Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, NSW, Australia.
School of Public Health, The University of Sydney, Sydney, NSW, Australia.
Aust N Z J Psychiatry. 2023 Jun;57(6):884-894. doi: 10.1177/00048674221114597. Epub 2022 Aug 13.
Apathy is a common symptom in dementia, though can be difficult to distinguish from depression due to shared features and frequent co-occurrence. As such, a significant limitation of much previous research on apathy is the failure to control for depression. The current study sought to address this by examining the trajectory and clinical correlates of apathy after controlling for depression.
Seven hundred and seventy-nine patients with dementia were recruited from nine memory clinics around Australia. Measures of dementia severity, cognition, functional ability, neuropsychiatric symptoms, caregiver burden and medication use were completed at baseline and at regular intervals over a 3-year period. Driving and institutionalisation data were obtained throughout the study. Mortality data were obtained from state registries 8 years after baseline.
Of the 662 patients with completed measures of neuropsychiatric symptoms, 342 (51.7%) had apathy and 332 (50.2%) had depression at baseline, while 212 (32.0%) had both. Whereas apathy increased over time, depression remained relatively stable. Apathy, but not depression, was associated with greater dementia severity, poorer cognition and function, driving cessation and mortality. Both apathy and depression were associated with greater neuropsychiatric symptoms, psychosis, caregiver burden and institutionalisation.
Apathy increases over the course of dementia and is associated with worse clinical outcomes independent of depression. Distinguishing apathy and depression appears important given their different implications for prognosis and management.
淡漠是痴呆症的常见症状，但由于其具有共同特征且常同时发生，因此与抑郁症难以区分。因此，以往许多关于淡漠的研究的一个显著局限性是未能控制抑郁。本研究通过在控制抑郁的情况下检查淡漠的轨迹和临床相关性来解决这个问题。
从澳大利亚的 9 个记忆诊所招募了 779 名痴呆症患者。在基线和 3 年的定期时间间隔内，完成了痴呆严重程度、认知、功能能力、神经精神症状、照料者负担和药物使用的测量。在整个研究过程中都获得了驾驶和机构化数据。从州登记处获得了 8 年后的死亡率数据。
在完成神经精神症状测量的 662 名患者中，342 名（51.7%）在基线时患有淡漠，332 名（50.2%）患有抑郁症，而 212 名（32.0%）同时患有两种疾病。虽然淡漠随时间推移而增加，但抑郁相对稳定。淡漠而不是抑郁与更严重的痴呆症、认知和功能较差、停止驾驶和死亡率有关。淡漠和抑郁都与更多的神经精神症状、精神病、照料者负担和机构化有关。
在痴呆症的过程中，淡漠会增加，并且与抑郁无关的预后更差。鉴于其对预后和管理的不同影响，区分淡漠和抑郁似乎很重要。
