解析长期接受护理的伴有和不伴有脑血管并发症的柯萨科夫综合征患者淡漠症状的原因。
Unraveling Apathy in Korsakoff Syndrome Patients Receiving Long-Term Care With and Without Cerebrovascular Comorbidity.
机构信息
From the, Experimental Psychology, (MJO, VHEWB, MJB, AP, EO), Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.
Lelie Care Group, (MJO, JWW, AP, EO), Slingedael Korsakoff Center, Rotterdam, The Netherlands.
出版信息
Alcohol Clin Exp Res. 2021 Jan;45(1):131-139. doi: 10.1111/acer.14513. Epub 2020 Dec 24.
BACKGROUND
Korsakoff syndrome (KS) is a severe neuropsychiatric disorder caused by acute deficiency of vitamin B1 and concomitant alcoholism. Patients with KS are particularly vulnerable for cerebrovascular comorbidity. KS is characterized by cognitive and neuropsychiatric symptoms, one of which is apathy. Apathy is a pathological lack of goal-directed behaviors, goal-directed cognitions, and goal-directed emotions. Cerebrovascular accidents are known to carry a risk for developing apathy. Apathy has a dramatic effect on the autonomy and daily lives of patients suffering from this condition.
METHODS
We assessed general apathy and related subconstructs in fifteen patients with KS, fifteen patients with KS and cerebrovascular comorbidity who reside in a 24-hour care facility, and fifteen healthy controls.
RESULTS
Compared with healthy controls, both KS patient groups showed higher levels of apathy as rated by a close informant. We found no difference between both KS patient groups and the healthy control group on the self-report section of the Pleasant Activities List, suggesting that motivation is still intact in KS patients. It is important to note a discrepancy was found between self-reporting and proxy reporting on this list. KS patients with cerebrovascular comorbidity showed more severe emotional blunting compared to both KS patients without cerebrovascular comorbidity and healthy controls. The competency to consent was lower in patients compared with healthy controls, but no difference was found between KS patients with cerebrovascular comorbidity and those without.
CONCLUSIONS
Our results suggest that KS patients show increased levels of general apathy compared with healthy controls. Patients show a diminished competency to consent and increased emotional blunting, while motivation is not compromised. Cerebrovascular comorbidity in KS forms a high risk for emotional blunting. The results of this study suggest that apathy is a severe problem in KS. More attention in both the literature and clinical practice would benefit this complex patient population.
背景
柯萨科夫综合征（KS）是一种由维生素 B1 急性缺乏和同时存在的酒精中毒引起的严重神经精神障碍。KS 患者特别容易发生脑血管并发症。KS 的特征是认知和神经精神症状，其中之一是冷漠。冷漠是一种病理性的缺乏目标导向行为、目标导向认知和目标导向情感。众所周知，脑血管意外会增加发生冷漠的风险。冷漠对患有这种疾病的患者的自主性和日常生活产生了巨大影响。
方法
我们评估了 15 名 KS 患者、15 名居住在 24 小时护理机构的 KS 合并脑血管并发症患者和 15 名健康对照者的一般冷漠和相关亚结构。
结果
与健康对照组相比，两组 KS 患者的密切知情者评定的冷漠程度均较高。在愉快活动清单的自我报告部分，我们未发现两组 KS 患者与健康对照组之间存在差异，这表明 KS 患者的动机仍然完整。需要注意的是，在这份清单上，自我报告和代理报告之间存在差异。与无脑血管并发症的 KS 患者和健康对照组相比，KS 合并脑血管并发症患者的情绪迟钝更为严重。与健康对照组相比，KS 患者的同意能力较低，但 KS 合并脑血管并发症患者与无脑血管并发症患者之间无差异。
结论
我们的研究结果表明，与健康对照组相比，KS 患者表现出更高水平的一般冷漠。患者表现出同意能力下降和情绪迟钝增加，而动机没有受到影响。KS 合并脑血管并发症增加了情绪迟钝的风险。这项研究的结果表明，冷漠是 KS 中的一个严重问题。无论是在文献中还是在临床实践中，对这个复杂的患者群体给予更多关注都将受益。
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