Human Cognitive Neuroscience Unit - School of Philosophy, Psychology & Language Sciences, University of Edinburgh, Edinburgh, UK; Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK; Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK; Euan MacDonald Centre for MND Research, University of Edinburgh, Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.
Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK; Euan MacDonald Centre for MND Research, University of Edinburgh, Edinburgh, UK.
Cortex. 2017 Sep;94:142-151. doi: 10.1016/j.cortex.2017.06.023. Epub 2017 Jul 13.
Apathy and cognitive dysfunction are prominent symptoms of Amyotrophic lateral sclerosis (ALS). More specifically ALS patients show increased Initiation apathy-a lack of motivation for self-generation of thoughts as assessed by the Dimensional Apathy Scale. This study aimed to investigate the cognitive underpinnings of apathy subtypes in ALS. We hypothesized that increased Initiation apathy would be associated deficits on tests of intrinsic response generation, such as verbal fluency. We also explored the relationship of other apathy subtypes to cognitive processes, in particular emotional apathy with emotional and social cognition deficits and executive apathy with planning and goal management deficits. ALS patients, and their carers (N = 30), and healthy matched controls, and their informants (N = 29) were recruited. All participants completed self- and informant/carer-rated Dimensional Apathy Scale, to quantify apathy subtypes (Executive, Emotional and Initiation), along with standard apathy and depression measures. Patients and controls completed the Edinburgh Cognitive and behavioural ALS Screen, and a comprehensive neuropsychological battery including emotional recognition, social cognition, intrinsic response generation tasks (verbal fluency and random number generation) and a new ecologically valid, computerised measure of planning and goal management. The results demonstrated that increased Initiation apathy was the only significantly elevated subtype in ALS (self-rated p < .05, informant/carer-rated p < .01). Initiation apathy was found to be significantly associated with verbal fluency deficit, while Emotional apathy was significantly associated with emotional recognition deficits. No associations were found between apathy subtypes and depression or in controls. This is the first study to show specific associations between apathy subtypes (Emotional and Initiation) and executive and emotional cognitive dysfunction, indicating possible distinct underlying mechanisms to these demotivational symptoms.
淡漠和认知功能障碍是肌萎缩侧索硬化症（ALS）的突出症状。更具体地说，ALS 患者表现出增加的启动淡漠——缺乏自我思维产生的动机，这可以通过维度淡漠量表来评估。本研究旨在探讨 ALS 中淡漠亚型的认知基础。我们假设增加的启动淡漠会与内在反应生成测试的缺陷相关，例如言语流畅性。我们还探讨了其他淡漠亚型与认知过程的关系，特别是情感淡漠与情感和社会认知缺陷以及执行淡漠与计划和目标管理缺陷的关系。我们招募了 ALS 患者及其照顾者（N=30）以及健康匹配的对照组及其知情人（N=29）。所有参与者都完成了自我和知情人/照顾者评定的维度淡漠量表，以量化淡漠亚型（执行、情感和启动），以及标准的淡漠和抑郁测量。患者和对照组完成了爱丁堡认知和行为 ALS 筛查，以及全面的神经心理学测试，包括情绪识别、社会认知、内在反应生成任务（言语流畅性和随机数生成）以及新的生态有效、计算机化的计划和目标管理测量。结果表明，增加的启动淡漠是 ALS 中唯一显著升高的亚型（自我评定 p<.05，知情人/照顾者评定 p<.01）。启动淡漠与言语流畅性缺陷显著相关，而情感淡漠与情绪识别缺陷显著相关。在对照组中，没有发现淡漠亚型与抑郁或其他方面之间的关联。这是第一项研究表明，淡漠亚型（情感和启动）与执行和情感认知功能之间存在特定关联，这表明这些动机缺失症状可能有不同的潜在机制。
