Neuropsychiatric features of corticobasal degeneration

被引:110
作者
Litvan, I
Cummings, JL
Mega, M
机构
[1] NINDS, Neuropharmacol Unit, Def & Vet Head Injury Program, Jackson Fdn,NIH, Bethesda, MD 20892 USA
[2] NINDS, Med Neurol Branch, NIH, Bethesda, MD 20892 USA
[3] Univ Calif Los Angeles, Sch Med, Dept Psychiat & Biobehav Sci, Los Angeles, CA 90024 USA
关键词
corticobasal degeneration; progressive supranuclear palsy; neurobehaviour;
D O I
10.1136/jnnp.65.5.717
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective-To characterise the neuropsychiatric symptoms of patients with corticobasal degeneration (CBD). Methods-The neuropsychiatric inventory (NPI), a tool with established validity and reliability, was administered to 15 patients with CBD (mean (SEM), age 67.9 (2) years); 34 patients with progressive supranuclear palsy (PSP) (66.6 (1.2) years); and 25 controls (70 (0.8) years), matched for age and education. Both patient groups had similar duration of symptoms and mini mental state examination scores. Semantic fluency and motor impairment were also assessed. Results-Patients with CBD exhibited depression (73%), apathy (40%), irritability (20%), and agitation (20%) but less often had anxiety, disinhibition, delusions, or aberrant motor behaviour (for example, pacing). The depression and irritability of patients with CBD were more frequent and severe than those of patients with PSP. Conversely, patients with PSP exhibited significantly more apathy than patients with CBD. The presence of high depression and irritability and low apathy scale scores correctly differentiated the patients with CBD 88% of the time. The irritability of patients with CBD was significantly associated with disinhibition (r = 0.85) and apathy (r = 0.72). In CBD, apathy was associated with disinhibition (r = 0.67); disinhibition was associated with aberrant motor behaviour (r = 0.68) and apathy (r = 0.67); and aberrant motor behaviour with delusions (r = 1.0). On the other hand, depression was not associated with any other behaviour, suggesting that it has a different pathophysiological mechanism. Symptom duration was associated with total motor scores (r = 0.69). However, total motor score was not associated with any behaviour or cognitive scores. Conclusions-The findings indicate that frontosubcortical pathways mediating cognition, emotion, and motor function in CBD are not affected in parallel. Patients with CBD and PSP have overlapping neuropsychiatric manifestations, but they express distinctive symptom profiles. Evaluating the behavioural abnormalities of parkinsonian patients may help clarify the role of the basal ganglia in behaviour.
引用
收藏
页码:717 / 721
页数:5
相关论文
共 40 条
[1]  
[Anonymous], 1976, GERIATRIC PSYCHIAT H
[2]   Unusual clinical presentations of cortical basal ganglionic degeneration [J].
Bergeron, C ;
Pollanen, MS ;
Weyer, L ;
Black, SE ;
Lang, AE .
ANNALS OF NEUROLOGY, 1996, 40 (06) :893-900
[3]  
Bergeron C, 1997, J NEUROPATH EXP NEUR, V56, P726
[4]   CORTICOBASAL DEGENERATION - DECREASED AND ASYMMETRICAL GLUCOSE CONSUMPTION AS STUDIED WITH PET [J].
BLIN, J ;
VIDAILHET, MJ ;
PILLON, B ;
DUBOIS, B ;
FEVE, JR ;
AGID, Y .
MOVEMENT DISORDERS, 1992, 7 (04) :348-354
[5]   UNIQUE MYOCLONIC PATTERN IN CORTICOBASAL DEGENERATION [J].
BRUNT, ERP ;
VANWEERDEN, TW ;
PRUIM, J ;
LAKKE, JWPF .
MOVEMENT DISORDERS, 1995, 10 (02) :132-142
[6]  
Cummings, 1996, Semin Clin Neuropsychiatry, V1, P241
[7]  
CUMMINGS JL, 1992, AM J PSYCHIAT, V149, P443
[8]   THE NEUROPSYCHIATRIC INVENTORY - COMPREHENSIVE ASSESSMENT OF PSYCHOPATHOLOGY IN DEMENTIA [J].
CUMMINGS, JL ;
MEGA, M ;
GRAY, K ;
ROSENBERGTHOMPSON, S ;
CARUSI, DA ;
GORNBEIN, J .
NEUROLOGY, 1994, 44 (12) :2308-2314
[9]   STATISTICAL-DATA ANALYSIS IN THE COMPUTER-AGE [J].
EFRON, B ;
TIBSHIRANI, R .
SCIENCE, 1991, 253 (5018) :390-395
[10]  
FAHN S, 1987, UNIFIED PARKINSONS D, P153