Fox Michelle E, King Tricia Z
Department of Psychology and the Neuroscience Institute, Georgia State University, Atlanta, Georgia.
Pediatr Blood Cancer. 2016 Nov;63(11):2019-25. doi: 10.1002/pbc.26144. Epub 2016 Jul 27.
The relationship between apathy and endocrine dysfunction, both frequent outcomes of neurological insult, has not yet been investigated in brain tumor survivors. The present study aimed to assess the relationship between pituitary disorders and apathy and other facets of executive function in long-term adult survivors of childhood brain tumors and to differentiate between apathy and depression in this population.
Seventy-six adult survivors of childhood brain tumors at least 5 years past diagnosis participated. An informant completed the Frontal Systems Behavior Scale (FrSBe), and 75 of the 76 participants completed a Structured Clinical Interview for the DSM-IV-TR (SCID). Information on neuroendocrine dysfunction was obtained through medical chart review.
Clinically significant levels of apathy on the FrSBe were identified in 41% of survivors. Pituitary dysfunction significantly explained 9% of the variance in apathy scores and affected whether an individual presented with clinical levels of apathy. Pituitary dysfunction predicted higher levels of executive dysfunction but did not impact whether a participant reached clinical levels of executive dysfunction. A past major depressive episode (MDE) significantly predicted current apathy but showed no relationship with pituitary disorders. Radiation treatment predicted pituitary dysfunction but not the differences in apathy or executive functions.
Apathy and executive dysfunction in survivors of childhood brain tumors are strongly predicted by pituitary dysfunction, and individuals with pituitary dysfunction are more likely to present with clinical levels of apathy as adults. Clinical levels of apathy may present absent of current depression, and pituitary dysfunction impacts apathy uniquely.
冷漠与内分泌功能障碍都是神经损伤常见的后果，二者之间的关系在脑肿瘤幸存者中尚未得到研究。本研究旨在评估儿童脑肿瘤成年长期幸存者垂体疾病与冷漠及执行功能其他方面之间的关系，并区分该人群中的冷漠与抑郁。
76名诊断后至少5年的儿童脑肿瘤成年幸存者参与了研究。一名知情者完成了额叶系统行为量表（FrSBe），76名参与者中的75人完成了《精神疾病诊断与统计手册》第四版修订版（DSM-IV-TR）的结构化临床访谈（SCID）。通过查阅病历获取神经内分泌功能障碍的信息。
41%的幸存者在FrSBe上表现出具有临床意义的冷漠水平。垂体功能障碍显著解释了冷漠得分中9%的变异，并影响个体是否表现出临床水平的冷漠。垂体功能障碍预示着更高水平的执行功能障碍，但并未影响参与者是否达到执行功能障碍的临床水平。过去的重度抑郁发作（MDE）显著预测了当前的冷漠，但与垂体疾病无关。放射治疗预示着垂体功能障碍，但与冷漠或执行功能的差异无关。
垂体功能障碍强烈预示着儿童脑肿瘤幸存者的冷漠和执行功能障碍，垂体功能障碍的个体成年后更有可能表现出临床水平的冷漠。冷漠的临床水平可能在当前无抑郁的情况下出现，且垂体功能障碍对冷漠有独特影响。
