很可能的特发性正常压力脑积水患者淡漠、焦虑和抑郁症状特点分析

Charateristics of apathic,anxietious and depression symptoms in patients with probable idiopathic normal pressure hydrocephalus

目的总结很可能的特发性正常压力脑积水(probable idiopathic normal pressure hydrocephalus,Probable iNPH)患者淡漠、焦虑、抑郁症状的出现率、严重程度和特点,通过增强对这些神经精神症状的认识,提高iNPH诊疗效率。方法收集自2017年3月至2021年3月就诊于航空总医院神经内科诊断为很可能的iNPH患者资料60例,进行改良淡漠评定量表(modified apathy evaluation scale,MAES)、宗氏焦虑自评量表(Zung self-rating anxiety scale,SAS)和抑郁自评量表(Zung self-rating depression scale,SDS)测定,分析淡漠、焦虑和抑郁症状的出现率、严重程度和特点。进一步根据有无淡漠、焦虑和抑郁症状,分别将患者分为有无淡漠组、有无焦虑组和有无抑郁组,分别对比分析有无上述症状患者的临床特点。结果53例很可能的iNPH患者纳入研究,男37例、女16例。出现淡漠症状33例(62.3%),焦虑症状14例(26.4%),抑郁症状15例(28.3%),以出现轻度焦虑和抑郁症状比例最大。进一步按照有无淡漠、有无焦虑和有无抑郁分组分析显示,淡漠组患者北京版蒙特利尔认知测验(Montreal cognitive assessment,MoCA)量表得分低于无淡漠组〔(15.1±5.8)分比(18.7±5.8)分,t=2.15,P=0.04〕;焦虑组患者SDS量表得分高于无焦虑组〔(53.6±12.3)分比(37.0±11.6)分,t=-4.52,P<0.001),病程短于无焦虑组〔24.0(12.0,27.0)个月比36.0(18.0,60.0)个月,Z=-2.20,P=0.03〕;抑郁组患者SAS和MAES量表得分均高于无抑郁组〔分别(48.0±12.9)分比(32.6±10.9)分,t=-4.41,P<0.001;(20.3±8.1)分比(15.0±5.1)分,t=2.90,P<0.001〕。结论淡漠、焦虑和抑郁症状在很可能的iNPH患者中出现率较高,以淡漠出现率最高(62.3%);抑郁和焦虑症状严重程度多为轻度损害;淡漠、焦虑和抑郁症状之间存在相互影响。通过常用量表有利于对这些特征进行识别,提高iNPH诊疗效率。

Objective To summarize the frequency,severity,and feature of apathy,anxiety and depression in patients with probable idiopathic normal pressure hydrocephalus(iNPH).Methods Sixty patients with probable iNPH were sequentially recruited from the Department of Neurology of Aviation General Hospital between March 2017 and March 2021.Apathic,anxious and depressive symptoms were evaluated using the modified apathy evaluation scale(MAES),Zung self-rating anxiety scale(SAS)and Zung self-rating depression scale(SDS).The frequency,severity,and characteristics of apathic,anxious and depressive symptoms were analyzed.Further,according to the symptoms of apathy,anxiety,and depression,patients were divided into apathy and non-apathy subgroups,anxious and non-anxious subgroups,and depressive and non-depressive subgroups.The clinical characteristics were compared between different subgroups.Results Fifty-three patients with probable idiopathic normal pressure hydrocephalus were recruited,including 37 males and 16 females.The frequency of apathic,anxious and depressive symptoms was 62.3%,26.4%and 28.3%,respectively.Mild anxious and depressive patients were most common.The score of Montreal cognitive assessment(MoCA)in apathy group was lower(15.1±5.8 vs.18.7±5.8,P=0.04)than those in non-apathy group.The anxiety group showed higher SDS score,(53.6±12.3 vs.37.0±11.6,P<0.001),and shorter disease duration[24.0(12.0,27.0)months vs.36.0(18.0,60.0)months,Z=-2.20,P=0.03].The scores of anxiety and apathy were both higher in depression group(48.0±12.9 vs.32.6±10.9,P<0.001;20.3±8.1 vs.15.0±5.1,P<0.001 respectively)than those in non-depression group.Conclusions Apathic,anxious and depressive symptoms are common in patients with probable iNPH.There are some overlaps between apathy,anxiety and depression.Identifying these features by scales is helpful to improve the diagnosis and treatment of iNPH.