帕金森病中的淡漠
Apathy in Parkinson's disease.
作者信息
Pluck G C, Brown R G
机构信息
Division of Psychological Medicine, Section of Old Age Psychiatry, Institute of Psychiatry, King's College London, London SE5, UK.
出版信息
J Neurol Neurosurg Psychiatry. 2002 Dec;73(6):636-42. doi: 10.1136/jnnp.73.6.636.
OBJECTIVE
To assess apathy in patients with Parkinson's disease and its relation to disability, mood, personality, and cognition.
METHODS
Levels of apathy in 45 patients with Parkinson's disease were compared with a group of 17 similarly disabled patients with osteoarthritis. Additional neuropsychiatric data were collected concerning levels of depression, anxiety, and hedonic tone. Personality was assessed with the tridimensional personality questionnaire. Cognitive testing included the mini-mental state examination, the Cambridge examination of cognition in the elderly, and specific tests of executive functioning.
RESULTS
Patients with Parkinson's disease had significantly higher levels of apathy than equally disabled osteoarthritic patients. Furthermore, within the Parkinson sample, levels of apathy appear to be unrelated to disease progression. The patients with Parkinson's disease with the highest levels of apathy where not more likely to be depressed or anxious than those with the lowest levels of apathy, though they did show reduced hedonic tone. No differences in personality traits were detected in comparisons between patients with Parkinson's disease and osteoarthritis, or between patients in the Parkinson group with high or low levels of apathy. As a group, the patients with Parkinson's disease tended not to differ significantly from the osteoarthritic group in terms of cognitive skills. However, within the Parkinson's disease sample, the high apathy patients performed significantly below the level of the low apathy patients. This was particularly evident on tests of executive functioning.
CONCLUSIONS
Apathy in Parkinson's disease is more likely to be a direct consequence of disease related physiological changes than a psychological reaction or adaptation to disability. Apathy in Parkinson's disease can be distinguished from other psychiatric symptoms and personality features that are associated with the disease, and it is closely associated with cognitive impairment. These findings point to a possible role of cognitive mechanisms in the expression of apathy.
目的
评估帕金森病患者的冷漠情绪及其与残疾、情绪、个性和认知的关系。
方法
将45例帕金森病患者的冷漠程度与17例残疾程度相似的骨关节炎患者进行比较。收集了关于抑郁、焦虑和享乐基调水平的额外神经精神数据。使用三维个性问卷评估个性。认知测试包括简易精神状态检查、剑桥老年人认知检查和执行功能的特定测试。
结果
帕金森病患者的冷漠程度明显高于残疾程度相同的骨关节炎患者。此外，在帕金森病样本中，冷漠程度似乎与疾病进展无关。冷漠程度最高的帕金森病患者并不比冷漠程度最低的患者更易出现抑郁或焦虑，尽管他们确实表现出享乐基调降低。在帕金森病患者与骨关节炎患者之间，或帕金森病组中冷漠程度高或低的患者之间，未检测到个性特征的差异。总体而言，帕金森病患者在认知技能方面与骨关节炎组没有显著差异。然而，在帕金森病样本中，冷漠程度高的患者在执行功能测试中的表现明显低于冷漠程度低的患者。这在执行功能测试中尤为明显。
结论
帕金森病中的冷漠更可能是疾病相关生理变化的直接后果，而非对残疾的心理反应或适应。帕金森病中的冷漠可与该疾病相关的其他精神症状和个性特征相区分，且与认知障碍密切相关。这些发现表明认知机制在冷漠表达中可能发挥作用。
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