帕金森病患者的情感淡漠及其相关因素分析

Apathy and related factors in patients with Parkinson＇ s disease

目的探讨帕金森病情感淡漠的患病率、症状学特点及相关因素。方法收集77例帕金森病患者和40名健康人分为病例组和对照组，使用Lille情感淡漠评定量表（LARS）分别对其进行情感淡漠评分。以一21分为界将病例组分为淡漠组和非淡漠组，对两组的年龄、性别、受教育程度、病程、运动症状、认知损害、抑郁、多巴胺能及精神科药物使用情况进行t检验、X^2检验及Logistic回归分析。结果77例帕金森病患者中，情感淡漠的发生率为49．4％（38／77），抑郁的发生率为46．8％（36／77），其中不伴抑郁的情感淡漠发生率为14．3％（11／77），情感淡漠同时伴有抑郁的发生率为35．1％（27／77）。在38例情感淡漠患者中，以认知型受损者为主占86．8％（33／38）。帕金森病患者淡漠组（n=38）和非淡漠组（n=39）在受教育程度、统一帕金森病评定量表（UPDRS）II和Ⅲ评分、H—Y分级、蒙特利尔认知评估量表和汉密尔顿抑郁量表（HAMD）评分之间差异有统计学意义（t=2．309、-3．144、-4．000、-3．217、2．649、-3．909，均P〈0．05）。在情感淡漠相关因素的Logistic回归分析中，依次进入方程的是HAMD评分、UPDRS1I和受教育程度。结论帕金森病患者的情感淡漠发生率高，可独立于抑郁而单独存在，并且可能与患者的受教育程度、运动症状严重程度、认知损害程度及抑郁存在情况之间存在相关性。

Objective To investigate the prevalence, clinical traits and correlates of apathy in patients with Parkinson＇ s disease （PD）. Methods Seventy-seven cases of PD patients and 40 health controls were recuited in the present study. Apathy was assessed using Lille Apathy Rating Scale（LARS） and related factors, such as motor function, cognition, depression, age, sex, education level, disease duration, levodopa equivalent doses （LED） and use of antipsychotic drugs were also evaluated. Four kinds of scales, Unified Parkinson＇ s Disease Rating Scale （UPDRS） , Hoehn-Yahr staging, Montreal Cognitive Assessment （MoCA） , Hamilton Depression Rating Scale （HAMD） were employed to evaluate the motor function, cogniton and depression, respectively. Results The prevalence of apathy and depression in the 77 PD patients were 49.4% （ 38/77 ） and 46. 8% （ 36/77）, respectively. Of the 77 PD patients, 11 cases had apathy without depression （ 14. 3% ） ; 9 cases had depression without apathy （ 11.7% ） and 27 cases had apathy combined with depression（ 35.1% ）. Among the PD patients with apathy, the cognitive type is the most common one, accounting for 86. 8% （33/38）. There were significant statistical differences in education level, UPDRS- Ⅱ /Ⅲ scores, Hoehn-Yahr staging, MoCA and HAMD scores between apathy （ n = 38 ） and no-apathy（n =39） PD patients（t = 2. 309, -3. 144, -4. 000, -3. 217, 2. 649, -3. 909, all P 〈0. 05）. According to the unifactoral Logistic regression analysis of apathy correlates, UPDRS- Ⅱ /Ⅲ scores, Hoehn- Yahr staging and HAMD scores were the risk factors for apathy while education level and MoCA were the protective factors for apathy. In the multiple Logistic regression analysis, HAMD scores, UPDRS-Ⅱ scores and education level were included. Conclusions The prevalence of apathy in PD patients was significantly higher than healthy controls. Apathy could be present without depression in PD patients, and was associated with education level, motor dysfunction degree, cognitive impairment and depression severity.