Characteristics Of Serum Vitamin B12 And Correlation Between Serum Vitamin B12 And Non-motor Symptoms In Patients With Parkinson’s Disease

Background Parkinson’s disease(PD)was the second largest neurodegenerative disease plaguing the elderly,some non-motor symptoms such as sleep disorder and cognitive impairment have gradually become the important reason for affecting the quality of life of the PD patients,increasing the difficulty of diagnosis and treatment of clinical PD patients.Vitamin B12(VB12)is involved in some metabolic reaction of the nervous system,the incidence of low serum VB12 in PD patients is higher than that in the general elderly,and its change may be related to some clinical symptoms in PD patients.ObjectiveThis paper explores the changing characteristics of VB12 in PD patient;to observe the change characteristics of serum VB12 and cognitive function scores in PD patients with different types,drug use or not,and different non-motor symptoms compared with the control group;whether there is correlation between different serum VB12 and the occurrence of some non-motor symptoms is explored.Methods1.From September 2020 to December 2022,110 patients with primary PD and 112 controls(other diseases such as vertigo syndrome)were selected from the Affiliated Hospital of Yangzhou University were selected.The gender,age,body mass index,years of education,previous history of hypertension,diabetes and others,normal medicine and personal hobbies(including whether you smoke,whether you drink,and how much you drink)were collected.2.Record the course of PD disease,levodopa equivalent daily dose,whether to take dopamine receptor agonist,Hoehn ? Yahr stage,Unified Parkinson’s Disease Rating Scale-Ⅲ score and clinical classification of PD patients.3.Ask PD patients whether to have subjective olfactory hypoesthesia,visual hallucination and frequent urination or not;restless leg syndrome(RLS)and orthostatic hypotension were diagnosed.The cognition,constipation,nocturnal sleep,excessive daytime sleepiness(EDS),rapid eye movement sleep behavior disorde,anxiety,depression and other non-motor symptoms of all PD patients were assessed by the Beijing version of the Montreal Cognitive Assessment(Mo CA-BJ)scale,the Chronic Constipation Scale(CSS),the Pittsburgh Sleep Index(PSQI),the Epworth Sleepiness Scale(ESS),the Rapid Eye Movement Sleep Behavior Disorder Screening Scale(RBDSQ),the Self-Rating Anxiety Scale(SAS)and the Beck Depression Scale-Ⅱ(BDI-Ⅱ).4.Serum VB12 was determined for all participants,according to the threshold value of258.3pmol/L,the incidence of low VB12 was calculated and PD patients were divided into low serum VB12 group and normal serum VB12 level group.5.The mean serum VB12 of PD observation and control group was compared by independent-samples t test,chi-square test was used to compare the incidence of low serum VB12 between PD patients and control group.PD patients were divided into groups according to face-to-face inquiry,diagnosis results and non-motor symptoms displayed by the definition of each scale,One-way analysis of variance was used to compare serum VB12 and cognitive function scores in PD group,and between PD group and control group.The incidence of non-motor symptoms between the two groups of PD patients with different serum VB12 was compared by chi-square test and multivariate logistic regression analysis.The predictive value of serum VB12 for nonmotor symptoms in PD patients was evaluated by receiver operating characteristic curve.Results1.The average level of serum VB12 in PD group(305.97 ± 150.05 pmol/L)was lower than that in control group(319.24 ± 130.02 pmol/L),and the difference was not statistically significant(P > 0.05).There were 47 cases(42.7%)of PD patients with low serum VB12,compared with 33 cases(29.5%)of the control group,the incidence of low serum VB12 in PD patients was higher,and the difference was statistically significant(P = 0.040).2.The serum VB12 in PD patients with EDS was significantly higher than that without EDS(349.09 ± 159.44 vs 277.23 ± 137.27 pmol/L)(P = 0.015);serum VB12 in PD patients with RLS was significantly lower than that in patients without RLS(349.09 ±159.44 vs 277.23 ± 137.27 pmol/L)(P = 0.016).When PD patients who took PD-related drugs(P = 0.027)or had constipation(P = 0.046)/ frequent micturition(P = 0.013)/EDS(P = 0.009)/ RLS(P = 0.032)/ anxiety(P = 0.012)/ depression(P = 0.034),the cognitive function of PD patients in this group was significantly lower than that in the control group(P < 0.05).3.In PD patients,the incidence of RLS was higher in low serum VB12 group(59.6% vs38.1%,OR = 0.315,P = 0.008)than that in normal serum VB12 group,and the incidence of EDS in low serum VB12 group was lower(27.7% vs 49.2%,OR = 3.015,P= 0.014)than that in normal serum VB12 group.Multivariate logistic regression analysis showed that serum VB12 was an independent influencing factor of EDS and RLS in PD patients.4.The area under the receiver operating characteristic curve of serum VB12 in predictin g RLS was 0.659(95% CI :0.555-0.762,P = 0.004)with excellent diagnostic value of 224.5pmol/L;the area under the receiver operating characteristic curve of serum VB12 in predicting EDS was 0.640(95% CI : 0.533-0.747,P = 0.013)with excelle nt diagnostic value of 250.5pmol/L.ConclusionsThe incidence of low serum VB12 in PD patients is higher than that in the control group,and low VB12 may lead to high incidence of RLS and low incidence of EDS,serum V B12 is an independent influencing factor of RLS and EDS in PD patients.Therefore,V B12 is helpful for the diagnosis of some non-motor symptoms in PD patients.Take PDrelated drugs or having some non-motor symptoms(constipation,frequent micturition,EDS,RLS,anxiety,depression)may be associated with cognitive decline in PD patients.