Behavioural and emotional symptoms of apathy are associated with distinct patterns of brain atrophy in neurodegenerative disorders
Behavioural and emotional symptoms of apathy are associated with distinct patterns of brain atrophy in neurodegenerative disorders
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DOI：
10.1007/s00415-013-6989-9
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发表时间：
2013-10-01
影响因子：
6
通讯作者：
Brown, Richard G.
中科院分区：
文献类型：
--
作者：
Stanton, Biba R.;Leigh, P. Nigel;Brown, Richard G.
冷漠是一种目标导向行为减少的神经认知综合症，是神经退行性疾病致残的重要原因。额叶-皮质下功能障碍被认为是冷漠的重要因素，但个别大脑区域对冷漠综合症的不同方面的贡献却知之甚少。我们的目的是检验这样的假设，即两种不同的神经退行性疾病的冷漠与额叶萎缩有关，主动性和情绪迟钝的减少将与功能相关大脑区域的不同模式萎缩有关。对17例进行性核上性麻痹(PSP)和17例阿尔茨海默病(AD)患者进行了3T结构MRI扫描，为基于体素的形态计量学分析提供数据。冷漠的定义使用罗伯特2009年的诊断标准，具体的症状用冷漠问卷进行评估。有冷漠和没有冷漠的患者在重要的人口学和临床特征上是匹配的。在AD和PSP中，冷漠与腹内侧眶前叶皮质和左侧脑岛的萎缩有关。主动性降低与前扣带回和腹外侧眶前叶皮质的萎缩特别相关，而情绪迟钝与左侧脑岛的萎缩特别相关。这些发现进一步支持了内侧额叶区域和岛叶皮质在冷漠中的作用，并表明冷漠综合征的行为和情感方面可能有明显的神经解剖学基础。
Apathy is a neurocognitive syndrome of reduced goal-directed behaviour and is an important cause of disability in neurodegenerative disorders. Frontal-subcortical dysfunction is thought to be important in apathy, but the contribution of individual brain regions to different aspects of the apathy syndrome is poorly understood. We aimed to test the hypotheses that apathy in two distinct neurodegenerative disorders would be associated with frontal lobe atrophy and that reduced initiative and emotional blunting would be associated with distinct patterns of atrophy in functionally relevant brain areas. Seventeen patients with progressive supranuclear palsy (PSP) and 17 patients with Alzheimer's disease (AD) underwent structural MRI scanning at 3 T to provide data for voxel based morphometric analysis. Apathy was defined using Robert's 2009 diagnostic criteria and specific symptoms were assessed with the Apathy Inventory. Patients with and without apathy were matched for important demographic and clinical characteristics. Apathy was associated with atrophy of the ventromedial orbitofrontal cortex and left insula in both AD and PSP. Reduced initiative was specifically associated with atrophy of the anterior cingulate and ventrolateral orbitofrontal cortex whilst emotional blunting was specifically associated with atrophy of the left insula. These findings provide further support for the role of medial frontal regions and insular cortex in apathy and suggest that behavioural and emotional aspects of the apathy syndrome may have distinct neuroanatomical bases.