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Authors: Chen Haibo, chief physician, Department of Neurology, Beijing Hospital, deputy director, Department of Neurology, Peking University Health Science Center, professor. The Chinese society of microcirculation neurodegenerative diseases, member of the Standing Committee of Specialized Committee, Chinese Medical Doctor Association vice president of Neurology Doctor Association and Parkinson disease and movement disorders, vice chairman of Specialized Committee, neurology and behavioral medicine branch of the Standing Committee and neuropsychological group leader, Parkinson's disease and movement disorders group member of Chinese Medical Association, the elderly cognitive psychological diseases branch vice chairman Chinese study on the elderly health care medicine, neurology branch vice chairman and Parkinson's disease and movement disorders study group, Beijing Medical Association, Beijing Cerebrovascular Disease Prevention Association executive director.
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The mechanism of depressive symptoms associated with Parkinson's disease is different. Parkinson's disease patients with apathy may be associated with speech, memory and time dependent task disorders. A study found that patients with Parkinson disease associated with emotional indifference of prefrontal executive ability, but the MRI study did not found apathy score and associated definite frontotemporal lobe atrophy.
In patients with Parkinson's disease, emotional apathy may be related to decreased levels of dopamine in the brain, but Dujardin has found that non dopaminergic neuronal circuits may also be involved in the pathophysiology of apathy. Robert and other clinical observation found that Parkinson's disease patients with apathy in the right inferior frontal gyrus, middle frontal gyrus, wedge, insula glucose metabolism decreased. But so far, the pathogenesis of Parkinson's disease apathy is still unclear.
Pederson's study showed that 14% of patients with Parkinson's disease in the incidence or incidence occurred 4 years after apathy, 49% of the patients in the 4 years after the onset of apathy, 37% in the observation period of follow-up, no emotional indifference, apathy in patients with Parkinson's disease are more likely to progress to dementia. It is suggested that apathy may be a signal of the extensive and progressive development of Parkinson's disease. Most of the patients with apathy is indifferent to what is happening around, it is difficult to cause corresponding emotional reaction to external stimuli, or reduce the lack of inner experience, by the unexpected blow when not surprised by others without fear, anger tease.
According to different clinical manifestations, apathy can be divided into 3 subtypes: (1) behavioral type. Lack of creativity, dependence on others. (2) cognitive type. Lack of interest in new things, indifferent to the problems of the people around them. (3) emotional type. Emotional dull, lack of proper emotional reaction to negative events. Apathy Evaluation Scale (AES) and apathy scale (AS) and the unified Parkinson's Disease Rating Scale (UPDRS) Part IV (power or original power) can be used to evaluate the disease apathy of Parkinson, but the testing items of UPDRS Part IV is less, can comprehensively evaluate the feelings of indifference, therefore can only be as a screening scale.
Leentjens on the 4 evaluation apathy scale comparison, recommended apathy scale as Parkinson disease Apathy Evaluation Scale, the scale has good content and sensitivity, patients and their families in two parts, and previous stroke and Alzheimer's disease patients in clinical application with good reliability.
At present, the following criteria are often used as the diagnostic criteria of apathy in Parkinson's disease: (1) the lack of motivation is not consistent with the patient's age, educational level and previous activities. (2) there are at least 1 symptoms in each of the following 3 criteria. The reduction of goal directed behavior (behavioral priming depends on others, lack of subjective effort). The cognitive activities of goal oriented behavior (lack of interest in new things, lack of attention to their own problems). Goal directed behavior and emotional decline (lack of positive and negative events). (3) after the exclusion of consciousness and drug factors, the lack of new motivation. The above situation can cause the decline of the social function of patients with Parkinson disease with apathy.
The treatment of Parkinson's disease apathy is enough evidence, generally to dopaminergic drugs, amphetamine, atypical anti drugs and psychiatric drugs are cholinesterase inhibition can improve Parkinson's disease apathy in the treatment of Parkinson's disease. A randomized, double-blind, placebo-controlled clinical trial of Ray Chaudhuri et al. Compared the effects of duloxetine on the non motor symptoms of Parkinson's disease, and found that the high dose of duloxetine transdermal patch improves patient apathy. Chatterjee and Fahn believe that methylphenidate has a certain therapeutic effect on Parkinson's disease. In addition, environmental stimuli and behavioral modification can also have a certain effect on the treatment of Parkinson's disease.
Li Shuhua, Chen Haibo. Emotional disorder of the patients with the disease of the heart. Chinese Journal of modern nervous diseases. 2013, 13 (): 679-682.