BPSD AND INTERNAL DISEASE IN PATIENTS WITH DEMENTIA: PRELIMINARY STUDY OF THE “HEART” AND “SPLEEN” DISORDER IN THE TRADITIONAL CHINESE MEDICINE–TAJIRI PROJECT

Abstract

Background: The “heart” in the traditionalChinesemedicine (TCM) controls not only circulation but also psychic function and is easy to be excited and patients show the psychological symptoms frequently when it is damaged.When the “spleen” in TCM (function of digestion and absorption) weakens, patients show not only digestive symptom but also depression and weakened vitality. We evaluated the medical validity in the association between Behavioral and Psychological Symptoms ofDementia (BPSD) and internal diseases in patients with dementia.Methods: The subjects are patients with Alzheimer’s disease (AD) or vascular dementia (VaD). They consulted a memory clinic in Tajiri SKIP Center in Miyagi prefecture from 1999 to 2010 and received medical intervention more than three months and were followed until one year before death. The morbidity of disease of cardiovascular system, respiratory system, alimentary tract, liver and biliary tract, kidney and urinary tract were analyzed using their clinical record retrospectively. These datawere coded to prevent an ethical problem. The aggressive delusion was defined as a positive symptom according to BEHAVE-AD, and depression or anxiety were defined as negative ones. Furthermore, we are conducting a prospective study on the complication of non-treated dementia patients.Results: 170 patients were recruited. 77 patients showed BPSDwith the positive symptom, and 34 patients showed negative symptoms. 59 patients did not present with BPSD. Cardiovascular diseasewas found in 49.5%of patientswith positive symptom, and alimentary tract disease was found in 17.8%. In the patients with negative symptoms, alimentary tract disease was found in 41.3% and cardiovascular disease was found in 28.6%. A significant difference was found in morbidity of the organ damage in the difference state of BPSDby chi square test (a1⁄4.001). As a secondary analysis, we examined only for cardiovascular disease and alimentary tract disease in the AD patients with BPSD and a significant difference was maintained (chi square test ; a1⁄4.001). Four of nine non-treated dementia patients showed positive BPSD and one showed negative BPSD. One patient with positive BPSDhad cardiovascular disease and two had disease in alimentary tract. All of patients without BPSD and patient with negative BPSD had alimentary tract disease. Conclusions: Morbidity of internal disease in patients with dementia significantly varies according to the absence or presence of BPSD and its nature. There is a limitation of the retrospective analysis with clinical record.But anassociation betweenBPSDand the “heart” and “spleen” disorder ofTCMwas suggested. In the practice ofTCM, treatmentsofphysical diseases often shows good effects on patient’s emotion. A. Damasio points out a relation between emotion and the visceral sense in his “Somaticmarker” hypothesis.Medical treatment on the internal diseasesmay contribute to stabilize emotion. A prospective study is now undergoing.