Apathy And Related Factors In Patients With Parkinson's Disease

Objective:To investigate the prevalence, clinical traits and correlates of apathy in a population-based sample of patients with Parkinson's disease (PD)Methods:Seventy-seven cases of PD patients, who met the inclusion criteria, and 40 health controls, matched with sex, age, and educational duration, were recuited in the present study. Apathy was assessed using Lille Apathy Rating Scale (LARS) and related factors, such as motor, cognition, depression, age, sex, educational duration, disease duration, levodopa equivalent doses (LED) and use of antipsychosis drugs were also evaluated. Apathy was further divided into three subtypes based on impaired fields of LARS, in which scores ranged from-4 to 4. The higher the score is, the more severe the impairment is. Four kinds of scales, Unified Parkinson's disease rating scale (UPDRS)/Hoehn-Yahr staging/Montreal Cognition Assessment (MoCA)/Hamilton Depression Rating Scale (HAMD) were employed to evaluate the motor, cogniton and depression, respectively. The LED was calculated using the unified formula:LED= standard levodopa×1+controlled levodopa×0.75+pergolide×100+bromocriptine×10+(standard levodopa×1+controlled levodopa X 0.75)×0.25(if using entacapone)+dihydro-a-ergocryptine mesylate×1.7+piribedil×1+pramipexol×100+selegiline×10.Results:The prevalence of apathy and depression in the 77 PD patients was 49.4% and 46.8%, respectively. Of the 77 PD patients,11 cases had apathy without depression(14.3%); 9 cases had depression without apathy(11.7%) and 27 cases had apathy combined with depression(35.1%). Among the PD patients with apathy, the cognitive type accounted for 86.8%(33/38), the emotional type accounted for 2.6%(1/38), the behavior companied by cognitive type accounted for 10.6%(4/3), while the cognition companied by emotional type accounted for 2.6%(1/38). Among them, the cognitive type was the most common one. There were significant statistic differences of education duration, UPDRS-Ⅱ/Ⅲscores, Hoehn-Yahr staging, MoCA and HAMD scores between apathy and non-apathy PD patients,. According to the unifactoral Logistic analysis of apathy correlates, UPDRS-Ⅱ/Ⅲscores, Hoehn-Yahr staging and HAMD scores were the risk factors for apathy while education duration and MoCA were the protective factors for apathy. In the multifactorial Logistic analysis, education duration(-0.12), UPDRS-II(0.17) and HAMD scores(1.50) were added into the equation in turn while the other 3 factors were excluded.Conclusion:The prevalence of apathy in PD patients was significantly higher than healthy controls. Apathy could be present without depression in PD patients, and was associated with education duration, movement disorder degree, cognition impairment and depression severity.