Department of Psychiatry and Clinical Neurosciences, University of Western Australia and Fremantle Hospital, Fremantle, Western Australia, Australia.
Mov Disord. 2012 Feb;27(2):174-8. doi: 10.1002/mds.24061. Epub 2012 Jan 11.
About one-third of patients with Parkinson's disease (PD) are diagnosed with apathy in cross-sectional studies. However, once patients with concomitant depression and dementia are excluded, the frequency of apathy drops to 5% to 10%. Several scales have been recommended to rate apathy in PD, but specific psychiatric interviews have not been developed, and recently proposed standardized diagnostic criteria are still in the validation process. Most studies assessing the association between subthalamic deep brain stimulation (STN-DBS) and apathy have reported a relative increase in the frequency and severity of apathy, although discrepant findings have also been reported. Several mechanisms to explain apathy in PD have been proposed, from dopaminergic imbalances in frontal-basal ganglia circuits to dysfunction of nondopaminergic circuits and the cingulate gyrus. Future studies should provide reliable and valid instruments to diagnose apathy in PD, and should examine the mechanism of apathy accounting for relevant confounders, such as depression and cognitive deficits, and important contextual factors. Finally, treatment for apathy in PD should not be restricted to psychoactive drugs, but should also include nonpharmacological techniques such as psychotherapy and occupational therapy.
大约三分之一的帕金森病 (PD) 患者在横断面研究中被诊断为冷漠。然而，一旦排除同时患有抑郁症和痴呆症的患者，冷漠的频率降至 5%至 10%。已经推荐了几种量表来评定 PD 中的冷漠，但尚未制定特定的精神科访谈，最近提出的标准化诊断标准仍在验证过程中。大多数评估丘脑底核深部脑刺激 (STN-DBS) 与冷漠之间关联的研究报告称，冷漠的频率和严重程度相对增加，尽管也有不一致的发现。已经提出了几种解释 PD 中冷漠的机制，从额-基底节回路中的多巴胺能失衡到非多巴胺能回路和扣带回的功能障碍。未来的研究应该提供可靠和有效的工具来诊断 PD 中的冷漠，并应该检查解释相关混杂因素（如抑郁和认知缺陷）和重要背景因素的冷漠机制。最后，PD 中冷漠的治疗不应仅限于精神活性药物，还应包括心理治疗和职业治疗等非药物技术。
