A Clinical Study Of Behavioral And Psychological Symptoms Of Dementia In Alzheimer’s Disease And Vascular Dementia

Objective:To investigate the characteristics of behavioral and psychological symptoms of Dementia(BPSD)in patients with Alzheimer’s disease(AD)and vascular dementia(VaD)and their relationship with Event-related potential P300.Method:We retrospectively analyzed patients who visited the neurology clinic at the First Hospital of Jilin University from November 2015 to December 2017.According to Clinical Dementia Rating Scale(CDR)scores,patients were divided into mild cognitive impairment group(166 cases in aMCI group,84 cases in VCI-ND group),mild dementia group(149 cases of mild AD,mild VaD 136 cases),moderate dementia group(moderate AD 75 cases,moderate VaD 84 cases),severe dementia group(severe AD 57 cases,severe VaD 42 cases).Collect general clinical data of these patients and conduct neuropsychological tests(Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA),Memory and Executive Screening Scale(MES),CDR,and Neuropsychiatric Inventory(NPI)scores),and summarizes the characteristics of BPSD symptoms in patients with dementia.Among them,126 patients were divided into 75 patients with BPSD group(NPI>0)and 51 patients with non-BPSD group(NPI=0)according to NPI scores.The latency,amplitude and ART(average reaction time)at PZ and CZ of event-related potential P300 were collected to explore the relationship between BPSD and P300.Statistical analysis of the data was performed using SPSS 18.0 software.Result:1.There was a significant difference in age,education level,MMSE total score,MOCA total score and MES total score between AD and VaD patients in the cognitive decline group,mild,moderate,and severe dementia groups(P <0.05).There was no statistical difference between the groups in terms of gender(P >0.05).2.The incidence of BPSD in patients with AD with different degrees of dementia was different(57.2% of aMCI <57.7% of mild dementia <88.0% of moderate dementia <91.2% of severe dementia),the difference was statistically significant(P<0.05).There was a statistically significant difference in the incidence of delusions,hallucinations,agitation,abnormal motor behaviors,sleep disturbances and apathy(P <0.05).The incidence of delusions,hallucinations,agitation,abnormal motor behaviors,and sleep disturbances increased with increasing dementia.Apathy was higher in the moderate and severe dementia group.3.There was no significant difference in the incidence of BPSD in VaD patients with different degrees of dementia.The difference was not statistically significant(P>0.05).The rates of delusions,hallucinations,agitation,anxiety,abnormal motor behavior and sleep disturbance were different,and the difference was statistically significant(P<0.05).At the same time,it was found that the incidence of delusions,hallucinations,anxiety,abnormal motor behaviors,and sleep disturbances increased with increasing dementia.The incidence of agitation was higher in the moderate and severe dementia group.4.In the AD and VaD groups,the incidence of BPSD symptoms in AD(66.9%)was higher than that of VaD(58.7%),and the difference was statistically significant(P<0.05).The difference in delusions and abnormal motor symptoms was statistically significant(P<0.05).The incidence of delusions(15.2%)and abnormal movement(13.9%)in the AD group was higher than that in the VaD group(9.5%,7.8%).5.In the moderate dementia group,the incidence of BPSD in AD was 88.0%,which was higher than that in VaD 64.3%.The difference was statistically significant(P<0.05).In severe dementia group,the incidence of BPSD in AD(91.2%)was higher than that in VaD(71.4%),with a significant difference(P<0.05).There was no significant difference in the severity of BPSD between AD and VaD patients with the same degree of dementia(P>0.05).6.Under the same degree of dementia,there was no significant difference in the severity of BPSD between AD and VaD(P>0.05).In the moderate dementia group,the delusions and abnormal motor behaviors of the AD group were more severe than those of the VaD.The difference was statistically significant(P<0.05).In mild cognitive decline,mild dementia,and severe dementia groups,there was no significant difference in the severity of BPSD symptoms between AD and VaD(P>0.05).7.There was no significant difference in the distribution of gender,age,education,hypertension,diabetes,and smoking history between the BPSD group and the non-BPSD group(P>0.05).In the BPSD group(32.8%),there were more alcoholic history than non-BPSD group(24.5%),and the difference was statistically significant(P =0.011<0.05).Drinking history is an independent risk factor for BPSD.Patients with a history of drinking had a 1.492 times risk of developing BPSD compared with non-drinkers.8.Of the 126 patients with dementia who were examined with P300,there were more patients with drinking history in the BPSD group than in the non-BPSD group(P =0.032<0.05).The CZ latency of the BPSD group was longer than that of the non-BPSD group(P<0.05).Patients with depressive and apathetic dementia had a longer CZ latency than those without depressive and apathetic dementia(P<0.05).There was no statistically significant difference in P300 data between patients with sleep disorders and those without sleep disorders(P>0.05).Conclusion:1.The incidence of BPSD in both AD and VaD is high,which increases the suffering of patients and the burden on caregivers and accelerates disease progression.2.Delusions,hallucinations,agitation,abnormal motor behaviors,and sleep disturbances increased with the increasing incidence of dementia.3.The incidence of BPSD in moderate and severe AD was higher than VaD.There was no significant difference in the severity of BPSD between the same degree of dementia AD and VaD.In moderate dementia,the delusions and abnormal motor behavior in the AD group were more severe than VaD.4.Drinking history is an independent risk factor for BPSD.5.Brain function in patients with BPSD was more pronounced than in patients with dementia without BPSD.