Apathy in Neuropsychiatric Disease: Diagnosis, Pathophysiology, and Treatment
Apathy in Neuropsychiatric Disease: Diagnosis, Pathophysiology, and Treatment
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DOI：
10.1007/s12640-010-9196-9
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发表时间：
2011-02-01
影响因子：
3.7
通讯作者：
Chase, Thomas N.
中科院分区：
文献类型：
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作者：
Chase, Thomas N.
冷漠是一个越来越多地认识到伴随着广泛的中枢神经系统疾病。然而，其疾病学、发病机制和治疗仍然存在着混乱和争议。到目前为止，关于检测冷漠、区分冷漠与抑郁或评估冷漠严重程度的方法还没有达成共识。许多人现在认为冷漠综合征主要反映了缺乏动机，损害了情感，认知和明显的行为功能。即使认识不足和诊断不足，冷漠似乎并不罕见：目前的流行病学研究表明，超过1000万美国人可能受到影响。其在各种神经和精神疾病中的报告频率差异很大，从不到10%到超过80%，反映了人群特征和评估程序的差异。冷漠通常与阿尔茨海默病、帕金森病和额颞叶痴呆等神经退行性疾病有关。但它也发生在那些精神疾病，如精神分裂症和重度抑郁症。临床，神经病理学和神经影像学观察越来越多地表明，冷漠反映功能障碍的额叶皮层下电路，特别是那些连接腹内侧前额叶皮层相关区域的基底神经节。在治疗上，许多小型研究表明，精神兴奋剂，多巴胺能药物和胆碱酯酶抑制剂可能有利于那些表现出这种综合征。然而，没有足够的动力，随机对照试验报告成功，也没有药物被批准用于这种疾病。尽管如此，目前研究的加速步伐有望提高我们对冷漠的理解，并更好地解决那些遭受其后果的人未满足的医疗需求。
Apathy is an increasingly recognized concomitant of a broad range of central nervous system disorders. Nevertheless, its nosology, pathogenesis and therapy remain shrouded in confusion and controversy. As yet, there is little consensus regarding methods for detecting apathy, or distinguishing it from depression, or for assessing its severity. Many now regard the apathy syndrome as primarily reflecting a lack of motivation that compromises emotional, cognitive, and overt behavioral function. Even though under-recognized and under-diagnosed, apathy hardly appears uncommon: current epidemiologic studies suggest over 10 million Americans may be affected. Its reported frequency in various neurologic and psychiatric conditions varies widely, from less than 10 to over 80%, reflecting differences in population characteristics and assessment procedures. Often apathy has been associated with such neurodegenerative disorders as Alzheimer's disease, Parkinson's disease, and fronto-temporal dementia. But it also occurs in those with psychiatric disorders such as schizophrenia and major depression. Clinical, neuropathologic, and neuroimaging observations increasingly suggest that apathy reflects dysfunction of frontal-subcortical circuits, especially those linking the ventromedial prefrontal cortex to related regions in the basal ganglia. Therapeutically, numerous small studies suggest that psychostimulants, dopaminergics, and cholinesterase inhibitors may benefit those manifesting this syndrome. However, no adequately powered, randomized controlled trials have reported success and no medication have ever been approved for this disorder. The accelerating pace of current research nevertheless promises to improve our understanding of apathy and to better address the unmet medical needs of those suffering its consequences.