行为变异额颞叶痴呆和阿尔茨海默病中认知淡漠和计划的共同认知和神经基础。

A shared cognitive and neural basis underpinning cognitive apathy and planning in behavioural-variant frontotemporal dementia and Alzheimer's disease.

机构信息

Macquarie University, Department of Psychology, Sydney, Australia; The University of Sydney, Brain and Mind Centre, Sydney, Australia.

The University of Sydney, Brain and Mind Centre, Sydney, Australia; The University of Sydney, School of Psychology, Sydney, Australia.

出版信息

Cortex. 2022 Sep;154:241-253. doi: 10.1016/j.cortex.2022.05.012. Epub 2022 Jun 1.

Abstract

Apathy is the most common and disabling non-cognitive feature of dementia, affecting up to 90% of individuals over the disease course. Despite its prevalence, the underlying mechanisms of apathy remain elusive. This study aimed to investigate whether cognitive apathy and executive functioning have a shared cognitive and neural basis, in behavioural-variant frontotemporal dementia (bvFTD) and Alzheimer's disease (AD). Seventy-one participants (31 bvFTD, 17 AD and 23 controls) were assessed on a neuropsychological battery of executive tasks including the Zoo Map Test, Modified Six Elements Test, Tower Test and verbal fluency. The Dimensional Apathy Scale (DAS) was used to quantify cognitive apathy. Principal components analysis identified a single component underpinning performance on the neuropsychological tests, with both bvFTD and AD showing significantly reduced "planning ability" compared to controls. On the DAS, 74% of bvFTD patients and 59% of AD patients showed clinically significant cognitive apathy. Importantly, linear regression revealed that lower planning ability significantly predicted increased cognitive apathy, even after controlling for cognitive impairment and disease duration. Voxel-based morphometry analyses revealed that planning ability and cognitive apathy were both associated with atrophy of the right frontal pole and orbitofrontal cortex, as well as the thalamus and putamen. From a theoretical perspective, our results reveal a shared mechanism underpinning both cognitive apathy and planning deficits in bvFTD and AD. Clinically, this knowledge will help to improve the identification of apathy in clinical syndromes and inform targeted interventions to improve independence and wellbeing for those living with dementia.

摘要

冷漠是痴呆最常见和最具致残性的非认知特征,影响高达 90%的疾病患者。尽管它很普遍,但冷漠的潜在机制仍然难以捉摸。本研究旨在探讨认知冷漠和执行功能是否具有共同的认知和神经基础,分别在行为变异额颞叶痴呆(bvFTD)和阿尔茨海默病(AD)中。71 名参与者(31 名 bvFTD、17 名 AD 和 23 名对照组)接受了执行任务的神经心理学测试,包括动物园地图测试、改良六要素测试、塔测试和言语流畅性测试。使用维度冷漠量表(DAS)来量化认知冷漠。主成分分析确定了神经心理学测试表现的单一成分,bvFTD 和 AD 与对照组相比,均表现出明显降低的“计划能力”。在 DAS 上,74%的 bvFTD 患者和 59%的 AD 患者表现出明显的认知冷漠。重要的是,线性回归表明,较低的计划能力显著预测了认知冷漠的增加,即使在控制了认知障碍和疾病持续时间后也是如此。基于体素的形态测量学分析显示,计划能力和认知冷漠都与右侧额极和眶额皮质、丘脑和壳核的萎缩有关。从理论角度来看,我们的结果揭示了 bvFTD 和 AD 中认知冷漠和计划缺陷的共同机制。从临床角度来看,这一知识将有助于提高在临床综合征中识别冷漠的能力,并为改善痴呆症患者的独立性和幸福感提供针对性的干预措施。

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