导致淡漠的大脑机制。
Brain mechanisms underlying apathy.
机构信息
Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
Department of Experimental Psychology, University of Oxford, Oxford, UK.
出版信息
J Neurol Neurosurg Psychiatry. 2019 Mar;90(3):302-312. doi: 10.1136/jnnp-2018-318265. Epub 2018 Oct 26.
The past few decades have seen growing interest in the neuropsychiatric syndrome of apathy, conceptualised as a loss of motivation manifesting as a reduction of goal-directed behaviour. Apathy occurs frequently, and with substantial impact on quality of life, in a broad range of neurological and psychiatric conditions. Apathy is also consistently associated with neuroimaging changes in specific medial frontal cortex and subcortical structures, suggesting that disruption of a common systems-level mechanism may underlie its development, irrespective of the condition that causes it. In parallel with this growing recognition of the clinical importance of apathy, significant advances have been made in understanding normal motivated behaviour in humans and animals. These developments have occurred at several different conceptual levels, from work linking neural structures and neuromodulatory systems to specific aspects of motivated behaviour, to higher order computational models that aim to unite these findings within frameworks for normal goal-directed behaviour. In this review we develop a conceptual framework for understanding pathological apathy based on this current understanding of normal motivated behaviour. We first introduce prominent theories of motivated behaviour-which often involves sequences of actions towards a goal that needs to be maintained across time. Next, we outline the behavioural effects of disrupting these processes in animal models, highlighting the specific effects of these manipulations on different components of motivated behaviour. Finally, we relate these findings to clinical apathy, demonstrating the homologies between this basic neuroscience work and emerging behavioural and physiological evidence from patient studies of this syndrome.
在过去的几十年中,人们对神经精神综合征淡漠症越来越感兴趣,其概念是动机丧失,表现为目标导向行为减少。淡漠症在广泛的神经和精神疾病中经常发生,并对生活质量产生重大影响。淡漠症还与特定的内侧前额叶皮层和皮质下结构的神经影像学变化一致,这表明无论引起它的疾病如何,共同的系统水平机制的破坏可能是其发展的基础。随着对淡漠症临床重要性的认识不断提高,在理解人类和动物正常动机行为方面也取得了重大进展。这些进展发生在几个不同的概念层面上,从将神经结构和神经调制系统与动机行为的特定方面联系起来的工作,到旨在将这些发现统一到正常目标导向行为框架中的更高阶计算模型。在这篇综述中,我们基于对正常动机行为的现有理解,为理解病理性淡漠症建立了一个概念框架。我们首先介绍了动机行为的突出理论——这些理论通常涉及一系列朝着需要跨时间维持的目标的行动。接下来,我们概述了在动物模型中破坏这些过程的行为影响,强调了这些操作对不同动机行为成分的具体影响。最后,我们将这些发现与临床淡漠症联系起来,证明了这项基础神经科学工作与该综合征患者研究中出现的行为和生理证据之间的同形性。