Neuropsychiatric symptoms in elderly people with and without dementia followed up at a Homeopathy service in Rio Branco, Acre

Abstract

Neuropsychiatric symptoms are present in all types of dementia, and they are related to the stage of disease evolution, caregiver burden and drug treatment. The aim of the study was to evaluate the neuropsychiatric symptoms of patients diagnosed with dementia followed at a homeopathy service in Rio Branco, Acre. Between 2019 and 2021, forty-three patients followed at a complementary homeopathic outpatient service were evaluated, prior to initiating Homeopathic treatment, using the Neuropsychiatric Inventory Questionnaire (NPI-Q) to assess neuropsychiatric symptoms. These patients were reevaluated during complementary homeopathic treatment between 2019 and 2021. Of a total of 43 elderly, 30 had a clinical diagnosis of dementia, and 12 had frontotemporal dementia, 6 had Alzheimer's type of dementia, 3 had vascular dementia and 9 had dementia of unknown etiology. The most frequent neuropsychiatric symptom was for apathy / indifference (76.7%) and the least frequent symptom was euphoria / elation (13.3%). The total NPI-Q score was 14.13 in patients with dementia and 5.00 in patients without dementia (p<0.001). Nocturnal behaviors were more intense in patients with frontotemporal dementia than in patients with Alzheimer's (p = 0.045). The NPIq scores varied according to CDR result, being higher in patients with CDR 1, 2 and 3 than in patients with CDR 0.5 (p = 0.015). Most caregivers were female (96.7%), the majority being the patient's daughter (73.3%). There was a significant difference in  the caregiver´s urden score according to the type of dementia, being higher in caregivers of patients with frontotemporal dementia and vascular dementia or undefined etiology than probable Alzheimer's dementia (p = 0.031). The caregiver burden score was also higher in patients with education greater than or equal to one year than with patients without formal education (p = 0.024). As for caregiver burden in relation to each patient's symptom, scores were greater in relation to the nocturnal behavior of patients with one or more years of formal education (p = 0.046) and in patients with frontotemporal dementia (p = 0.044). Caregiver burden was greater as the intensity of the patient's symptoms increased in both the first and last assessments. The neuropsychiatric symptoms intensity scores according to the NPI-Q decreased in the last assessment, with the average changing from 15.55 points to 11.11 points, and the median changed from 16 points to 8.5 points (p = 0.011) In conclusion,  there are potential relationships of neuropsychiatric symptoms (frequency and intensity) with the evolution of dementia, caregiver wear and homeopathic treatment. This pilot study serves to evaluate the potential contribution of homeopathy as complementary treatment in patients with dementia and provides basis for controlled and randomized clinical trials for the management of neuropsychiatric symptoms.