Shin Jung Hwan, Shin Seong A, Lee Jee-Young, Nam Hyunwoo, Lim Jae-Sung, Kim Yu Kyeong
Department of Neurology, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, College of Medicine Seoul National University, Seoul, Republic of Korea.
Department of Nuclear Medicine, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, College of Medicine Seoul National University, Seoul, Republic of Korea; Department of Biomedical Sciences, Seoul National University, Seoul, Republic of Korea.
Neurosci Lett. 2017 Jul 13;653:250-257. doi: 10.1016/j.neulet.2017.05.061. Epub 2017 Jun 1.
To investigate isolated apathy in a set of consecutively enrolled Parkinson's disease (PD) patients without dementia, depression, and significant motor response fluctuations, by conducting neuropsychological and neuroimaging analyses.
One hundred twenty-four patients were eligible for inclusion in this study. Clinical information and data were collected from a predefined neuropsychological test battery, including the mini-mental status examination, apathy scale, geriatric depression scale, digit span test, Boston naming test, Seoul verbal learning test, controlled oral word association test, go-no-go test, and the Rey figure copy test. From matched groups of 10 non-apathetic and 12 apathetic patients in the initial cohort and 9 healthy controls, [F]fluorodeoxyglucose positron emission tomography and volumetric magnetic resonance images were acquired.
Apathy was detected in 59.7% of the initial cohort. Apathetic patients had lower scores in the digit span forward, digit span backward, and immediate recall of verbal learning tests than did those without apathy (p <0.05). The results were unaffected by parkinsonian motor severity and medication dose. Neuroimaging analyses revealed precuneus atrophy and hypometabolism in patients with isolated apathy. These precuneus changes were well-correlated with apathy severity (p <0.001). Apathy severity was also positively correlated with gray matter volume in the superior frontal gyrus and cerebellar vermis, and with metabolism in the medial frontal and anterior cingulate regions (p < 0.001).
PD patients with isolated apathy showed attention and working memory dysfunction, and precuneus degeneration might be related to this distinctive nonmotor symptom in PD.
通过进行神经心理学和神经影像学分析，研究一组连续入组的无痴呆、抑郁且无明显运动反应波动的帕金森病（PD）患者中的孤立性冷漠。
124名患者符合本研究的纳入标准。从预先定义的神经心理测试组合中收集临床信息和数据，包括简易精神状态检查、冷漠量表、老年抑郁量表、数字广度测试、波士顿命名测试、首尔言语学习测试、控制口语单词联想测试、停止信号测试和雷氏图形复制测试。从初始队列中匹配的10名无冷漠症状患者、12名有冷漠症状患者和9名健康对照中，采集了[F]氟脱氧葡萄糖正电子发射断层扫描和容积磁共振图像。
在初始队列中，59.7%的患者检测出冷漠。与无冷漠症状的患者相比，有冷漠症状的患者在数字顺背、数字倒背和言语学习测试的即时回忆方面得分更低（p<0.05）。结果不受帕金森病运动严重程度和药物剂量的影响。神经影像学分析显示，孤立性冷漠患者存在楔前叶萎缩和代谢减低。这些楔前叶变化与冷漠严重程度密切相关（p<0.001）。冷漠严重程度还与额上回和小脑蚓部的灰质体积以及额内侧和前扣带回区域的代谢呈正相关（p<0.001）。
患有孤立性冷漠的PD患者表现出注意力和工作记忆功能障碍，楔前叶变性可能与PD中这种独特的非运动症状有关。
