Dujardin K, Defebvre L
Service de neurologie et pathologie du mouvement, hôpital Salengro, CHU, Lille cedex, France.
Rev Neurol (Paris). 2012 Aug-Sep;168(8-9):598-604. doi: 10.1016/j.neurol.2012.05.002. Epub 2012 Aug 24.
Apathy is a loss of motivation compared to the previous level of functioning of the subject. It affects the subject's behavior, cognition and emotional state. It is one of the main behavioral manifestations of Parkinson's disease. Although it may be a symptom of depression, it often exists as an isolated syndrome in Parkinson's disease patients. Apathy is usually not related to the severity of the motor symptoms, but frequently associated with the severity of cognitive impairment. Apathy is also a possible complication of treatment by stimulation of the subthalamic nucleus. Screening and assessment of apathy require the use of specific tools, some of which are validated in Parkinson's disease. From a pathophysiological point of view, apathy results from a dysfunction of the limbic circuit connecting the ventral striatum to orbitofrontal and anterior cingulate cortex. The dopaminergic denervation in these regions seems to play a key role, but other mechanisms are probably involved. Further studies are warranted to progress in the therapeutic management of this invalidating syndrome.
与之前的功能水平相比，冷漠是动机的丧失。它会影响患者的行为、认知和情绪状态。它是帕金森病的主要行为表现之一。虽然它可能是抑郁症的症状，但在帕金森病患者中它通常作为一种孤立的综合征存在。冷漠通常与运动症状的严重程度无关，但经常与认知障碍的严重程度相关。冷漠也是丘脑底核刺激治疗的一种可能并发症。冷漠的筛查和评估需要使用特定工具，其中一些在帕金森病中已得到验证。从病理生理学角度来看，冷漠是由于连接腹侧纹状体与眶额皮质和前扣带回皮质的边缘回路功能障碍所致。这些区域的多巴胺能去神经支配似乎起关键作用，但可能还涉及其他机制。有必要进行进一步研究以推进对这种致残综合征的治疗管理。
