Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
Department of Psychology, Kings College London, London, UK.
J Neurol Neurosurg Psychiatry. 2020 Sep;91(9):953-959. doi: 10.1136/jnnp-2020-323092. Epub 2020 Jul 10.
To determine whether apathy or depression predicts all-cause dementia in small vessel disease (SVD) patients.
Analyses used two prospective cohort studies of SVD: St. George's Cognition and Neuroimaging in Stroke (SCANS; n=121) and Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort (RUN DMC; n=352). Multivariate Cox regressions were used to predict dementia using baseline apathy and depression scores in both datasets. Change in apathy and depression was used to predict dementia in a subset of 104 participants with longitudinal data from SCANS. All models were controlled for age, education and cognitive function.
Baseline apathy scores predicted dementia in SCANS (HR 1.49, 95% CI 1.05 to 2.11, p=0.024) and RUN DMC (HR 1.05, 95% CI 1.01 to 1.09, p=0.007). Increasing apathy was associated with dementia in SCANS (HR 1.53, 95% CI 1.08 to 2.17, p=0.017). In contrast, baseline depression and change in depression did not predict dementia in either dataset. Including apathy in predictive models of dementia improved model fit.
Apathy, but not depression, may be a prodromal symptom of dementia in SVD, and may be useful in identifying at-risk individuals.
确定淡漠或抑郁是否可预测小血管疾病（SVD）患者的全因痴呆。
分析使用了两项 SVD 的前瞻性队列研究：圣乔治中风认知和神经影像学研究（SCANS；n=121）和奈梅亨拉德布德大学弥散张量和磁共振队列研究（RUN DMC；n=352）。在两个数据集的基线淡漠和抑郁评分中，使用多变量 Cox 回归预测痴呆。在具有 SCANS 纵向数据的 104 名参与者的子集中，使用淡漠和抑郁的变化来预测痴呆。所有模型均控制年龄、教育和认知功能。
基线淡漠评分可预测 SCANS 中的痴呆（HR 1.49，95%CI 1.05 至 2.11，p=0.024）和 RUN DMC（HR 1.05，95%CI 1.01 至 1.09，p=0.007）。SCANS 中淡漠的增加与痴呆相关（HR 1.53，95%CI 1.08 至 2.17，p=0.017）。相比之下，基线抑郁和抑郁变化在两个数据集中均与痴呆无关。在痴呆的预测模型中包含淡漠可改善模型拟合。
淡漠，而不是抑郁，可能是 SVD 中痴呆的前驱症状，可能有助于识别高危个体。
