情感淡漠与阿尔茨海默病

Apathy in patients with Alzheimer's disease

目的淡漠是一个多维度概念。本实验旨在通过神经心理学检测发现AD患者淡漠症状的潜在的支配因素,以及探讨这些潜在因子与其他临床症状的相关性,为淡漠的病因学提供线索。方法 152例淡漠AD患者与36例非淡漠AD患者分别接受人口学及神经心理学检测并进行两独立样本t检验对比;2用Pearson相关回归分析淡漠与人口学及神经心理学的相关性;3对AES-C量表进行主成分因子分析;4多重线性回归模型分析AES-C量表派生的因子与认知及NPI各子量表的关系。结果淡漠与非淡漠组AD患者在性别、年龄、发病年龄、病程、教育程度方面比较,差异无统计学意义(P>0.05),但淡漠组整体认知水平低于非淡漠组(P<0.01);淡漠的严重程度与认知功能,尤其是额叶执行功能呈负相关(r=-0.61,P<0.01);与照顾者负担正相关(r=0.66,P<0.01))。AES-C量表派生出2个因子:认知-行为因子与社交淡漠因子,其中前者主要与认知和抑郁相关(R2=0.50),后者与抑郁与睡眠相关(R2=0.24)。结论淡漠与整体认知尤其是执行功能关系密切,且会给照顾者带来巨大负担。AD患者的淡漠症状可以解离为2个维度因子,而这些因子与不同的临床症状相关,这些相关性可能对淡漠症状的病因学提供重要线索。

Objective To explore the phenomenology of apathy in a series of AD participants by examining the underlying dimensions of the behaviors and their associated clinical features.Methods We performed a clinical cross-sectional observational study by recruiting 88 patients who met NINCDS-ADRDA criteria for AD.①52 apathy AD patients and 36 AD patients without apathy underwent demographic and neuropsychological testing , then compare the data of two groups in two independent samples t-test; ②Analysis correlation of the apathy with the demographic and neuropsychological score; ③We then took factor analysis to define specific underlying dimensions of apathy; ④Regression models were developed to determine the associated NPI subscores and the derived dimensions.Results There is no significant difference in gender, age, disease of onset, duration of disease, level of education between apathy and non-apathy AD patients （P〉0.05） .However, compare to non-apathy group, apathy patients had lower overall cognitive level （P〈0.01）; the severity of apathy was negatively correlated with decline of cognitive function, especially the frontal executive function（r=-0.61, P〈0.01）; positively correlated with caregiver burden （r =0.66, P〈0.01）.AES-C scale derived two factors： cognitive-behavioral factors and social apathy factor, where the former is mainly associated with cognitive and depression （ R 2 =0.50 ）, the latter with depression and sleep-related （R2 =0.24）.Conclusion Apathy and overall cognitive function especially executive function is closely related which leads to a huge burden to caregivers.