Analysis of the characteristics of agitated behavior and its influencing factors in patients with cognition disorders

Abstract

Objective To analyze the correlations between plasma orexin⁃A and clinical manifestations of dementia with Lewy bodies (DLB). Methods A total of 51 patients with DLB from Beijing Tiantan hospital, Capital Medical University, and 46 sex, age and education matched controls were conducted from January 2019 to December 2021. Overall cognitive function was assessed by Mini⁃Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), dementia severity was assessed by Clinical Dementia Rating Scale (CDR), activities of daily living was assessed by Activities of Daily Living Scale (ADL), depression severity was assessed by Hamilton Depression Rating Scale 17 (HAMD⁃17), neuropsychiatric symptoms was assessed by Neuropsychiatric Inventory (NPI), and plasma orexin⁃A level was measured. The univariate and multivariate Logistic regression analyses were used to screen influencing factors for DLB. Pearson and partial correlation analyses were used to explore the correlation between plasma orexin⁃A and core clinical features of DLB. Multivariate linear stepwise regression analysis was used to analyze the linear correlation between plasma orexin⁃A level and neuropsychological tests. Results The scores of MMSE (Z=⁃ 8.387, P=0.000) and MoCA (Z=⁃8.479, P=0.000) in DLB group were significantly lower than those in control group, while the scores of CDR (Z=⁃9.072, P = 0.000), ADL(Z=⁃8.692, P=0.000), HAMD⁃17 (Z=⁃7.568, P=0.000), NPI (Z=⁃8.270, P=0.000) and plasma orexin⁃A level (Z=⁃2.688, P=0.007) were significantly higher than those in control group. Plasma orexin⁃A level in DLB patients with fluctuating cognition (Z=⁃2.172, P=0.030) and with Parkinsonism (Z=⁃1.981, P=0.048) were lower than those without these symptoms, respectively. Logistic regression analysis showed drinking history was a potentially independent protective factor for DLB (OR=0.278, 95%CI:0.095-0.808; P=0.019), while increased plasma orexin⁃A level was an independent risk factor for DLB (OR=6.878, 95%CI:1.241-38.137; P=0.027). Correlation analysis showed that plasma orexin⁃A level was negatively correlated with the occurrence of Parkinsonism in patients with DLB (r=⁃ 0.322, P=0.043). Multivariate linear stepwise regression analysis showed no statistically significant relationship between the plasma orexin⁃A level and the scores of neuropsychological tests (P>0.05, for all). Conclusions The plasma orexin⁃A level in patients with DLB were higher than controls, and the elevated plasma orexin⁃A level could significantly increase the risk of DLB, while reduce the incidence of Parkinsonism. Dysfunction of orexin⁃A system might be a potential mechanism for the occurrence of DLB.

Keywords

• lewy body disease
• orexins
• risk factors
• logistic models