From the Department of Clinical Neurosciences (J.T., M.J.H., R.L.B., D.J.T., H.S.M.), University of Cambridge, UK; Department of Neurology (A.M.T., F.-E.d.L.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands; Neuroscience Research Centre (T.R.B.), Molecular and Clinical Sciences Research Institute, St. George's University of London; and Nuffield Department of Clinical Neurosciences (M.H.), University of Oxford, UK.
Neurology. 2019 Mar 12;92(11):e1157-e1167. doi: 10.1212/WNL.0000000000007095. Epub 2019 Feb 8.
To investigate whether white matter network disruption underlies the pathogenesis of apathy, but not depression, in cerebral small vessel disease (SVD).
Three hundred thirty-one patients with SVD from the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort (RUN DMC) study completed measures of apathy and depression and underwent structural MRI. Streamlines reflecting underlying white matter fibers were reconstructed with diffusion tensor tractography. First, path analysis was used to determine whether network measures mediated associations between apathy and radiologic markers of SVD. Next, we examined differences in whole-brain network measures between participants with only apathy, only depression, and comorbid apathy and depression and a control group free of neuropsychiatric symptoms. Finally, we examined regional network differences associated with apathy.
Path analysis demonstrated that network disruption mediated the relationship between apathy and SVD markers. Patients with apathy, compared to all other groups, were impaired on whole-brain measures of network density and efficiency. Regional network analyses in both the apathy subgroup and the entire sample revealed that apathy was associated with impaired connectivity in premotor and cingulate regions.
Our results suggest that apathy, but not depression, is associated with white matter tract disconnection in SVD. The subnetworks delineated suggest that apathy may be driven by damage to white matter networks underlying action initiation and effort-based decision making.
探讨脑小血管病（SVD）患者的淡漠是否与白质网络破坏有关，而不是与抑郁有关。
来自拉德堡德大学尼梅根弥散张量和磁共振队列研究（RUN DMC）的 331 名 SVD 患者完成了淡漠和抑郁的测量，并接受了结构 MRI 检查。使用弥散张量纤维束追踪技术重建反映潜在白质纤维的轨迹。首先，路径分析用于确定网络测量是否在淡漠与 SVD 放射学标志物之间的关联中起中介作用。接下来，我们检查了只有淡漠、只有抑郁以及同时患有淡漠和抑郁的参与者与无神经精神症状的对照组之间的全脑网络测量差异。最后，我们检查了与淡漠相关的区域网络差异。
路径分析表明，网络中断介导了淡漠与 SVD 标志物之间的关系。与其他所有组相比，淡漠患者在全脑网络密度和效率的测量上存在障碍。在淡漠亚组和整个样本中的区域网络分析都表明，淡漠与运动前和扣带区域的连接受损有关。
我们的研究结果表明，淡漠，而不是抑郁，与 SVD 中的白质束断开有关。描绘的子网络表明，淡漠可能是由与动作启动和基于努力的决策相关的白质网络损伤引起的。
