Scott Bonnie M, Eisinger Robert S, Burns Matthew R, Lopes Janine, Okun Michael S, Gunduz Aysegul, Bowers Dawn
From the Department of Clinical and Health Psychology (B.M.S., D.B.), Departments of Neuroscience (R.S.E., A.G.) and Neurology (M.R.B., J.L., M.S.O.), Norman Fixel Institute of Neurological Diseases, and J. Crayton Pruitt Department of Biomedical Engineering (A.G.), University of Florida, Gainesville.
Neurology. 2020 Nov 17;95(20):e2769-e2780. doi: 10.1212/WNL.0000000000010965. Epub 2020 Oct 1.
To empirically test whether apathy and impulse control disorders (ICDs) represent independent, opposite ends of a motivational spectrum.
In this single-center, cross-sectional study, we obtained retrospective demographics and clinical data for 887 patients with idiopathic Parkinson disease (PD) seen at a tertiary care center. Mood and motivation disturbances were classified using recommended cutoff scores from self-reported measures of apathy, ICD, anxiety, and depression.
Prevalence rates included 29.0% of patients with PD with depression, 40.7% with anxiety, 41.3% with apathy, 27.6% with ICDs, and 17.0% with both apathy and ICD. The majority (61.6%) of people reporting clinically significant ICDs also reported clinically significant apathy, and more than a third of patients with apathy (41.3%) also reported elevated ICD. Anxiety and depression were highest in patients with both apathy and ≥1 ICDs. Dopamine agonist use was higher in people with only ICD compared to people with only apathy. Mood significantly interacted with demographic variables to predict motivational disturbances.
Motivational disturbances are common comorbid conditions in patients with PD. In addition, these complex behavioral syndromes interact with mood in clinically important ways that may influence the design of future clinical trials and the development of novel therapies. This study challenges the concept of apathy and ICD in PD as opposite ends of a spectrum.
通过实证检验冷漠和冲动控制障碍（ICD）是否代表动机谱的独立且相反的两端。
在这项单中心横断面研究中，我们获取了在一家三级医疗中心就诊的887例特发性帕金森病（PD）患者的回顾性人口统计学和临床数据。使用来自自我报告的冷漠、ICD、焦虑和抑郁测量的推荐临界值分数对情绪和动机障碍进行分类。
患病率包括29.0%的PD患者伴有抑郁，40.7%伴有焦虑，41.3%伴有冷漠，27.6%伴有ICD，17.0%既伴有冷漠又伴有ICD。报告有临床显著ICD的大多数人（61.6%）也报告有临床显著的冷漠，超过三分之一的冷漠患者（41.3%）也报告ICD升高。冷漠且伴有≥1种ICD的患者焦虑和抑郁程度最高。仅患有ICD的人多巴胺激动剂的使用比仅患有冷漠的人更高。情绪与人口统计学变量存在显著交互作用以预测动机障碍。
动机障碍是PD患者常见的共病情况。此外，这些复杂的行为综合征在临床上以重要方式与情绪相互作用，这可能会影响未来临床试验的设计和新疗法的开发。本研究对PD中冷漠和ICD作为谱的相反两端这一概念提出了挑战。
