Li Hao, Cui Liqian, Wang Meng, Liao Mengshi, Li Jin Biao, Ouyang Fubing, Mei Ting, Zen Huixing, Fan Yuhua
Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou 510080, China; Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands.
Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou 510080, China.
J Affect Disord. 2023 May 1;328:39-46. doi: 10.1016/j.jad.2023.02.004. Epub 2023 Feb 10.
Apathy has been considered a common neuropsychiatric symptom and an important contributor to cognitive impairment in cerebral small vessel disease (SVD). However, the mechanism leading to apathy in SVD and the process whereby apathy promotes cognitive impairments remain largely unknown. We aimed to explore the relationship between apathy, cognition, and structural changes of deep grey matter (DGM) in SVD patients.
Participants were screened for SVD, completed assessments of apathy cognition, underwent magnetic resonance imaging (MRI) scanning, and then stratified into apathy and non-apathy groups. We used region of interest (ROI)-based, voxel-based volume, and vertex-based shape analyses to compare DGM structures between study groups. Using linear regression analysis, we examined the association between apathy, structural changes, and cognition, followed by a mediation analysis of these factors.
A total of sixty-four SVD participants were included, with thirty in the apathy group and thirty-four in the non-apathy group. Intergroup comparison showed significantly lower volumes in bilateral caudate, right putamen, and pallidum and smaller vertex-based shapes in the right caudate and pallidum in participants with apathy compared to those without apathy. Apathy was associated with the striatal atrophy (i.e., lower volumes and smaller shape) and independently contributed to cognitive impairments in SVD. However, the above structural differences did not mediate the association between apathy and cognitive impairments.
These results highlight the important role of striatal atrophy in apathy in SVD and call for additional studies to explore the relationship between apathy, cognition, and DGM.
冷漠被认为是一种常见的神经精神症状，也是导致脑小血管病（SVD）认知障碍的重要因素。然而，SVD中导致冷漠的机制以及冷漠促进认知障碍的过程在很大程度上仍不清楚。我们旨在探讨SVD患者中冷漠、认知与深部灰质（DGM）结构变化之间的关系。
对参与者进行SVD筛查，完成冷漠认知评估，进行磁共振成像（MRI）扫描，然后分为冷漠组和非冷漠组。我们使用基于感兴趣区域（ROI）、基于体素的体积和基于顶点的形状分析来比较研究组之间的DGM结构。使用线性回归分析，我们检验了冷漠、结构变化和认知之间的关联，随后对这些因素进行中介分析。
共纳入64名SVD参与者，其中冷漠组30名，非冷漠组34名。组间比较显示，与非冷漠参与者相比，冷漠参与者双侧尾状核、右侧壳核和苍白球的体积显著降低，右侧尾状核和苍白球基于顶点的形状更小。冷漠与纹状体萎缩（即体积减小和形状变小）相关，并且独立导致SVD患者的认知障碍。然而，上述结构差异并未介导冷漠与认知障碍之间的关联。
这些结果突出了纹状体萎缩在SVD冷漠中的重要作用，并呼吁进行更多研究以探讨冷漠、认知和DGM之间的关系。
