Alzheimer & Dementia:淡漠的人不仅更容易痴呆,大脑结构都大不相同!

2021-06-15 MedSci原创 MedSci原创

淡漠是FTD相关变化的早期标志,并可预测随后在痴呆症发病前认知能力的亚临床恶化。

神经精神症状(NPS)在老年人的认知功能谱中很常见,在认知能力的发展上,它影响了半数的轻微认知障碍患者和几乎所有的痴呆患者。神经精神症状在预测疾病的加速进展和功能衰退方面有预测价值。因此有研究人员提出轻度的行为障碍可能是痴呆症发病的前期表现。

淡漠apathy,被定义为动机减少和目标导向行为,是痴呆亚型中最普遍的神经精神症状,通常被描述为“无动于衷”的一种表现。淡漠与抑郁症有关,但是在背外侧脑前额叶外皮和基底神经节的相关分区,淡漠有着独特的神经解剖学特点。

据报道,高达72%的老年痴呆(AD)患者存在淡漠的现象。同时,淡漠是额颞叶痴呆(FTD)的一个常见和致残特征,目前已成为FTD行为变异型(bvFTD)诊断标准的一部分,并且经常发生在所有FTD变异型中。

同时,有证据表明,患有轻微认知障碍和冷漠的病人患痴呆症的风险更高。去年12月,发表在权威杂志《神经病学》Neurology上的研究更是表明,在认知正常的老年人中,淡漠会增加痴呆的风险。但有关淡漠与FTD病程之间的关系尚未有所研究。

近日,由英国剑桥大学团队领衔的、发表在《老年痴呆》Alzheimer & Dementia杂志上的研究对淡漠是否可预测无症状FTD患者认知功能变化进行了全面的分析。

研究人员纳入无症状的MAPT、GRN或C9orf72突变携带者(N = 304)和无突变的亲属(N = 296)在基线时进行了临床评估和MRI检查,并在2年内每年检查一次。用潜在增长曲线模型分析了淡漠、认知、大脑灰质体积的纵向变化及其关系。

无症状携带者(红色)和非携带者(蓝色)的淡漠评分在2年内的变化。

结果显示,在无症状携带者中,淡漠的严重程度随着时间的推移而增加,但在非携带者中则没有上述表现。在无症状携带者中,基线淡漠预示着两年后认知能力的下降,反之则不然。同时,淡漠的发展与基线的额叶和扣带区的低灰质体积有关。

进一步将基线CBI-R冷漠评分作为数字符号纵向评分模型的预测因素进行模型建设,发现模型与数据拟合良好(χ2= 29.29, P = 0.006)。同样,该模型仅确定了无症状携带者的显著下降(EST = -0.064,SE = 0.031,Z值 = -2.095,P = 0.036),且基线淡漠严重程度对认知下降速度有显著影响,但对截距即认知基线没有影响。

基线淡漠对Digit Symbol测试表现的年度变化率的影响("斜率")。

综上,淡漠是FTD相关变化的早期标志,并可预测随后在痴呆症发病前认知能力的亚临床恶化。淡漠可能是FTD高危人群的一个可改变的因素。

 

参考文献:

Apathy in presymptomatic genetic frontotemporal dementia predicts cognitive decline and is driven by structural brain changes. Alzheimers Dement. 2021 Jun;17(6):969-983. doi: 10.1002/alz.12252.

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    2021-06-17 wmr116
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    2021-06-16 医鸣惊人

    认真学习了

    0

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    2021-06-16 亭儿789

    努力让自己乐观开朗

    0

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    2021-06-16 ms9000001266443457

    学习

    0

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    2021-06-16 杨思

    学习到了,👍

    0

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    2021-06-16 junJUN

    老年人痴呆何药可用??

    0

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    2021-06-16 ms1000001734148147

    0