Apathy and Depression in Huntington's Disease: Distinct Longitudinal Trajectories and Clinical Correlates.

IF 2.4 4区 医学 Q2 CLINICAL NEUROLOGY Journal of Neuropsychiatry and Clinical Neurosciences Pub Date : 2023-01-01 DOI:10.1176/appi.neuropsych.21070191
Michael H Connors, Armando Teixeira-Pinto, Clement T Loy
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引用次数: 6

Abstract

Objective: Huntington's disease (HD) is an autosomal-dominant neurodegenerative disease resulting in motor disturbances, dementia, and psychiatric symptoms. Apathy is a common manifestation and rated as one of the most impactful by patients and caregivers. It can often be difficult to distinguish from depression because of shared features and frequent overlap. This study examined the longitudinal trajectories and clinical correlates of apathy and depression.

Methods: Data were drawn from the Cooperative Huntington Observational Research Trial, a prospective, multicenter observational study that recruited 1,082 patients with HD. Measures of cognition, function, neuropsychiatric symptoms, motor function, and medication use were completed annually over 5 years.

Results: Overall, 423 patients (39%) showed evidence of apathy at study baseline, and both the prevalence and overall severity of apathy increased over time. Depression, by contrast, affected a similar proportion at baseline, although levels remained relatively stable over the study. Apathy was associated with worse cognition, function, neuropsychiatric symptoms, and motor symptoms. Depression was associated with worse neuropsychiatric symptoms, suicidal ideation, and independence but not other outcomes after control for other variables.

Conclusions: Apathy in HD increased over time and was associated with worse clinical outcomes. These associations were independent of depression and other clinical variables. The findings highlight the need to distinguish between apathy and depression given their distinct implications for prognosis and management.

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亨廷顿舞蹈病的冷漠和抑郁:不同的纵向轨迹和临床相关性。
目的:亨廷顿舞蹈病(HD)是一种常染色体显性神经退行性疾病,导致运动障碍、痴呆和精神症状。冷漠是一种常见的表现,被患者和护理人员评为最具影响力的表现之一。由于共同的特征和频繁的重叠,它通常很难与抑郁症区分开来。本研究考察了冷漠和抑郁的纵向轨迹和临床相关性。方法:数据来自合作亨廷顿观察性研究试验,这是一项前瞻性、多中心观察性研究,招募了1082名HD患者。认知、功能、神经精神症状、运动功能和药物使用的测量在5年内每年完成一次。结果:总体而言,423例患者(39%)在研究基线时表现出冷漠的证据,并且随着时间的推移,冷漠的患病率和总体严重程度都在增加。相比之下,抑郁症在基线时影响的比例相似,尽管在研究期间水平保持相对稳定。冷漠与较差的认知、功能、神经精神症状和运动症状相关。抑郁与更严重的神经精神症状、自杀意念和独立性相关,但与其他变量控制后的其他结果无关。结论:HD患者的冷漠随着时间的推移而增加,并且与较差的临床结果相关。这些关联与抑郁症和其他临床变量无关。研究结果强调了区分冷漠和抑郁的必要性,因为它们对预后和治疗有不同的影响。
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来源期刊
CiteScore
5.30
自引率
3.40%
发文量
67
审稿时长
6-12 weeks
期刊介绍: As the official Journal of the American Neuropsychiatric Association, the premier North American organization of clinicians, scientists, and educators specializing in behavioral neurology & neuropsychiatry, neuropsychology, and the clinical neurosciences, the Journal of Neuropsychiatry and Clinical Neurosciences (JNCN) aims to publish works that advance the science of brain-behavior relationships, the care of persons and families affected by neurodevelopmental, acquired neurological, and neurodegenerative conditions, and education and training in behavioral neurology & neuropsychiatry. JNCN publishes peer-reviewed articles on the cognitive, emotional, and behavioral manifestations of neurological conditions, the structural and functional neuroanatomy of idiopathic psychiatric disorders, and the clinical and educational applications and public health implications of scientific advances in these areas. The Journal features systematic reviews and meta-analyses, narrative reviews, original research articles, scholarly considerations of treatment and educational challenges in behavioral neurology & neuropsychiatry, analyses and commentaries on advances and emerging trends in the field, international perspectives on neuropsychiatry, opinions and introspections, case reports that inform on the structural and functional bases of neuropsychiatric conditions, and classic pieces from the field’s rich history.
期刊最新文献
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