脑小血管病患者淡漠综合征的临床评定

目的 评价脑小血管病（cerebral small vessel disease，CSVD）患者淡漠综合征的发生情况及临床特征。方法 回顾性收集2019年1-6月在解放军总医院第七医学中心神经内科诊断为CSVD的住院患者的临床资料。采用2018年国际淡漠综合征诊断标准进行淡漠诊断。患者淡漠程度、认知功能、抑郁、白质病变程度及陪护负担分别采用神经精神调查表淡漠分量表（neuropsychiatric inventory-apathy，NPI -apathy）或淡漠评价评定量表临床版（apathy evaluating scale-clinician，AES-C）、老年痴呆量表-认知评分（Alzheimer’s disease assessment scale-cognition，ADAS-cog）、老年抑郁量表（geriatric depression scale，GDS）、白质损伤Fazekas量表、陪护负担量表（caregiver burden scale，CBS）进行评定，总结评价CSVD患者淡漠综合征的发生情况及临床相关性。结果 共纳入67例CSVD患者，平均年龄66.39±5.29岁，男性36例（53.73%）。23例（34.33%）诊断为淡漠综合征，进一步分析淡漠综合征临床表现，以认知与行为活动减少发生率最高（86.96%）。淡漠程度与白质高信号严重程度呈正相关（r = 0.301，P = 0.013），与认知障碍程度呈正相关（r =0.336，P =0.007），与抑郁障碍无明显相关性（r =0.186，P =0.458），与陪护负担呈正相关（r =0.312,P =0.010）。结论 淡漠综合征在老年CSVD患者中较常见，主要症状表现为认知障碍与行为活动减少，增加陪护负担。

Clinical Evaluation of Apathy in Patients with Cerebral Small Vessel Disease

Objective To evaluate the incidence and clinical charateristics of apathy in patients with cerebral
small vessel disease (CSVD).
Methods Clinical data of elderly inpatients diagnosed with CSVD at Department of Neurology of
the Seventh Medical Center of Chinese PLA General Hospital between January 2019 and June 2019
were retrospectively collected. The international Diagnostic Criteria of Apathy 2018 was used for
the diagnosis of apathy. The neuropsychiatric inventory-apathy (NPI-apathy) and apathy evaluating
scale-clinician (AES-C), Alzheimer’s disease assessment scale-cognition (ADAS-cog), geriatric
depression scale (GDS), Fazekas scale and caregiver burden scale (CBS) were used to assess the
level of apathy, cognitive impairment, depression, white matter lesion and caregiver burden of these
patients, to analyze clinical characteristics and relevance of apathy.
Results A total of 67 eligible patients were included, with a mean age of 66.39±5.29 years and 36
males (53.73%). 23 (34.33%) patients were diagnosed as apathy. The diminishing cognitive and
behavioral activities (86.96%) were the most common symptoms in patients with apathy. Apathy level
was positively correlated with white matter hyperintensities severity (r =0.301, P =0.013) and cognitiveimpairment (r =0.336, P =0.007) and caregiver burden (r =0.312, P =0.010), while had no obvious
correlation with depression (r =0.186, P =0.458) .
Conclusions Apathy was common in elderly patients with CSVD, with predominant symptoms of
cognitive and behavioral activities diminishing, which increased caregiver burden.