Movement Disorders Unit, Neurology Department, Sant Pau Hospital and Biomedical Research Institute, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas, Madrid, Spain.
Movement Disorders Unit, Neurology Department, Sant Pau Hospital and Biomedical Research Institute, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas, Madrid, Spain; Universitat Oberta de Catalunya, Barcelona, Spain.
Lancet Neurol. 2015 May;14(5):518-31. doi: 10.1016/S1474-4422(15)00019-8. Epub 2015 Apr 12.
Normal maintenance of human motivation depends on the integrity of subcortical structures that link the prefrontal cortex with the limbic system. Structural and functional disruption of different networks within these circuits alters the maintenance of spontaneous mental activity and the capacity of affected individuals to associate emotions with complex stimuli. The clinical manifestations of these changes include a continuum of abnormalities in goal-oriented behaviours known as apathy. Apathy is highly prevalent in Parkinson's disease (and across many neurodegenerative disorders) and can severely affect the quality of life of both patients and caregivers. Differentiation of apathy from depression, and discrimination of its cognitive, emotional, and auto-activation components could guide an individualised approach to the treatment of symptoms. The opportunity to manipulate dopaminergic treatment in Parkinson's disease allows researchers to study a continuous range of motivational states, from apathy to impulse control disorders. Parkinson's disease can thus be viewed as a model that provides insight into the neural substrates of apathy.
人类动机的正常维持依赖于将前额叶皮层与边缘系统联系起来的皮质下结构的完整性。这些回路中不同网络的结构和功能的破坏改变了自发心理活动的维持能力，以及受影响个体将情绪与复杂刺激联系起来的能力。这些变化的临床表现包括一系列被称为冷漠的目标导向行为异常。冷漠在帕金森病中（以及许多神经退行性疾病中）非常普遍，并且会严重影响患者和护理人员的生活质量。将冷漠与抑郁区分开来，以及区分其认知、情感和自动激活成分，可以指导针对症状的个体化治疗方法。在帕金森病中操纵多巴胺治疗的机会使得研究人员能够研究从冷漠到冲动控制障碍的一系列连续的动机状态。因此，帕金森病可以被视为一种模型，为冷漠的神经基础提供了深入的了解。
