Butterfield London C, Cimino Cynthia R, Salazar Robert, Sanchez-Ramos Juan, Bowers Dawn, Okun Michael S
1 Department of Psychology, College of Arts and Sciences, University of South Florida, Tampa, FL, USA.
2 Department of Clinical and Health Psychology, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA.
J Geriatr Psychiatry Neurol. 2017 Jan;30(1):11-25. doi: 10.1177/0891988716673467. Epub 2016 Oct 17.
Apathy, one of the most common neuropsychiatric symptoms in Parkinson's disease (PD), has been associated with reduced daily functioning, cognition, treatment compliance, quality of life, and increased caregiver burden and distress, among other outcomes.
The purpose of the present study was to develop and gather pilot data on the feasibility, acceptability, and efficacy of the Parkinson's Active Living (PAL) program, to our knowledge, the first behavioral treatment specifically designed to target apathy in patients with PD. The Parkinson's Active Living is a primarily telephone-based, 6-week activity scheduling and monitoring intervention that incorporates external cueing to target disease-related self-generational deficits to reduce levels of apathy in nondemented, highly apathetic patients with PD.
Participants aged 44 to 86 years (mean = 66, SD [standard deviation] = 10.7) ranging in disease duration from <1 to 23 years with elevated apathy (Apathy Evaluation Scale >35) were enrolled in a 1-arm trial and tested at 3 time points (baseline, posttest, and 1-month follow-up).
Feasibility aspects (ie, acceptability, demand, implementation, practicality, adaptation, integration, and expansion) and efficacy of PAL program are reported. Matched pairs t tests showed a medium to large effect of treatment on patient apathy (52% showing ≥1 SD improvement), depression (33% showing ≥1 SD improvement), and quality of life at posttest, with improvements in apathy and depression maintained at follow-up.
The program may hold promise as an effective nonpharmacological intervention for apathy in PD. Implications and future directions are discussed. Randomized controlled trials are needed.
冷漠是帕金森病（PD）最常见的神经精神症状之一，与日常功能减退、认知、治疗依从性、生活质量下降以及照顾者负担和痛苦增加等诸多后果相关。
本研究的目的是开发并收集关于帕金森积极生活（PAL）项目的可行性、可接受性和有效性的试点数据，据我们所知，这是首个专门针对PD患者冷漠症状设计的行为治疗方法。帕金森积极生活是一项主要基于电话的、为期6周的活动安排和监测干预措施，它采用外部提示来针对与疾病相关的自我产生缺陷，以降低无痴呆、高度冷漠的PD患者的冷漠程度。
年龄在44至86岁（平均 = 66岁，标准差[SD] = 10.7）、病程从<1年至23年、冷漠程度较高（冷漠评估量表>35）的参与者被纳入单组试验，并在3个时间点（基线、测试后和1个月随访）进行测试。
报告了PAL项目的可行性方面（即可接受性、需求、实施、实用性、适应性、整合性和扩展性）和有效性。配对t检验显示，治疗对患者的冷漠（52%显示改善≥1个标准差）、抑郁（33%显示改善≥1个标准差）和测试后的生活质量有中度至较大影响，冷漠和抑郁的改善在随访时得以维持。
该项目有望成为一种有效的非药物干预措施，用于治疗PD患者的冷漠症状。讨论了其意义和未来方向。需要进行随机对照试验。
