Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France CINAC-HM Puerta del Sur, CEU-San Pablo University, Madrid, Spain.
Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France.
J Neurol Neurosurg Psychiatry. 2016 Mar;87(3):311-8. doi: 10.1136/jnnp-2014-310189. Epub 2015 Apr 30.
Subthalamic nucleus deep brain stimulation (STN-DBS) improves motor symptoms of Parkinson's disease, leading to improvement in health-related quality of life (HRQoL). However, an excessive decrease in dopaminergic medication can lead to a withdrawal syndrome with apathy as the predominant feature. The present study aims to assess the impact of postoperative apathy on HRQoL.
A cohort of 88 patients who underwent STN-DBS was divided into two groups, those who were apathetic at 1 year and those who were not, as measured by the Starkstein scale. HRQoL was assessed using the Parkinson's disease questionnaire 39 (PDQ-39) and was compared between the two groups. We also compared activities of daily living, motor improvement and motor complications (Unified Parkinson's Disease Rating Scale, UPDRS), depression and anxiety, as well as cognition and drug dosages. Baseline characteristics and postoperative complications were recorded.
One year after surgery, 27.1% of patients suffered from apathy. While motor improvement was significant and equivalent in both the apathy (-40.4% of UPDRS motor score) and non-apathy groups (-48.6%), the PDQ-39 score did not improve in the apathy group (-5.5%; p=0.464), whereas it improved significantly (-36.7%; p≤0.001) in the non-apathy group. Change in apathy scores correlated significantly with change in HRQoL scores (r=0.278, p=0.009). Depression and anxiety scores remained unchanged from baseline in the apathy group (p=0.409, p=0.075), while they improved significantly in patients without apathy (p=0.006, p≤0.001). A significant correlation was found between changes in apathy and depression (r=0.594, p≤0.001).
The development of apathy after STN-DBS can cancel out the benefits of motor improvement in terms of HRQoL. Systematic evaluation and management of apathy occurring after subthalamic stimulation appears mandatory.
丘脑底核深部脑刺激（STN-DBS）可改善帕金森病的运动症状，从而提高健康相关生活质量（HRQoL）。然而，多巴胺能药物的过度减少会导致出现以淡漠为主要特征的戒断综合征。本研究旨在评估术后淡漠对 HRQoL 的影响。
对 88 例接受 STN-DBS 的患者进行队列研究，根据 Starkstein 量表将患者分为淡漠组和非淡漠组。使用帕金森病问卷 39 项（PDQ-39）评估 HRQoL，并对两组进行比较。我们还比较了两组的日常生活活动、运动改善和运动并发症（统一帕金森病评定量表，UPDRS）、抑郁和焦虑以及认知和药物剂量。记录基线特征和术后并发症。
术后 1 年，27.1%的患者出现淡漠。虽然两组患者的运动改善均显著且相当（UPDRS 运动评分分别降低了 40.4%和 48.6%），但淡漠组的 PDQ-39 评分并未改善（降低了 5.5%，p=0.464），而非淡漠组的 PDQ-39 评分显著改善（降低了 36.7%，p≤0.001）。淡漠评分的变化与 HRQoL 评分的变化显著相关（r=0.278，p=0.009）。淡漠组的抑郁和焦虑评分与基线相比无明显变化（p=0.409，p=0.075），而无淡漠组的抑郁和焦虑评分显著改善（p=0.006，p≤0.001）。淡漠与抑郁的变化之间存在显著相关性（r=0.594，p≤0.001）。
STN-DBS 后出现的淡漠可能会抵消运动改善对 HRQoL 的益处。对 STN 刺激后出现的淡漠进行系统评估和管理似乎是必要的。
