Department of Psychiatry, Rhode Island Hospital, Providence, USA.
Int J Geriatr Psychiatry. 2013 Jan;28(1):50-6. doi: 10.1002/gps.3789. Epub 2012 Feb 27.
Apathy and depression are the most common neuropsychiatric features in mild cognitive impairment (MCI). These syndromes have been linked to cognitive and functional decline. This study aimed to examine their unique relationships with specific cognitive abilities and daily functioning among MCI patients with memory impairment (amnestic MCI).
Data from 90 individuals referred for outpatient clinical neuropsychological evaluation and subsequently characterized as having amnestic MCI were obtained from a memory disorders center. MCI was defined using current NIA-Alzheimer's Association criteria. Variables included caregiver-reported apathy (Frontal Systems Behavior Scale) and depression (Memory and Behavioral Problems Checklist), scores on neuropsychological measures, and the Lawton-Brody Instrumental Activities of Daily Living Scale. Data were analyzed with multiple regressions controlling for age and education.
Depression was independently associated with composite scores of executive functioning. Neither apathy nor depression was associated with composite scores of attention, memory, or language. With regard to individual measures of executive functioning, depression was independently associated with poorer set-shifting (i.e., Trails B). Apathy was independently associated with poorer letter fluency (i.e., FAS). Apathy, but not depression, was associated with greater functional impairment.
Apathy and depression are associated with different aspects of executive functioning in amnestic MCI, which may reflect differing patterns of frontal lobe pathology. Apathy exerts a greater impact on daily functioning than depression and may therefore increase reliance on caregivers. Results support the separability of apathy and depression in amnestic MCI. Clinicians should differentiate these neuropsychiatric states during assessment and treatment.
淡漠和抑郁是轻度认知障碍（MCI）中最常见的神经精神特征。这些综合征与认知和功能下降有关。本研究旨在检查它们与记忆障碍（遗忘型 MCI）患者特定认知能力和日常功能的独特关系。
从一家记忆障碍中心获得了 90 名因门诊临床神经心理评估而转诊的个体的数据，随后将其特征描述为遗忘型 MCI。MCI 是使用当前的 NIA-阿尔茨海默病协会标准定义的。变量包括照顾者报告的淡漠（额叶系统行为量表）和抑郁（记忆和行为问题检查表）、神经心理学测量的分数以及 Lawton-Brody 工具性日常生活活动量表。数据通过多元回归进行分析，控制年龄和教育。
抑郁与执行功能的综合评分独立相关。淡漠和抑郁均与注意力、记忆或语言的综合评分无关。就执行功能的个别测量而言，抑郁与较差的转换能力（即 Trails B）独立相关。淡漠与较差的字母流畅性（即 FAS）独立相关。淡漠但不是抑郁与更大的功能障碍相关。
淡漠和抑郁与遗忘型 MCI 中的执行功能的不同方面相关，这可能反映了额叶病理的不同模式。淡漠对日常生活功能的影响大于抑郁，因此可能会增加对照顾者的依赖。结果支持在遗忘型 MCI 中区分淡漠和抑郁。临床医生在评估和治疗期间应区分这些神经精神状态。
