Fishman Keera N, Ashbaugh Andrea R, Lanctôt Krista L, Cayley Megan L, Herrmann Nathan, Murray Brian J, Sicard Michelle, Lien Karen, Sahlas Demetrios J, Swartz Richard H
a Department of Psychology, Faculty of Social Sciences , University of Ottawa , Ottawa , ON , Canada.
b Department of Medicine (Psychiatry) , Sunnybrook Health Sciences Centre , Toronto , ON , Canada.
J Clin Exp Neuropsychol. 2018 Jun;40(5):449-461. doi: 10.1080/13803395.2017.1371282. Epub 2017 Sep 15.
This study examined the relationship between apathy and cognition in patients with cerebrovascular disease. Apathy may result from damage to frontal subcortical circuits causing dysexecutive syndromes, but apathy is also related to depression. We assessed the ability of apathy to predict phonemic fluency and semantic fluency performance after controlling for depressive symptoms in 282 individuals with stroke and/or transient ischemic attack.
Participants (N = 282) completed the Phonemic Fluency Test, Semantic Fluency Test, Center for Epidemiologic Studies Depression Scale, and Apathy Evaluation Scale. A cross-sectional correlational design was utilized.
Using hierarchical linear regressions, apathy scores significantly predicted semantic fluency performance (β = -.159, p = .020), but not phonemic fluency performance (β = -.112, p = .129) after scaling scores by age and years of education and controlling for depressive symptoms. Depressive symptoms entered into the first step of both hierarchical linear regressions did not predict semantic fluency (β = -.035, p = .554) or phonemic fluency (β = -.081, p = .173). Apathy and depressive symptoms were moderately correlated, r(280) = .58, p < .001.
The results of this study are consistent with research supporting a differentiation between phonemic and semantic fluency tasks, whereby phonemic fluency tasks primarily involve frontal regions, and semantic fluency tasks involve recruitment of more extended networks. The results also highlight a distinction between apathy and depressive symptoms and suggest that apathy may be a more reliable predictor of cognitive deficits than measures of mood in individuals with cerebrovascular disease. Apathy may also be more related to cognition due to overlapping motivational and cognitive frontal subcortical circuitry. Future research should explore whether treatments for apathy could be a novel target for improving cognitive outcomes after stroke.
本研究探讨脑血管疾病患者冷漠与认知之间的关系。冷漠可能源于额叶皮质下回路受损导致执行功能障碍综合征，但冷漠也与抑郁有关。我们评估了在控制282名中风和/或短暂性脑缺血发作患者的抑郁症状后，冷漠对音素流畅性和语义流畅性表现的预测能力。
参与者（N = 282）完成了音素流畅性测试、语义流畅性测试、流行病学研究中心抑郁量表和冷漠评估量表。采用横断面相关设计。
通过年龄和受教育年限对分数进行标准化并控制抑郁症状后，使用分层线性回归分析，冷漠得分显著预测了语义流畅性表现（β = -0.159，p = 0.020），但未预测音素流畅性表现（β = -0.112，p = 0.129）。在两个分层线性回归的第一步中纳入的抑郁症状未预测语义流畅性（β = -0.035，p = 0.554）或音素流畅性（β = -0.081，p = 0.173）。冷漠与抑郁症状中度相关，r(280) = 0.58，p < 0.001。
本研究结果与支持区分音素和语义流畅性任务的研究一致，即音素流畅性任务主要涉及额叶区域，而语义流畅性任务涉及更多扩展网络的参与。结果还突出了冷漠与抑郁症状之间的区别，并表明在脑血管疾病患者中，冷漠可能比情绪测量更能可靠地预测认知缺陷。由于动机和认知额叶皮质下回路重叠，冷漠也可能与认知更相关。未来的研究应探索针对冷漠的治疗是否可能成为改善中风后认知结果的新靶点。
