临床实践中淡漠的诊断标准。

Diagnostic criteria for apathy in clinical practice.

机构信息

Centre Mémoire de Ressources et de Recherche, CHU, Université de Nice Sophia, Antipolis, France.

出版信息

Int J Geriatr Psychiatry. 2011 Feb;26(2):158-65. doi: 10.1002/gps.2508.

DOI:10.1002/gps.2508

PMID:20690145

Abstract

BACKGROUND

Apathy is an important and distressing behavioural symptom in Alzheimer's disease and in various neuropsychiatric disorders. Recently, diagnostic criteria for apathy have been proposed.

OBJECTIVES

In groups of patients suffering from different neuropsychiatric diseases, (i) to estimate the prevalence of patients meeting the proposed diagnostic criteria; (ii) to estimate the concurrent validity of the criteria with the neuropsychiatric inventory (NPI) apathy item; (iii) to identify the most frequently met criteria or sub-criteria in each specific neuropsychiatric disease and (iv) to estimate the inter-observer reliability of the diagnostic criteria for apathy.

METHODS

This cross-sectional, multicentric, observational study was performed on 306 patients. Each of the participating centres had to check the presence of apathy according to the diagnostic criteria for apathy in consecutive patients belonging to the following diagnoses list: Alzheimer disease (AD), mixed dementia, mild cognitive impairment (MCI), Parkinson's disease (PD), Schizophrenia (DSM-IV) and major depressive episode. In addition to the clinical interview, the assessment included the Mini Mental Score Examination (MMSE) and the NPI. At the end of the visit, clinicians were required to check the diagnostic criteria for apathy.

RESULTS

Using the diagnostic criteria for apathy, the frequency of apathy was of 53% in the whole population, 55% in AD, 70% in mixed dementia, 43% in MCI, 27% in PD, 53% in schizophrenia and 94% in major depressive episode. In AD, mixed dementia, MCI and PD, the NPI apathy score was significantly higher for patient fulfilling the apathy criteria. Goal-directed cognitive activity (criteria B2-Cognition) was the most frequently observed domain followed by goal-directed behaviour (criteria B1-Behaviour) and emotion (criteria B3), respectively. Inter-rater reliability was high for the overall diagnostic (κ coefficient = 0.93; p = 0.0001) and for each criteria.

CONCLUSION

This study is the first one to test the diagnostic criteria for apathy in clinical practice. Results make the diagnostic criteria useful for clinical practice and research.

摘要

背景

冷漠是阿尔茨海默病和各种神经精神疾病中重要且令人痛苦的行为症状。最近，提出了冷漠的诊断标准。

目的

在患有不同神经精神疾病的患者群体中，（i）估计符合拟议诊断标准的患者的患病率；（ii）估计标准与神经精神疾病问卷（NPI）冷漠项目的同时有效性；（iii）确定每种特定神经精神疾病中最常符合的标准或子标准；（iv）估计冷漠的诊断标准的观察者间可靠性。

方法

这项横断面、多中心、观察性研究在 306 名患者中进行。每个参与中心都必须根据连续患者的冷漠诊断标准检查以下诊断列表中的患者是否存在冷漠：阿尔茨海默病（AD）、混合性痴呆、轻度认知障碍（MCI）、帕金森病（PD）、精神分裂症（DSM-IV）和重性抑郁发作。除了临床访谈外，评估还包括简易精神状态检查（MMSE）和 NPI。在就诊结束时，临床医生需要检查冷漠的诊断标准。

结果

使用冷漠诊断标准，整个人群的冷漠发生率为 53%，AD 为 55%，混合性痴呆为 70%，MCI 为 43%，PD 为 27%，精神分裂症为 53%，重性抑郁发作时为 94%。在 AD、混合性痴呆、MCI 和 PD 中，符合冷漠标准的患者的 NPI 冷漠评分明显更高。有目的的认知活动（标准 B2-认知）是观察到的最常见的领域，其次是有目的的行为（标准 B1-行为）和情绪（标准 B3）。总体诊断的观察者间可靠性很高（κ系数=0.93；p=0.0001）和每个标准。