Diagnostic criteria for apathy in clinical practice
Diagnostic criteria for apathy in clinical practice
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DOI：
10.1002/gps.2508
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发表时间：
2011-02-01
影响因子：
4
通讯作者：
Robert, P. H.
中科院分区：
文献类型：
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作者：
Mulin, E.;Leone, E.;Robert, P. H.
背景：冷漠是阿尔茨海默病和各种神经精神障碍的重要和令人痛苦的行为症状。最近，冷漠的诊断标准被提出。目的：(I)估计符合建议诊断标准的患者的患病率；(Ii)估计该标准与神经精神病学问卷(NPI)冷漠项目的同时效度；(Iii)确定每种特定神经精神疾病中最常满足的标准或亚标准；(Iv)评估冷漠诊断标准的观察者间可靠性。每个参与中心都必须根据冷漠的诊断标准检查属于以下诊断列表的连续患者的冷漠：阿尔茨海默病(AD)、混合性痴呆、轻度认知障碍(MCI)、帕金森病(PD)、精神分裂症(DSM-IV)和严重抑郁发作。除临床访谈外，评估还包括简易智力量表(MMSE)和不良反应指数(NPI)。结果：采用冷漠诊断标准，冷漠发生率为53%，AD为55%，混合性痴呆为70%，MCI为43%，PD为27%，精神分裂症为53%，重度抑郁发作为94%。在AD、混合性痴呆、轻度认知障碍和帕金森病患者中，符合冷漠标准的患者的NPI冷漠得分显著高于对照组。目标导向的认知活动(标准B2-认知)是最常被观察到的领域，其次分别是目标导向行为(标准B1-行为)和情绪(标准B3)。总体诊断(kappa系数=0.93p=0.0001)和每个标准的评分者间信度都很高。结论：本研究是首次在临床实践中检验冷漠的诊断标准。结果为临床实践和研究提供了有用的诊断标准。版权所有(C)2010 John Wiley&Sons，Ltd.
Background: Apathy is an important and distressing behavioural symptom in Alzheimer's disease and in various neuropsychiatric disorders. Recently, diagnostic criteria for apathy have been proposed.Objectives: In groups of patients suffering from different neuropsychiatric diseases, (i) to estimate the prevalence of patients meeting the proposed diagnostic criteria; (ii) to estimate the concurrent validity of the criteria with the neuropsychiatric inventory (NPI) apathy item; (iii) to identify the most frequently met criteria or sub-criteria in each specific neuropsychiatric disease and (iv) to estimate the inter-observer reliability of the diagnostic criteria for apathy.Methods: This cross-sectional, multicentric, observational study was performed on 306 patients. Each of the participating centres had to check the presence of apathy according to the diagnostic criteria for apathy in consecutive patients belonging to the following diagnoses list: Alzheimer disease (AD), mixed dementia, mild cognitive impairment (MCI), Parkinson's disease (PD), Schizophrenia (DSM-IV) and major depressive episode. In addition to the clinical interview, the assessment included the Mini Mental Score Examination (MMSE) and the NPI. At the end of the visit, clinicians were required to check the diagnostic criteria for apathy.Results: Using the diagnostic criteria for apathy, the frequency of apathy was of 53% in the whole population, 55% in AD, 70% in mixed dementia, 43% in MCI, 27% in PD, 53% in schizophrenia and 94% in major depressive episode. In AD, mixed dementia, MCI and PD, the NPI apathy score was significantly higher for patient fulfilling the apathy criteria. Goal-directed cognitive activity (criteria B2-Cognition) was the most frequently observed domain followed by goal-directed behaviour (criteria B1-Behaviour) and emotion (criteria B3), respectively. Inter-rater reliability was high for the overall diagnostic (kappa coefficient = 0.93; p = 0.0001) and for each criteria.Conclusion: This study is the first one to test the diagnostic criteria for apathy in clinical practice. Results make the diagnostic criteria useful for clinical practice and research. Copyright (C) 2010 John Wiley & Sons, Ltd.