Department of Psychiatry,College of Medicine,Kaohsiung Medical University,Kaohsiung,Taiwan.
Department of Medical Imaging and Radiological Sciences,College of Health Sciences,Kaohsiung Medical University,Kaohsiung,Taiwan.
Int Psychogeriatr. 2018 May;30(5):761-768. doi: 10.1017/S1041610217002381. Epub 2017 Nov 16.
ABSTRACTBackground:Apathy is a condition characterized by a lack of motivation that manifests in emotional, behavioral, and cognitive domains. Although previous studies have indicated that apathy is associated with frontal lesions, few studies have focused on the different subdomains of apathy, and no in vivo human biochemical data have been obtained to examine the neurochemical changes related to apathy in patients with Alzheimer's disease (AD). Thus, we investigated the frontal neurochemical alterations related to apathy among patients with AD using proton magnetic resonance spectroscopy (1H MRS).
Apathy was assessed through the Apathy Evaluation Scale (AES). 1H MRS was performed to measure neurochemical metabolite levels in the anterior cingulate region and right orbitofrontal region. Associations between neurochemical metabolites and the total score and subscores of each domain of the AES were analyzed.
Altogether, 36 patients completed the study. Patients with lower N-acetylaspartate/creatine ratios (NAA/Cr) in the anterior cingulate region demonstrated higher total apathy scores (β = -0.56, p = 0.003) with adjustments for age, gender, educational level, dementia severity, and depression severity. In a further analysis, a lower NAA/Cr in the anterior cingulate region was associated with all subdomains of apathy, including cognition (β = -0.43, p = 0.028), behavior (β = -0.55, p = 0.002), and emotion (β = -0.50, p = 0.005). No statistically significant associations were discovered in the right orbitofrontal region.
Our results suggest that apathy, in each of its cognitive, behavioral, or emotional subdomains is associated with brain neurochemical alterations in the anterior cingulate region. Abnormal neuronal integrity over the anterior cingulate cortex may exhibit a central role in causing all aspects of apathy in patients with AD.
背景：冷漠是一种缺乏动机的状态，表现为情感、行为和认知领域。虽然以前的研究表明冷漠与额叶病变有关，但很少有研究关注冷漠的不同亚领域，也没有获得体内人类生化数据来检查与阿尔茨海默病（AD）患者冷漠相关的神经化学变化。因此，我们使用质子磁共振波谱（1H MRS）研究了 AD 患者与冷漠相关的额叶神经化学改变。
通过冷漠评估量表（AES）评估冷漠。进行 1H MRS 以测量前扣带回区域和右侧眶额区域的神经化学代谢物水平。分析神经化学代谢物与 AES 总分和各领域亚评分之间的关联。
共有 36 名患者完成了研究。前扣带回区域 N-乙酰天冬氨酸/肌酸比（NAA/Cr）较低的患者表现出更高的总冷漠评分（β=-0.56，p=0.003），调整年龄、性别、教育程度、痴呆严重程度和抑郁严重程度。在进一步分析中，前扣带回区域的 NAA/Cr 较低与冷漠的所有亚领域相关，包括认知（β=-0.43，p=0.028）、行为（β=-0.55，p=0.002）和情绪（β=-0.50，p=0.005）。在右侧眶额区域未发现统计学显著关联。
我们的研究结果表明，冷漠的每个认知、行为或情感亚领域都与前扣带回区域的脑神经化学改变有关。前扣带皮层的神经元完整性异常可能在 AD 患者的冷漠的所有方面都起着核心作用。
