Lozachmeur C, Drapier D
Service de psychiatrie et de psychologie médicale, centre hospitalier universitaire Pontchaillou, Rennes, France.
Rev Neurol (Paris). 2012 Aug-Sep;168(8-9):620-3. doi: 10.1016/j.neurol.2012.06.011. Epub 2012 Aug 24.
Apathy was defined by Marin as diminished motivation not attributable to diminished level of consciousness, cognitive impairment, or emotional distress. Up to 42% of Parkinson's disease patients could be concerned. It has a pejorative impact on quality of life and could be predictive of cognitive decline. It has been shown that deep brain stimulation in Parkinson's disease may induce apathy. It seems directly related to the stimulation target, i.e. the subthalamic nucleus, since such an effect has not been observed so far in thalamic and pallidal stimulation. It should certainly not make us question the remarkable effectiveness of subthalamic stimulation in Parkinson's disease patients, but encourages us to be very careful about operability criteria. We must, in this sense, improve identification of at risk patients, seeking a thoroughly diminished motivation, loss of interest or blunting affects.
马林将冷漠定义为并非由意识水平降低、认知障碍或情绪困扰导致的动机减退。高达42%的帕金森病患者可能会受到影响。它对生活质量有负面影响，并且可能预示着认知能力下降。已经表明，帕金森病的脑深部刺激可能会诱发冷漠。它似乎与刺激靶点直接相关，即丘脑底核，因为迄今为止在丘脑和苍白球刺激中尚未观察到这种效应。这当然不应使我们质疑丘脑底核刺激对帕金森病患者的显著疗效，但鼓励我们在手术标准方面要非常谨慎。从这个意义上说，我们必须改进对高危患者的识别，寻找动机彻底减退、兴趣丧失或情感迟钝的情况。
