Academic Psychiatry Department, Guillaume Régnier Hospital, EA 4712 Basal Ganglia and Behaviour team, University of Rennes I, Rennes, France.
Neurology. 2012 Sep 11;79(11):1155-60. doi: 10.1212/WNL.0b013e3182698c75. Epub 2012 Aug 15.
We sought to identify apathy metabolic bases in Parkinson disease (PD).
A total of 45 patients with PD who were not clinically depressed (Montgomery-Åsberg Depression Rating Scale [MADRS] <21) and had no dementia (Mattis Dementia Rating Scale [MDRS] >130) were assessed with the Apathy Evaluation Scale (AES) and underwent a resting-state F-18 fluorodeoxyglucose PET (FDG-PET) scan. A motor assessment comprising the Unified Parkinson's Disease Rating Scale Part III (UPDRS-III) was conducted and total levodopa equivalent daily dose (LEDD) was calculated. Imaging data were analyzed with statistical parametric mapping. Age, LEDD, and MDRS scores were introduced as covariates.
Positive correlations were observed between the AES score and cerebral metabolism in the right inferior frontal gyrus (Brodmann area [BA] 47), right middle frontal gyrus (BA 10), right cuneus (BA 18), and right anterior insula (BA 13). Negative correlations were observed between the AES score and cerebellar metabolism in the semilunar lobules bilaterally, within the posterior lobe. Using an AES score equal to or above 42 to define clinical apathy, prevalence in our patient group was 17.8%. The AES score was negatively correlated with the MDRS score and positively correlated with the "retardation" subscore of the MADRS. It was not correlated with either UPDRS III or LEDD.
Results indicate that the frontal, temporal, and cerebellar areas known to be involved in reward, emotion, and cognition are also implicated in apathy in patients with PD without dementia or depression. Their roles in the etiopathology of apathy are discussed.
我们旨在确定帕金森病（PD）患者淡漠的代谢基础。
共纳入 45 例符合以下条件的 PD 患者：临床无抑郁（蒙哥马利-阿斯伯格抑郁评定量表[MADRS]＜21），无痴呆（马修斯痴呆评定量表[MDRS]＞130）。所有患者均行静息态 F-18 氟脱氧葡萄糖正电子发射断层扫描（FDG-PET），并用淡漠评估量表（AES）进行评估。同时进行运动评估，包括统一帕金森病评定量表第三部分（UPDRS-III），并计算左旋多巴等效日剂量（LEDD）。采用统计参数图对影像数据进行分析。引入年龄、LEDD 和 MDRS 评分作为协变量。
AES 评分与右侧额下回（BA47）、右侧额中回（BA10）、右侧楔前叶（BA18）和右侧前岛叶（BA13）的脑代谢呈正相关，与双侧小脑半月球叶、后叶的代谢呈负相关。以 AES 评分≥42 定义为临床淡漠，我们的患者组中淡漠的患病率为 17.8%。AES 评分与 MDRS 评分呈负相关，与 MADRS 的“迟滞”亚评分呈正相关，与 UPDRS-III 或 LEDD 均无相关性。
结果表明，已知与奖赏、情绪和认知相关的额、颞和小脑区域也与无痴呆或抑郁的 PD 患者的淡漠有关。讨论了它们在淡漠发病机制中的作用。
