Analysis Of Clinical Characteristics Of Mental And Behavioral Symptoms Of Dementia And Its Correlation With White Matter Hyperintensity

Study 1 Analysis of clinical characteristics of patients with mental and behavioral symptoms of dementiaObjectivesExploring the clinical features of mental and behavioral symptoms of dementia and the distribution of TCM syndromes.MethodsSelect 33 patients with dementia in the outpatient and inpatient wards of the Third Department of Brain,Dongzhimen Hospital,Beijing University of Chinese Medicine,and record the general information of the patients in detail,and conduct neuropsychological assessment:Cognitive function assessment:Concise Mental State Examination Scale(MMSE),Draw Clock Test(CDT),Clinical Dementia Rating Scale(CDR).Psycho-behavioral symptom evaluation:Neuropsychiatric Questionnaire(NPI);TCM Syndrome Collection:Dementia Syndrome Element Scale(PES-D).The results obtained use SPSS 20.0 statistical software to perform descriptive analysis of each variable.Counting data are expressed in frequency(percentage),measurement data that meets the normal distribution are expressed in((?)),and non-normal distribution measurement data is expressed in median.Number(interquartile range)representation.Result1.The study included 33 dementia patients,13 males,and 20 females.The ages were normally distributed,with an average age of 74.30 years old.84.8%of the patients had an education level of junior high school or above,24.2%had a history of smoking,and 15.2%had a history of drinking.Hypertension accounted for 36.4%,coronary heart disease 12.1%,diabetes 9.1%,hyperlipidemia 12.1%.2.According to the CDR scale evaluation,3 patients scored 0.5 points,17 patients scored 1 point,12 patients scored 2,and 1 patient scored 3 points;CDR scores were not normally distributed,with a median of 1,and a total of 33 patients,3 people with mild cognitive impairment,4 people with mild dementia,17 people with moderate dementia,and 9 people with severe dementia.3.According to the neuropsychiatric questionnaire,the frequency of delusions is 48.5%,the frequency of hallucinations is 42.4%,the frequency of agitation/aggression is 48.5%,the frequency of depression/dysthymia is 48.5%,the frequency of anxiety is 45.5%,and the frequency of emotional high/euphoria is 12.1%,the frequency of emotional apathy/indifference is 60.6%,the frequency of disinhibition is 6.1%,the frequency of irritability/emotional instability is 60.6%,the frequency of abnormal motor behavior is 51.5%,the frequency of sleep/night behavior is 42.4%,appetite and The frequency of eating disorders was 15.2%.4.After evaluation by the Dementia Syndrome Element Scale(PES-D),the frequency of blood stasis syndrome is the highest,which is 60.6%,which decreases to 42.4%of turbid phlegm,30.0%of qi deficiency,and 24.2%of marrow loss.The frequency of spleen deficiency and blood deficiency syndromes is the same,18.2%.The lower frequency is 12.1%of yin deficiency,9.1%of yang deficiency,6.0%of yang hyperactivity,and 3.0%of hypertoxicity.Conclusions1.The most frequent psycho-behavioral symptoms in patients with dementia are emotional indifference and irritability.2.Blood stasis and phlegm turbidity occur most frequently in TCM syndromes of patients with BPSD.Study 2 Correlation between white matter hyperintensity and mental and behavioral symptoms of dementiaObjectivesTo study the correlation between white matter hyperintensity and mental and behavioral symptoms of dementiaMethodsSelect patients with dementia with mental behavioral symptoms as the research objects,collect the general data of the patients,and conduct neuropsychological evaluations.The scales used include the Simple Mental State Examination Scale(MMSE),the Clinical Dementia Rating Scale(CDR),and the Neuropsychiatric Questionnaire(NPI)scale,brain white matter hyperintensity evaluation method uses cranial magnetic resonance technology(MRI).TCM blood stasis syndromes were evaluated using "Dementia Syndrome Elements Scale";data analysis was performed using SPSS20.0 statistical software,P<0.05 indicated statistical difference,P<0.01 indicated statistically significant difference.Each measurement data is represented by the mean±standard deviation((?)),and the data that obviously does not conform to the normal distribution are represented by the median(interquartile range).Numerical variables conforming to the normal distribution were compared using t-test for comparison between two groups,and analysis of variance was used for comparison between multiple groups.For measurement data or categorical variables that do not conform to the normal distribution,the rank sum test is used for comparison between groups.Result1.Compare the differences in NPI,CDR,and MMSE scores between the two groups.The NPI score is normally distributed.The average score of the none or mild group is 21.43±17.66,and the average score of the moderate to severe group is 17.31±15.36,P>0.05;the CDR score is positive The average score of the none or mild group was 1.14±0.63,and the average score of the moderate-to-severe group was 1.08±0.70,P>0.05;the MMSE score was a non-normal distribution,using the rank sum test,P>0.05.2.Comparing the frequency of 12 psycho-behavioral symptoms.Among the symptoms of delusions,hallucinations,agitation,depression,and irritability,there is a certain difference in the frequency of occurrence between the two groups,but after statistical analysis,P>0.05.3.Twenty patients were evaluated by the Dementia Syndrome Element Scale(PES-D).The overall distribution of TCM syndrome elements was:Blood stasis>turbidity of phlegm>marrow reduction=deficiency of qi>deficiency of kidney>deficiency of blood=deficiency of yin=deficiency of yang>deficiency of spleen=excessiveness of yang=excessive toxin;scoring order of syndrome elements:deficiency of yang>deficiency of yin>deficiency of qi>marrow reduction>turbid phlegm>Blood stasis>Kidney deficiency>Blood deficiency.4.Among the 11 syndrome elements,the frequency of marrow loss,phlegm turbidity,and blood stasis is relatively high.Due to the small number of research subjects,the statistics of the remaining syndrome elements are relatively small.Comparing the three syndrome elements of marrow reduction,phlegm turbidity,and blood stasis,P>0.05.There was no statistically significant difference in the frequency of the three syndrome elements in the two groups with different degrees of WMH.Conclusions1.In patients with moderate to severe white matter hyperintensity dementia,the most common mental and behavioral symptoms are delusions,hallucinations,agitation,and irritability.2.In patients with dementia with mental and behavioral symptoms,blood stasis,phlegm turbidity,and marrow reduction are the most common TCM syndrome elements.Study 3 Clinical efficacy of HuoxueHuayu Method on Behavioral and psychological symptoms of dementia:a Meta-analysisObjectiveTo systematically evaluate the efficacy of HuoxueHuayu Method in the treatment of Behavioral and psychological symptoms of dementia.Methodcomputer retrieval China hownet(CNKI),Wanfang database,VIP Chinese Journal Database database,Chinese biomedical database(CBM),Pubmed,Embase,the Cochrane Liberary,Web of Science8 database,retrieve the date from the building on September 21,2020,with the Cochrane risk assessment to evaluate its quality,through RevMan 5.4 software to extract data and Meta analysis.Results Nine RCT studies were eventually included,with a total of 691 cases,including 348 cases in the experimental group and 343 cases in the control group.ResultsCompared with the control group,the total effective rate of TCM based on HuoxueHuayu Method combined with Western medicine was higher,The difference was statistically significant[OR=3.64,95%CI=(2.14,6.20),P<0.0001].Improve mental behavior symptom-AD score[MD=-2.90,95%CI=(-4.56,-1.24),P=0.0006].Improve Blessed behavior score[MD=-5.19,95%CI=(-6.38,-3.99),P<0.00001].Improved MMSE score[MD=2.11,95%CI=(1.12,3.09),P<0.0001];Compared with the control group,the total effective rate of single-use Traditional Chinese medicine mainly used for HuoxueHuayu Method was higher[OR=2.51,95%CI=(1.09,5.77),P<0.03],and the MMSE score improved more significantly[MD=2.94,95%CI=(1.63,4.25),P<0.0001].ConclusionTraditional Chinese medicine based on the method of Huoxuehuayu combined with Western medicine treatment can improve the cognitive function and mental behavior symptoms of patients with dementia.