Apathy and impulsivity in frontotemporal lobar degeneration syndromes.
Apathy and impulsivity in frontotemporal lobar degeneration syndromes.
复制标题
DOI：
10.1093/brain/awx101
复制
发表时间：
2017-06-01
期刊：
影响因子：
--
通讯作者：
Rowe JB
中科院分区：
文献类型：
--
作者：
Lansdall CJ;Coyle-Gilchrist ITS;Jones PS;Vázquez Rodríguez P;Wilcox A;Wehmann E;Dick KM;Robbins TW;Rowe JB
Lansdall等人揭示了导致不同类型冷漠和冲动的脑结构变化，包括额颞叶变性引起的各种疾病，包括额颞叶痴呆、进行性核上性麻痹和皮质基底综合征。冷漠和冲动之间的正相关表明需要一个统一的治疗策略。冷漠和冲动是额颞叶变性的常见和致残的后果。他们造成实质性的照顾者痛苦，但他们的病因仍然难以捉摸。该领域之前的研究存在严重局限性，包括（i）单独评估冷漠或冲动，尽管它们经常共存;（ii）评估单个诊断组内的行为变化;（iii）使用有限的任务集或问题，仅与这些多因素结构的一个方面相关。我们提出了一种替代的，维度的方法，跨越行为和语言的变量额颞叶痴呆，进行性核上性麻痹和皮质基底综合征。这适应了冷漠和冲动的共性，并揭示了他们的认知和解剖基础。能够测量冷漠和冲动的组成部分及其相关的神经相关的诊断组将提供更好的药理学操作的新目标，并促进新的治疗策略和加强翻译模型。因此，我们试图确定额颞叶变性综合征的冷漠和冲动的神经认知成分。通过对149例患者和50例对照进行神经心理学和行为学评估，确定了冷漠和冲动的频率和特征，这些患者来自Picks病和进行性核上性麻痹患病率和发病率研究（PipPIN）。我们使用主成分分析得出冷漠和冲动的维度，并将其用于70例患者（进行性核上性麻痹，n = 22;皮质基底综合征，n = 13;行为变异，n = 14;原发性进行性失语症，n = 21）和27例对照受试者的灰质和白色物质的体积分析。冷漠和冲动存在于诊断组中，尽管是单独的行为变异性额颞叶痴呆的标准。冷漠和冲动的测量经常加载到相同的组件，反映了它们的重叠关系。然而，从客观任务，病人评定的问卷和照顾者评定的问卷加载到单独的组件，并揭示了不同的神经生物学的措施。皮质脊髓束与患者的自我评价相关。相比之下，照顾者评级与目标导向行为，社会认知，运动控制和植物功能，包括额纹状体回路，眶和颞极皮层和脑干的既定网络萎缩相关。反映反应抑制缺陷的成分与局灶性额叶皮质萎缩相关。额颞叶变性引起的复杂行为变化的维度方法提供了对冷漠和冲动的新见解，以及对它们的联合治疗策略的需要。客观测试与主观问卷的分离，以及患者与护理者评级的分离，对临床试验设计具有重要意义。
Lansdall et al. reveal the structural brain changes leading to different types of apathy and impulsivity, across the spectrum of disorders caused by frontotemporal lobar degeneration, including frontotemporal dementia, progressive supranuclear palsy and corticobasal syndrome. The positive correlation between apathy and impulsivity indicates the need for a unified therapeutic strategy. Apathy and impulsivity are common and disabling consequences of frontotemporal lobar degeneration. They cause substantial carer distress, but their aetiology remains elusive. There are critical limitations to previous studies in this area including (i) the assessment of either apathy or impulsivity alone, despite their frequent co-existence; (ii) the assessment of behavioural changes within single diagnostic groups; and (iii) the use of limited sets of tasks or questions that relate to just one aspect of these multifactorial constructs. We proposed an alternative, dimensional approach that spans behavioural and language variants of frontotemporal dementia, progressive supranuclear palsy and corticobasal syndrome. This accommodates the commonalities of apathy and impulsivity across disorders and reveals their cognitive and anatomical bases. The ability to measure the components of apathy and impulsivity and their associated neural correlates across diagnostic groups would provide better novel targets for pharmacological manipulations, and facilitate new treatment strategies and strengthen translational models. We therefore sought to determine the neurocognitive components of apathy and impulsivity in frontotemporal lobar degeneration syndromes. The frequency and characteristics of apathy and impulsivity were determined by neuropsychological and behavioural assessments in 149 patients and 50 controls from the PIck’s disease and Progressive supranuclear palsy Prevalence and INcidence study (PiPPIN). We derived dimensions of apathy and impulsivity using principal component analysis and employed these in volumetric analyses of grey and white matter in a subset of 70 patients (progressive supranuclear palsy, n = 22; corticobasal syndrome, n = 13; behavioural variant, n = 14; primary progressive aphasias, n = 21) and 27 control subjects. Apathy and impulsivity were present across diagnostic groups, despite being criteria for behavioural variant frontotemporal dementia alone. Measures of apathy and impulsivity frequently loaded onto the same components reflecting their overlapping relationship. However, measures from objective tasks, patient-rated questionnaires and carer-rated questionnaires loaded onto separate components and revealed distinct neurobiology. Corticospinal tracts correlated with patients’ self-ratings. In contrast, carer ratings correlated with atrophy in established networks for goal-directed behaviour, social cognition, motor control and vegetative functions, including frontostriatal circuits, orbital and temporal polar cortex, and the brainstem. Components reflecting response inhibition deficits correlated with focal frontal cortical atrophy. The dimensional approach to complex behavioural changes arising from frontotemporal lobar degeneration provides new insights into apathy and impulsivity, and the need for a joint therapeutic strategy against them. The separation of objective tests from subjective questionnaires, and patient from carer ratings, has important implications for clinical trial design.
登录
查看更多内容
影响因子：
9.9
作者：
Dutt, Shubir;Binney, Richard J.;Boxer, Adam L.
通讯作者：
Boxer, Adam L.
影响因子：
5.7
作者：
Barnes, Josephine;Ridgway, Gerard R.;Fox, Nick C.
通讯作者：
Fox, Nick C.
影响因子：
--
作者：
Chow TW;Binns MA;Cummings JL;Lam I;Black SE;Miller BL;Freedman M;Stuss DT;van Reekum R
通讯作者：
van Reekum R
影响因子：
3.6
作者：
Chong, Trevor T. -J.;Bonnelle, Valerie;Husain, Masud
通讯作者：
Husain, Masud
影响因子：
2.8
作者：
Eslinger, Paul J.;Moore, Peachie;Grossman, Murray
通讯作者：
Grossman, Murray