alzheimer’s disease(AD).To explore the related factors of dementia in patients with AD.To discuss the clinical significance of monitoring the concentration of Hcy,folic acid and Vit B12 in elderly population for AD.Methods:From July 2018 to October 2019,60 patients with AD were selected as the case group and were divided into BPSD group(NPI-Q score≥ 14)and non-BPSD group(NPI-Q score≤ 13).Sixty healthy elderly people were recruited as the control group.General data were collected and the Mini-Mental State Examination scale(MMSE)was measured in both groups.The Clinical Dementia Rating scale(CDR)and the Neuropsychiatric Inventory-Questionnaire scale(NPI-Q)were also measured in the case group.The concentrations of serum Hcy,folic acid and Vit B12 were measured in both groups.All the collected data were analyzed by SPSS25.0 statistical software,chi-square test was used for the comparison of classified variables between groups,t-test of independent samples was used for the comparison of continuous numerical variables between groups,correlation analysis was used to analyze the relationship between age,course of disease,years of education,the concentrations of serum Hcy,folic acid and Vit B12 and the score of MMSE,and further observation was made by linear regression analysis.Logistic regression analysis was used to analyze the correlation between the concentrations of serum Hcy,folic acid,Vit B12 and the score of CDR,and the correlation analysis was used to analyze the correlation between the concentration of Hcy,folic acid,Vit B12 and the score of NPI-Q subitems.Results:1.There was no significant difference in age,sex,BMI,comorbid hypertension or diabetes between the case group and the control group(P >0.05),but the concentrations of Hcy in the case group was higher than that in the control group,while the MMSE score,folic acid and Vit B12 levels in the case group were lower than those in the control group(P< 0.05).2.The MMSE score of the case group was negatively correlated with age and Hcy concentration(P < 0.05),and positively correlated with the years of education,folic acid and vitamin B12 concentration(P < 0.05),while the MMSE score of the control group was negatively correlated with age and Hcy concentration(P < 0.05),and positively correlated with the years of education(P < 0.05).3.Controlling age,years of education and controlling any two variables of Hcy,Vit B12 and folic acid,the MMSE score of the case group was negatively correlated with the concentration of Hcy and positively correlated with the concentration of folic acid(P< 0.05),but there was no independent correlation between MMSE score and the concentration of Vit B12(P > 0.05),while the correlation between MMSE score and Hcy concentration disappeared in the control group(P > 0.05).4.High concentration of Hcy and low concentration of folic acid are risk factors for CDR score(P< 0.05).5.The concentration of serum Hcy and the score of CDR in BPSD group were significantly higher than those in non-BPSD group(P < 0.05),but there was no significant difference in folic acid and Vit B12 concentration between the two groups(P >0.05).6.The NPI-Q score and serum Hcy concentration of AD patients with affective symptoms,psychotic symptoms or frontal lobe symptoms were significantly increased(P< 0.05),while the MMSE scores were significantly decreased with psychotic symptoms or frontal lobe symptoms(P< 0.05).7.serum Hcy concentration was correlated with several items of NPI-Q scale,such as delusion(r=0.399,P =0.002),depression / dysthymia(r=0.372,P=0.003),anxiety(r=0.367,P =0.004),irritability / emotional instability(r=0.313,P =0.015),abnormal motor behavior(r=0.301,P =0.019),disinhibition(r=0.263,P =0.042)and total scores of NPI-Q(r=0.371,P =0.004).Among them,the correlation between Hcy concentration and anxiety was the strongest,and the correlation coefficient with disinhibition was small r < 0.3.Conclusion1.In AD patients,high concentration of Hcy and low concentration of folic acid are risk factors for cognitive decline and the severity of dementia,but the concentration of Vit B12 is not directly related to cognitive function.2.The increase of serum Hcy concentration may be related to behavioral and psychological symptoms,while AD patients with behavioral and psychological symptoms may have a more severe degree of dementia.3.Monitoring the concentration of Hcy,folic acid and Vit B12 in the elderly population may be helpful for early detection,early diagnosis and early treatment of AD.